With the Medicare Annual Enrollment Period (AEP) fast approaching, now is the time to remind your clients to take another look at their current Medicare coverage. In some cases, a simple review may reveal that switching to a different plan could better suit their healthcare needs and financial goals.
A 2024 study by KFF found that 69% of Medicare beneficiaries didn’t compare their plan options during the 2022 AEP—meaning many may still be missing out on potential savings or improved benefits.
Encouraging clients to assess their coverage before each AEP gives them the opportunity to confirm that their plan still fits their lifestyle, budget, and medical needs—or discover a plan that serves them better.
Here are a few common reasons clients may decide it’s time to make a change.
1: Their Plan Has Become Too Costly
The total cost of a Medicare plan isn’t just about the monthly premium — it also includes deductibles, copayments, and coinsurance. Over time, these expenses can rise and gradually strain a beneficiary’s budget.
For example, a client with a Medicare Supplement plan may find their premium has climbed beyond what they can comfortably afford and begin considering whether a Medicare Advantage plan could offer similar coverage at a lower cost.
The Annual Enrollment Period (AEP) is the perfect moment to reassess affordability. It’s your chance to help clients determine if their current plan still fits their financial situation — and potentially guide them toward a plan that helps reduce their out-of-pocket expenses.
2: Their Health Needs Have Evolved
As clients age, their healthcare needs often shift — and their coverage should evolve with them.
A 65-year-old in good health likely requires different benefits than someone who’s now 85. If your client has recently received a new diagnosis or experienced significant health changes, it’s essential to review their plan to ensure it still aligns with their current situation.
For example, a client newly diagnosed with a chronic condition may benefit from enrolling in a Chronic Special Needs Plan (C-SNP) tailored to their specific illness. Or, if they’ve been prescribed a new medication that isn’t covered by their current plan’s formulary, it might be time to explore other MAPD or Part D options that include their full list of prescriptions.
3: Their Financial Situation Has Changed
A shift in your client’s finances can directly impact the type of Medicare coverage that’s best for them.
If they’ve recently experienced financial hardship, they may now qualify for programs like Extra Help (the Part D Low-Income Subsidy) or a Dual Eligible Special Needs Plan (D-SNP), both designed to make healthcare more affordable. On the other hand, if their income or assets have increased, they might lose eligibility for these programs and need to transition to a different plan.
When reviewing coverage, it’s important to discuss financial changes with sensitivity and verify whether your client qualifies for Extra Help or other assistance programs that could lower their healthcare costs.
4: They’re Unhappy with Their Plan’s Service
Sometimes, dissatisfaction with a plan isn’t about cost or coverage—it’s about the experience.
Maybe your client had a claim denied, received an unfavorable Annual Notice of Change (ANOC), or struggled to reach the carrier’s customer service team. Frustrations like these can leave beneficiaries questioning whether it’s time to switch plans.
Encourage your clients to share their concerns openly. Listen carefully and show empathy. Even if a plan offers impressive benefits on paper, poor service can quickly overshadow them. If their trust in the carrier has eroded, it may be time to explore alternative plans that provide both strong coverage and dependable support.
5: Their Plan’s Star Rating Has Dropped
The Centers for Medicare & Medicaid Services (CMS) uses a five-star rating system to measure the quality and performance of Medicare plans each year. These ratings help beneficiaries understand how well their plan compares to others in areas such as customer service, member experience, and care quality.
If your client’s plan has seen a decrease in its star rating, it may indicate that the plan’s overall quality or service has declined. And with CMS recently updating how these ratings are calculated, now is an important time for clients to review their plan’s standing.
Encourage them to see if a higher-rated option is available in their area—switching could mean better service, stronger benefits, and a more satisfying healthcare experience.
6: Their Doctor Is No Longer In-Network
Losing access to a trusted provider can be a major reason clients consider changing plans.
This situation can arise if your client moves to a new area, or if their current doctor—whether a primary care physician or specialist—no longer contracts with the plan’s network due to carrier or health system changes.
If keeping the same doctor is a top priority, it may be time to explore other plans that include their preferred providers in-network, ensuring continuity of care and peace of mind.
7: Their Plan Has Been Discontinued
The Medicare landscape is constantly evolving, and this year many plans are being restructured or phased out entirely. When clients receive their Annual Notice of Change (ANOC) this fall, some may discover that their current plan no longer exists and that they’re being automatically transitioned to a new one.
There are several reasons a plan might be discontinued — from carrier downsizing and business restructuring to broader regulatory or legislative changes.
Be proactive by reaching out to your clients to review their ANOCs and schedule AEP consultations. This ensures they fully understand any changes and can make informed decisions about whether to remain with their new plan or explore other options.
The Annual Enrollment Period (AEP) is more than just an opportunity to switch plans — it’s a chance to reconnect with your clients, reassess their evolving health and financial needs, and ensure their coverage continues to serve them well for the year ahead.
If their circumstances have shifted, AEP could be the perfect time to guide them toward a plan that better fits their current lifestyle and goals.
Not affiliated with or endorsed by Medicare or any government agency.
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