Janell Sluga Medicare & Individual Health Insurance Account Executive View Bio

Lawley Medicare Solutions Learning Center:

Ask Janell!

 

QUESTION:  I looked at my insurance for 2025. It looks good, and I don’t want to change my plan. Now what do I do?

ANSWER:  I spend a lot of time discussing changes to insurance coverage, but many individuals with Medicare are reviewing their plans for 2025 and finding them to still be good and useful products. The Medicare Annual Open Enrollment Period is well underway, and we are hearing this from several individuals. The year 2025 has seen significant changes, with many insurance plans not available in the new year (at least 12 plans). However, this change doesn’t impact everyone.

When evaluating your options, I understand the decision to stay with your current plan, as long as it continues to meet your needs in the coming year. The www.medicare.gov website is a valuable tool in this evaluation process. If you have set up a login and password to access the site, the information will be tailored to your current coverage and how it will work in the upcoming year.

When reviewing that information, you may determine that there is no better coverage available, considering pricing and the pharmacies you use. In this situation, you can simply maintain your insurance without moving to an alternative plan. This decision to keep your same coverage requires no action from you. The plan you are currently enrolled in will roll over into the new year, and there is nothing more you need to do after evaluating your coverage. You do not need to contact the plan to inform them, and you should not re-enroll in the plan you are already in. This applies to Medicare Supplement Plans, Stand-Alone Part D Plans (prescription drug coverage), and Medicare Advantage Plans of all types.

Individuals with Medicare are encouraged to evaluate their coverage options each year to ensure they have the best possible coverage for the coming year. An individual’s health situation can change yearly, including medications, doctors, and plan offerings. Therefore, this annual evaluation is essential to ensure you are doing the best you can for the upcoming calendar year. This evaluation process should include a brief review of these factors, as well as how well your plan performed this year. Are you satisfied with the coverage, customer service, medication coverage at your pharmacy, and pricing structures? If your answers are yes, and your medications are covered in a way that works for you, then you likely do not need to make any changes.

I want to note that one significant change this year involves pharmacy status. Several plans are altering how pharmacies are included in their coverage. A shift from a Preferred to a Standard contract for Part D coverage at your pharmacy can lead to a substantial change in your medication costs. Some plans are even excluding certain pharmacy chains completely. If this happens and you do not switch to an alternative pharmacy, you would have no Part D coverage at your current location. For example, a client and I reviewed their coverage yesterday: their current pharmacy was preferred, and their medication had a $0 co-pay during the deductible and initial coverage phases. The alternative pharmacy they were considering had a standard contract, which would increase their co-pays to $18 each. This significant difference in cost led them to decide to stay with their plan and keep their current pharmacy.

Conversely, you may encounter a situation where your plan changes its contract, and a pharmacy you’ve always used is now considered standard or not included at all. In such cases, preferred pricing will no longer apply, likely resulting in increased medication costs.

If you decide to stay with your current insurance coverage, you can let it roll over. Remember, there is still time for evaluation if you haven’t done so yet. The Annual Open Enrollment Period runs until December 7 each year, and there are also other Enrollment Periods and Special Enrollment Periods available if your situation changes throughout 2025.

If you have questions or need assistance navigating your options, don’t hesitate to reach out to the Lawley Medicare Solutions Team. You can contact Medicare Service Team Lead Gabrielle Connor at 716.849.8223, or submit an inquiry through our contact form below. We’re here to help you find the right coverage for your needs!

At Lawley Medicare Solutions, our Medicare and Individual Health Consultants are dedicated to helping you make the most informed decisions about your healthcare needs. We offer personalized service and expert advice tailored to your unique situation. Contact us today by phone or email to schedule a consultation and ensure you’re getting the best coverage for your needs.

 

Read all Inside Medicare articles HERE.

 

LAWLEY HAS A TEAM DEDICATED TO MEDICARE INSURANCE!

Our licensed Medicare & Individual Health Insurance team can help clients understand the details of Medicare insurance plans, assist with choosing the right benefits and coverage, and provide guidance when life events that affect health coverage occur.

For questions, concerns, or to reach Lawley Medicare Solutions, fill out the contact form below or call 716.849.8223.