The Annual Medicare Plan Review: A 30-Minute Checklist

A Medicare plan review is thirty minutes of work you do once a year, in the fall, with a specific set of documents and a fixed list of questions. The reason to do it is that your plan is allowed to change every January 1, and a plan that fit you last year is not obliged to fit you next year.

Most people skip it and let the plan renew automatically. That is a choice, not a neutral default, because the costs, the network, and the drug list can all move while the plan name stays the same.

Why the review is necessary

Medicare Advantage and Part D plan terms reset annually. Medicare states that each year, plans set the amounts they charge for premiums, deductibles, and services, and that what you pay the plan can only change once a year, on January 1.

That sentence is doing a lot of work. It means the plan cannot surprise you in June, which is good. It also means every change lands at once, which is why skipping the review is risky: you experience the entire year's worth of changes without having checked any of them.

Plans are required to tell you first. Medicare states that your plan will send your Annual Notice of Change by September 30, and that it includes any changes in coverage, costs, provider networks, service area, and more that will take effect in January. A separate Evidence of Coverage document, sent or made available by October 15, gives the full detail on what the plan covers and what you pay.

So the review is not detective work. The information arrives. The task is to read it against your own year.

What to have in front of you

The review is short only if you gather the inputs first. Collect these before you start.

• Your Annual Notice of Change for the coming year, which the plan sends by September 30.
• Your Evidence of Coverage, or the plan's current year version, for the detail the notice summarizes.
• A list of your prescriptions, with dosages and how often you fill them.
• Your pharmacy, including whether you use mail order for any of them.
• A list of your doctors, specialists, and any facility you used in the past year.
• Your Medicare Summary Notices or plan claim statements for the past year, or at least a sense of what care you actually used.
• Your current premium and what you paid out of pocket over the year.

That last item matters more than people expect. The premium is the number you remember. The out-of-pocket total is the number that actually reflects whether the plan worked.

The thirty-minute sequence

Work through this in order. Each step feeds the next.

Minutes 0 to 5: Confirm the plan is still the same plan. Read the first page of the Annual Notice of Change for the plan name, the plan type, and any service area change. A plan can change its name or be consolidated. Note any change before reading further.

Minutes 5 to 12: Check the drugs. Take your prescription list and verify each drug is still on the formulary, at the same tier, with the same restrictions. Medicare's Plan Finder tool lets you enter your drugs and pharmacies to get an estimate. Any drug that moved a tier or picked up a prior authorization is your biggest cost risk, because it can change what you pay for the whole year.

Minutes 12 to 18: Check the providers. Confirm each doctor, specialist, and facility is still in the network for the coming year. A network can narrow, and a provider can be dropped without the plan name changing. Medicare notes that with Advantage you may need to use doctors and other providers who are in the plan's network and service area for non-emergency care.

Minutes 18 to 24: Add up the year. Combine the premium, the deductible, and the copays you actually paid for your regular care, and compare that total to what the coming year implies. If you hit the plan's out-of-pocket limit, note that too, because Medicare states that once you reach the plan's limit you'll pay nothing for covered services for the rest of the year.

Minutes 24 to 28: Check the extras you actually used. If you used a dental allowance, a vision benefit, or a fitness membership, confirm it survived in a comparable form. If you did not use it, do not let it influence the decision. Our guide to Medicare Advantage extra benefits covers how to evaluate those.

Minutes 28 to 30: Decide and record. Either keep the plan or identify the alternatives. Write down the decision and the reason, so that next year's review starts from a record instead of from memory.

The decision you are actually making

At the end of the review, there are only a few possible outcomes, and naming them keeps the review honest.

Outcome	When it is right
Stay in the current plan	Nothing material changed, and the cost and network still fit
Switch to another Advantage plan	Another plan covers your drugs and doctors better, or costs less for the care you use
Switch to Original Medicare with a drug plan	The network or prior authorization limits cost you more than they save, or you want provider freedom
Return to Original Medicare and add Medigap	You want predictable costs and can buy a Supplement under the rules that apply to you
Add or change only the drug plan	The health plan fits but the drug coverage does not

The Medigap option deserves a warning attached to the row. Moving from Advantage to Original Medicare does not automatically give you protected access to a Medigap policy. Federal guaranteed-issue rights are limited to specific situations, and outside them an insurer may use medical underwriting. Our guide to Medigap underwriting sets out those windows, and our Advantage versus Supplement guide covers the larger comparison.

The enrollment calendar the review has to fit

The review is only useful if it finishes before the deadline.

Medicare's Open Enrollment Period runs October 15 to December 7. Within that window you can join, drop, or switch a Medicare Advantage plan with or without drug coverage, move between Original Medicare and Advantage, or join, drop, or switch a drug plan if you are in Original Medicare.

Timing within the window matters. Medicare states that for changes made in the fall, coverage starts January 1 of the next year, provided the plan receives your request to join by December 7. A request that arrives late is not a January 1 change.

There is a second, narrower window after that. If you are already in a Medicare Advantage plan, the Medicare Advantage Open Enrollment Period runs January 1 to March 31 and allows one change: switch to another Advantage plan, or drop Advantage and return to Original Medicare with the option to add a drug plan. Coverage generally starts the first of the month after the plan receives your request.

A caution about that second window. It is not a general do-over for drug plans if you are in Original Medicare, and it does not reopen Medigap rights. It exists for Advantage enrollees to correct an Advantage choice.

Documents to keep and the one to watch

Keep every Annual Notice of Change and Evidence of Coverage, at least for the current and prior year. They are what you compare against, and without last year's document the review becomes a guess about what changed.

Two documents deserve specific attention because they signal trouble:

• A reduction in a benefit you rely on. If a dental allowance shrinks or a fitness benefit changes tier, you have until December 7 to respond.
• A plan exit notice. If your plan is leaving Medicare, you will get a notice, and Medicare states that people with Extra Help in that situation also get a chance to buy a Medigap policy because the plan is leaving. Anyone in that position should read the notice carefully rather than assume the default reassignment is fine.

Medicare notes that if you do not get important plan documents in early fall, you should contact your plan. A missing notice is not a reason to skip the review.

A short version for next year

The review gets faster each year if you keep the output. At the end of thirty minutes, write down three things: what you decided, what would have changed your mind, and the date the notice arrived. Next year's review starts with that note and takes fifteen minutes.

If you want a second set of eyes on the comparison, ask NavaQuote about your Medicare options. Bring your Annual Notice of Change, your medication list, your doctors, and what you spent out of pocket last year. Our Part D coverage guide goes deeper on the drug comparison, and our Medicare enrollment periods guide covers every window, including the special periods that apply when circumstances change mid-year.

Premiums, benefits, and plan terms change every year and vary by plan and county. Confirm the current plan year's figures in the plan's own documents rather than relying on a prior year's summary.