Medicare Changes Every Year. Most People Don't Notice Until It Costs Them.
If there is one constant in Medicare, nothing stays the same for long.
Premiums change. Formularies change. Carrier networks change. Benefit structures change. A plan that served you well last year may quietly become a worse deal this year, and without a review, you will not find out until you are at the pharmacy counter or the specialist's office.
What changes annually — and why it matters
Medicare's annual enrollment period runs October 15 through December 7. During those weeks, beneficiaries can switch Medicare Advantage plans, change their Part D drug plan, or move between Original Medicare and Medicare Advantage. Most people let the window close without reviewing anything, which means defaulting into whatever they held the year before.
A lot can change between enrollment periods:
Premiums. Both Medicare Advantage and Part D premiums reset each year. A plan that was among the most affordable last year may not be this year.
Drug formularies. The list of covered medications, and what tier they sit on, changes annually. A drug your plan covered at a low copay may move to a higher tier or disappear from the formulary. For anyone taking multiple medications, this can mean hundreds or thousands of dollars of difference over a year.
Provider networks. Medicare Advantage plans use networks. Doctors and specialists who were in-network last year may not be this year. If you have established relationships with specific providers, verify their network status during every enrollment period.
Benefit structures. Dental, vision, hearing, and fitness benefits vary by plan and by year. Plans add and remove these regularly.
IRMAA thresholds. Above certain income levels, Medicare charges a surcharge on top of standard Part B and Part D premiums. These thresholds adjust annually, and a change in income, a Roth conversion, a required minimum distribution, a one-time sale, can push you into a higher bracket without warning.
The IRMAA problem most people discover too late
Medicare uses your tax return from two years ago to determine premium surcharges. If your income in that year exceeded the threshold, you pay more, sometimes far more, for Part B and Part D coverage.
A single financial decision can trigger an IRMAA surcharge that costs thousands of dollars per year in higher Medicare premiums. Because Medicare looks back two years, you may not feel the impact until it is already locked in.
This is why Medicare planning cannot happen separately from the broader financial plan. A decision your financial advisor helps you make today can show up in your Medicare premium two years from now. If those two conversations happen with different people who are not coordinating, you are exposed to surprises that could have been avoided with one conversation.
What good Medicare planning looks like
The annual enrollment period is not the only time Medicare deserves attention. The most important conversations happen earlier:
Six to twelve months before your 65th birthday: understanding enrollment options, evaluating Medicare Advantage versus Medigap, reviewing current providers and medications, and making a deliberate choice rather than a default one.
Any year income changes significantly: a Roth conversion, a business sale, a large distribution — warrants a review of IRMAA exposure before the financial decision is finalized.
Every year during open enrollment: a brief review of your current plan against available alternatives does not take long and can produce meaningful savings.
Ascent Advisors' insurance team, affiliated with American Senior Benefits, includes independent brokers who compare plans across dozens of carriers. Independent means they are not limited to one company's products. They look across the market and identify what fits your situation, not what fits a sales quota.
Because our wealth management and insurance teams work together, we review Medicare as part of your complete financial picture. That coordination is the difference between a surprise Medicare bill and a plan that anticipated it.
This blog is for informational purposes only. Medicare plan availability, costs, and benefits vary by location and change annually. Consult a licensed Medicare professional to evaluate options for your situation. Ascent Advisors' insurance brokers are affiliated with American Senior Benefits, an Integrity Company.