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 talking about changing your insurance coverage. But there are many individuals with Medicare who are looking at their coverage for 2025 and are finding it to still be a good and a useful product to them.

The Medicare Annual Open Enrollment Period is well underway and we are hearing this from some individuals. The 2025 year has been a big year of change and there are many insurance plans that will not be available in the new year (at least 12 plans), but that change doesn’t impact everyone. When evaluating your options, I understand the decision to stay where you are as long as it will continue to work for you in the coming year.

The medicare.gov website is a very useful tool in this evaluation process. If you have set up with a login and password to access the site, the information is tailored to your current coverage and how it works in the coming year. When reviewing that information, you may decide that there is not any better coverage out there, with regard to pricing and the pharmacies you use. In this situation, you can just leave your insurance alone and not move to an alternate plan. This decision to your same coverage requires no action from you. The plan you are currently enrolled in rolls over into the New Year and there is nothing more you need to do, after evaluating the coverage. You do not need to contact the plan to inform them, you should not re-enroll into the plan you are already in. This is true for Medicare Supplement Plans, Stand Alone Part D Plans (prescription drug coverage) and for Medicare Advantage Plans of all types.

Those with Medicare are encouraged to evaluate their coverage options each year, so that they have the best possible coverage for the coming year. An individual’s health situation changes year to year, the medications can be different, your doctors may be different and the plans offer different coverage each year. So this annual evaluation is important to be sure you are doing the best you can do for the upcoming calendar year. This evaluation process needs to include a brief review of each of those factors, as well as considering how well your plan did during this year. Are you happy with the coverage, the customer service, the medication coverage at your pharmacy and the pricing structures? If the answers are yes to those questions, and your medications will be covered in a way that works for you, then you should not need to make any changes.

I do want to say that one of the big changes we are seeing this year is the change in pharmacy status. A number of the plans are changing how pharmacies are included in their coverage. The move from Preferred to Standard contract with Part D coverage at your pharmacy can make a significant change in the cost of your medications. There are plans that are excluding pharmacy chains in their plan completely. If this situation happens to you and don’t move to an alternative pharmacy, you would have no Part D coverage at that pharmacy. A client and I reviewed their coverage yesterday, their current pharmacy was preferred and their medication was $0 co-pay during the deductible and initial coverage. The alternative pharmacy that they were thinking of moving to was a standard contract where those co-pays moved to $18 each. That is a big difference in cost, so they decided to stay with their plan and keep the same pharmacy. You may see the opposite, where your plan may change the contract and pharmacy you have always used is now a standard contract or not included at all, so it will no longer be preferred pricing and your medication costs will likely increase.

In the situation where you have decided to stay with your current insurance coverage, you can let it roll. It is also important to remember there is still time to do that evaluation if you haven’t done it yet. The Annual Open Enrollment Period runs until December 7, each year. There are also other Enrollment Periods and Special Enrollment Periods available if your situation changes as the year 2025 progresses.

Janell Sluga is a Geriatric Care Manager helping seniors in our community access services and insurance. To reach her, please email editorial@post-journal.com.