By Dr. Heather Swanson, Regional Medical Officer at CareMore Health
As Medicare's Annual Enrollment Period (AEP) looms, seniors will once again face a major decision about their healthcare coverage for the next year. It can be overwhelming.
With so many plan options and benefits to compare, it's tempting to focus only on premiums, copays, and attractive perks. From a physician's perspective, though, the key question is personal: How well will this plan support the care you're actually likely to need?
Start With the Care You Already Have
Sometimes the best way to start is by taking stock of the healthcare relationships you already have. Before choosing a plan, confirm that your primary care physician and the specialists you see regularly are in-network.
Continuous access to a doctor who knows your medical history is especially valuable for older adults managing multiple health needs, and it reduces the risk of fragmented care.
Give prescription coverage the same attention. Review the plan's formulary to make sure your current medications are covered, and check for changes in copays or prior authorization requirements. Find out whether certain pharmacies will lower your costs and how the plan would cover a new medication if your needs change during the year.
Ask Your Doctor What the Year Ahead Looks Like
Your doctor can also be a helpful resource when figuring out the best plan for you. Ask what your care needs may look like over the next year. Your physician may anticipate procedures, medications, tests, or specialist visits.
They may also know whether you'd benefit more from lower medication costs, transportation assistance, care management, or in-home health services, which can make a big difference in which plan fits best. That keeps the focus on your actual needs rather than on benefits that sound attractive but have little to do with your care.
If You're Managing Chronic Conditions
This forward-looking approach is particularly important for patients living with chronic conditions. If you work with several physicians and specialists, care coordination is paramount. A plan that supports communication among your care team helps you avoid conflicting treatment plans and makes the healthcare system easier to navigate.
Primary care access matters, too. You need to be able to address health concerns quickly, sometimes with same-day care, to prevent unnecessary emergency room visits and hospitalizations. Care management programs, nurse support, and proactive outreach are also valuable.
Account for What's Changed Since Last Year
Think carefully about any health changes since you last chose coverage. A plan may have served you well before, but a new diagnosis or health event can make it a poor match.
A recent hospital stay, for example, could mean specialist care, rehabilitation, or home health services play a larger role next year. New diagnoses often change the services and prescriptions you'll need, and all of that belongs in your decision.
Don't Just Let Your Plan Renew
That's why one of the biggest AEP mistakes is letting your coverage renew without taking another look. It's tempting to skip the confusing process, especially if your health has been stable, but your plan may have changed.
It's very common for provider networks, pharmacy benefits, and out-of-pocket costs to change from one year to the next. An inexpensive medication could become pricier or require extra approvals, or your preferred physician or specialist could leave the network. Things change even when your health doesn't, and your plan should reflect that.
Coverage Should Evolve With You
Medicare coverage should evolve with your health needs. The plan that was perfect for you at 65 might not fit at 70, especially as your care gets more complicated.
AEP may seem tedious, but it's a real opportunity to make sure your coverage still fits the doctors you trust, the medications you need, and the care that's right for you. Take your time and ask the right questions so you head into next year with coverage that works with you instead of creating obstacles as your health needs evolve.
Dr. Heather Swanson is Regional Medical Officer at CareMore Health.
