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Here’s What Might Happen If You Sit Out Medicare Open Enrollment This Year

The nice thing about the month of October is that it’s loaded with fun fall activities. You can hike your way through a local trail and take in the glorious changing leaves. You can visit a haunted house with your grandkids or, if that’s not your speed, spend a less frightening afternoon at the pumpkin patch.

Navigating Medicare’s open enrollment period, on the other hand, may not exactly land on your list of fun fall activities. But it should be high on your list of fall priorities.

A person at a laptop.

Image source: Getty Images.

An opportunity you don’t want to miss

There’s no rule stating that existing Medicare enrollees have to participate in fall open enrollment, which runs from Oct. 15 through Dec. 7 annually. If you’re satisfied with your existing Medicare coverage, you could opt to sit out open enrollment and stick with the Advantage or Part D drug plan you have. But whether that’s a strategic choice is a different story.

If you don’t review your plan choices during open enrollment and keep your existing Medicare coverage, a few things could happen. First, you could end up paying more for healthcare in a number of ways.

Say there’s a Part D plan that offers comparable coverage to your current one at a lower cost. If you don’t do your research, you won’t know about it, and you’ll continue paying higher premiums when you don’t have to.

Similarly, there may be a Part D plan that places your current medications into a less expensive tier. The result could be lower co-pays each time you renew a prescription.

Furthermore, if you don’t explore your plan choices during open enrollment, you might lose out on the chance to continue seeing the providers you’ve come to trust. And that could make it more difficult to get the care you need.

It’s not an uncommon thing for Medicare Advantage providers to go from being in-network to out-of-network from one year to the next. If that’s happening, and you don’t switch plans, you risk giving up access to the doctors who know your history and know how to give you the best care.

Don’t make a big mistake

Spending hours comparing Medicare plans may not make for a fun fall experience. But it’s an important thing to do, especially if you’re on a fixed income and have struggled with healthcare expenses in recent years.

One way to make open enrollment more palatable is to start early. You have more than seven weeks to make changes to your Medicare coverage, but waiting until November or December to get the ball rolling puts the pressure on. Start in mid-October, when open enrollment kicks off.

Next, understand how Medicare’s plan finder tool works. In a nutshell, you put in personal information that includes your medications and ZIP code, and you’ll be given a bunch of choices to wade through. From there, you can use Medicare’s star ratings system to get a sense of how satisfied current enrollees are with their respective plans.

Generally, a plan with a five-star rating is considered excellent, while a rating below three stars means you may want to proceed with caution. You shouldn’t only rely on star ratings when choosing a Medicare plan, but those ratings could help you narrow down your choices.

You may decide that after researching your Medicare coverage choices, your best bet is to stick with the plan you’re on right now. And that’s fine. But if you sit out open enrollment, you won’t know which plan is best for you. And that could lead to unfavorable consequences in the new year.

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