With the Annual Enrollment Period (AEP) approaching, it’s a great time to encourage clients to review their Medicare coverage and, if needed, explore switching to a different plan.
In the 2022 AEP, a significant 69 percent of Medicare beneficiaries did not compare their current plan with other available options, according to KFF. This means many clients might be missing out on plans that could better suit their needs.
A yearly review of their coverage allows clients to not only potentially save money but also ensures their plan continues to align with their lifestyle and budget.
The 2025 AEP promises to be a year of heightened plan changes, with many Medicare beneficiaries actively evaluating their options. Reviewing coverage with your clients is essential in helping them decide if a plan switch could benefit them.
Here are a few reasons your client might consider switching plans this year.
Reason 1: Rising Plan Costs
Various factors affect the cost of a Medicare plan, including premiums, deductibles, copayments, and coinsurance. These costs often increase yearly, and for some beneficiaries, they can become unmanageable. For instance, a client currently on a Medicare Supplement plan may find the monthly premium too high and might consider switching to a Medicare Advantage plan.
AEP is the perfect opportunity to reassess whether their plan remains affordable. With nearly two-thirds of Medicare Advantage Prescription Drug (MAPD) plans offering $0 premiums, there’s a good chance you can help your client find a plan that reduces their overall costs.
Reason 2: Changing Health Needs
As clients age, their healthcare needs often evolve. A 65-year-old in good health will likely have different coverage needs than an 85-year-old with more complex health issues. Has your client recently received a new diagnosis? Changes in health status are a key reason to review coverage and ensure their plan meets their specific needs.
For example, if they were recently diagnosed with a chronic condition, a Chronic Special Needs Plan (C-SNP) might be a better fit. Or, if they now require a medication not covered by their current plan’s formulary, it may be time to explore a new MAPD or Part D plan that provides comprehensive prescription coverage.
Reason 3: Changes in Financial Situation
A shift in your client’s financial situation could impact their Medicare options. If they’re experiencing financial hardship, they might now qualify for Extra Help (the Part D low-income subsidy) or a Dual Eligible Special Needs Plan (D-SNP). Conversely, if their financial standing has improved, they may lose eligibility for these programs and need a different plan.
During your coverage review, it’s essential to inquire tactfully about their financial resources and verify if they qualify for Extra Help. This ensures they’re enrolled in the most cost-effective plan for their circumstances.
Reason 4: Dissatisfaction with Carrier Service
A client may feel frustrated with their current plan for various reasons beyond cost or coverage changes. They might have experienced a claim denial, received an unfavorable annual notice of change (ANOC) on October 14, or struggled with unresponsive customer service. If they’re unhappy with their carrier, they may be considering a switch.
Encourage clients to share their concerns, listen empathetically, and acknowledge their frustrations. Even if a plan offers excellent benefits, a lack of quality customer service can be a deal-breaker, making it worth exploring other options.
Reason 5: Change in Plan’s Star Rating
The Centers for Medicare & Medicaid Services (CMS) uses a star rating system to help beneficiaries gauge the quality of their Medicare plans on a scale of one to five stars. This annual assessment might indicate that a client’s plan no longer offers the highest quality of coverage available.
With CMS’s recent adjustments to the star rating criteria, it’s a good idea to review your client’s current plan to see if higher-rated options are available in their area, ensuring they receive the best quality coverage possible.
Reason 6: Their Doctor Is No Longer In-Network
A change in network status for a doctor, whether primary care or a specialist, can result from a client’s relocation or shifts in carrier or health system agreements. If continuing care with a specific provider is essential to your client, it may be the right time to explore alternative plans that keep their preferred doctors in-network.
Reason 7: Their Plan Has Been Discontinued
When clients receive their Annual Notice of Change (ANOC) this AEP, they may find out that their current plan has been discontinued, with a transition to a new one underway. Reasons for this change can include carrier downsizing, restructuring, or legislative adjustments.
Be available to discuss their ANOC and set up AEP appointments to review their coverage and decide if it’s the right time to explore other options.
AEP is more than just an opportunity to enroll clients in new plans. It’s a time to connect with them, assess any changes in their needs, and determine if their plan remains the best choice for their health and budget over the next year. If their circumstances have shifted, it may be worth considering a switch to a plan that’s a better fit.
Not affiliated with or endorsed by Medicare or any government agency.
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