Thompson Medicare Brokerage
The #1 Mistake Medicare Beneficiaries Make
The #1 Mistake I See Medicare Beneficiaries Make Every January
Every January, after the dust settles from Annual Enrollment, I hear a version of the same story again and again:
“I didn’t change anything… but something feels different with my plan.”
And most of the time, the root of the problem is the same simple mistake.
❌ Assuming “No Changes” Means “Nothing Changed”
Too many Medicare beneficiaries assume that if they didn’t actively switch plans, then their Medicare coverage hasn’t changed.
But that’s not how Medicare works.
Even if you stay on the same plan:
- Your doctors could move out of network
- Your prescription drugs might change tiers
- New prior authorization rules may apply
- Costs you pay at the doctor or pharmacy might go up
These changes can happen without you doing anything — and often take effect starting January 1st.
🩺 Networks and Providers Can Shift
Plans update their provider networks every year.
That means a doctor who was “in network” last year:
- Might not be in network this year
- May have higher costs attached
- Or may require referrals you didn’t need before
This can result in unexpected bills or surprise denials — and most people don’t find out until the claim comes in.
💊 Drug Coverage Isn’t Set in Stone
Every fall, plans file a new formulary (drug list) with Medicare.
That can mean:
- A drug you take regularly moves to a higher cost tier
- A medication now needs prior authorization
- Quantity limits are introduced
- Or a drug is dropped from the plan
Even if your monthly premium stayed the same, how much you actually pay at the pharmacy can change.
💰 Premiums Don’t Tell the Whole Story
It’s easy to judge a plan based on the monthly premium. But:
- Copays and coinsurance matter more when you use the plan
- Specialist visits and imaging costs add up
- The annual maximum out-of-pocket can vary widely
Two plans with the same premium could behave very differently once you’re in care.
🔍 Why January Is When You Notice Things
January is when all of the current year’s changes finally kick in — and that’s when:
- Costs feel different
- Doctors bill differently
- Coverage surprises happen
This doesn’t mean panic — it means it’s the perfect time for a check-in.
✅ What You Should Do Instead
Here’s a simple three-step check every January:
1. Verify Your Provider Network
Make sure your doctors and specialists are still covered as you expect.
2. Review Your Medications
Check that your regular prescriptions are still on the plan’s drug list — and see if any have moved tier levels or now require prior authorization.
3. Compare Costs
Look at your typical usage (doctor visits, procedures, labs) and make sure the plan still fits your budget and health needs.
A quick review can confirm whether your current plan still makes sense — or whether a different option might serve you better this year.
🤝 Need Help Reviewing Your Medicare Advantage Plan?
The biggest mistake I see every January isn’t choosing the wrong plan.
It’s assuming that nothing changes just because you didn’t change your plan.
Medicare plans change every year — and many of those changes take effect on January 1st.
If something feels different with your coverage, or if you want peace of mind that your plan still meets your needs, now is the time to look at it.
¹ClearSpring, Molina & BCBS IL plan options are listed separately.