5 Common Mistakes When Enrolling in Medicare Advantage & Prescription Drug Plan 

1. Not Reviewing Plan Changes Annually

Medicare Advantage and Prescription Drug Plans can change every year in terms of coverage, costs, and participating providers. One of the most common mistakes enrollees make is assuming their current plan will remain the right option for the next year. To avoid this:

Tip: Review the Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) documents sent by your plan provider every fall.

Action: Compare changes in premiums, deductibles, copays, and coverage for your medications and healthcare needs for the upcoming year.

2. Ignoring Network Restrictions

Medicare Advantage plans often have networks of doctors, hospitals, and pharmacies where you can receive care. Failing to check if your preferred healthcare providers are in-network can lead to unexpected costs or limited access to care.

Tip: Use your plan’s provider directory or call the provider’s office directly to verify network status.

Action: Confirm that your primary care physician, specialists, and preferred hospitals are in-network before enrolling.

3. Not Understanding Drug Formularies

Prescription Drug Plans have formularies listing covered medications and their costs. Enrollees often don’t check if their medications are covered or are placed on higher cost tiers.

Tip: Review the plan’s formulary to ensure your medications are covered and at the most affordable tier.

Action: Consider discussing with your doctor or pharmacist if there are suitable alternatives or generics covered by your plan.

4. Overlooking Plan Star Ratings

Medicare evaluates Advantage and Prescription Drug Plans based on quality and performance, assigning star ratings from 1 to 5 stars. Plans with higher ratings generally provide better experiences and outcomes.

Tip: Check the Medicare Plan Finder or Medicare’s website for plan star ratings.

Action: Choose plans with higher ratings as they tend to offer better customer service, care coordination, and member satisfaction.

5. Not Considering Cost Sharing and Out-of-Pocket Limits

Enrollees sometimes focus solely on monthly premiums without fully understanding cost-sharing responsibilities such as copays, coinsurance, and deductibles. This can lead to unexpected out-of-pocket expenses.

Tip: Compare total costs including premiums, deductibles, copays, and coinsurance.

Action: Pay attention to maximum out-of-pocket limits which cap your annual spending on covered services.

Enrolling in Medicare Advantage and Prescription Drug Plans requires careful consideration of your healthcare needs, financial situation, and plan specifics. By avoiding these common mistakes and following the provided tips, you can make informed choices that maximize your coverage and help minimize unexpected costs for 2025. Remember, staying informed and reviewing your options annually helps ensure you’re always getting the right coverage for your health needs.

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