Medicare Review Guide

This guide is for you if you're already enrolled in Medicare A and B. Whether you have a Medicare Advantage plan or a Medicare Supplement (Medigap) policy in effect right now, this guide is about making sure it's still the right one.

Here's what most people don't realize: your plan can change on you, and you don't have to wait until October to respond. If you are on a Medigap plan, you will experience rate increases. A Medigap premium that felt reasonable at 65 might feel steep at 72.

If you are on a Medicare Advantage plan, your carrier can adjust networks, drug prices, increase out-of-pocket costs, and reduce benefits annually. A Medicare Advantage plan that was a great fit last year might look very different by the following year.

That's why we recommend reviewing your plan annually, even if you're completely happy with it. This guide walks you through your options and how to make changes if you see fit.

What this guide covers

• Understanding your plan: knowing how your plan works and how it can improve
• Reviewing your Medicare Advantage plan: what changes every year and what to double-check
• Reviewing your Medigap plan: lower the premium while keeping the same level of coverage
• Switching between the two: make a seamless transition into a better plan or lower premium

Medicare Advantage plans are approved by Medicare every year, and carriers are allowed to change nearly every detail of the plan for the following plan year. None of this requires your consent, which is exactly why a review matters.

What to check every year

• Network: Are your doctors, specialists, and preferred hospital still in-network? Networks shrink more often than people expect.
• Formulary: Are your prescriptions still covered, and at the same tier? A medication moving up a tier can significantly raise your cost.
• Star rating: Has your plan's quality rating dropped? A falling rating can be an early signal of service or coverage issues.
• Out-of-pocket maximum: This cap can increase year to year, changing your worst-case financial exposure.
• Extra benefits: Dental, vision, hearing, and OTC allowances are often the first things carriers trim or restructure.
• Referral and prior authorization rules: Some plans add new requirements for services that were previously unrestricted.

Medigap, also called Medicare Supplement Insurance, is private insurance that works alongside Original Medicare to pay costs that Medicare doesn't cover. Think of Medicare as the primary payor, and Medigap as the secondary payor that picks up what's left.

How Medigap works

• You keep Original Medicare (Parts A and B)
• You pay a monthly premium to a private insurer
• Medicare pays first, then Medigap pays the remaining costs
• See any doctor that accepts Medicare, nationwide, no networks
• No referrals needed to see specialists

Most popular plans

The opportunity to save money

Since a Plan G from one carrier covers exactly the same benefits as a Plan G from any other carrier, price is the only variable that separates them. If your premium has crept up, it's worth checking whether a different carrier offers your same plan letter for less. Same coverage, smaller bill.

Choosing the right Medicare coverage is not one-size-fits-all. The best plan depends on your health, finances, lifestyle, and the doctors you want to keep. Use this guide and the information presented today to help inform your decision.

Questions to ask yourself

• Do I have specific doctors I want to keep? Medigap lets you see any Medicare provider. Advantage may require you to stay in-network.
• How often do I use medical care? Frequent users often benefit more from Medigap's predictable costs.
• Do I travel frequently? Medigap works nationwide. Most Advantage plans are regionally restricted.
• What's my budget? Advantage often has lower premiums but higher out-of-pocket exposure when you need care.
• Am I okay with taking risk? By opting for Medicare Advantage you risk not being able to see your doctors, having claims denied, and not being able to obtain a Medigap plan in the future.

Medigap vs. Medicare Advantage

A yearly review takes less time than most people expect, and it's the only way to know for certain whether your current plan is still your best option.

Why work with an independent broker?

As independent brokers, we work with all insurance carriers and offer all Medicare plans available. Our allegiance is to you and not the insurance company. Advisors are paid by the carriers, never by you, and your premium is identical either way.