Watch For Trends That Emerge Every October
There are always market trends and changes influenced by laws and regulations—and you’ll first see them in October, when carriers release their plan information for Medicare AEP.

Prescription drug coverage—in Part D or in Medicare Advantage plans—is often a good place to look first during AEP. These plans frequently change. There is an average of 35 Part D plans per market, based on data from the Kaiser Family Foundation. And a careful look at seemingly minor changes in coverage, such as tiers, pharmacy networks and use of generics, is important.

If the number of Medicare Advantage plans (18 per market on average) shifts in the local market, or there are new carriers or consolidations, it’s a good signal that your client should take a closer look.

Some of these changes make it easier for the healthcare consumer to shop. For example, the Centers for Medicare & Medicaid Services (CMS) has pressed carriers to eliminate their plans that are too similar to each other. Consolidation of plans and number of carriers in the market could bring both pros and cons for the client to consider and evaluate—from higher quality rated plans to higher premiums.

Another trend among competitive providers of Medicare Advantage plans is the offering of gym memberships, dental services and other extras to attract new members. Clients should look carefully to ensure these features add necessary value compared to price.

Watch as well for coverage affected by the consolidation of provider networks in the local market. Many hospitals and physician groups are moving into larger, multi-facility networks, which gives them more leverage when negotiating reimbursement rates with plans. For your client, it could mean changes in available networks – even during a plan year. Many consumers are understandably upset when their Medicare plan announces mid-year it is shifting its in-network coverage from one network to another, limiting the client’s access to preferred doctors and hospitals.

CMS is watching this trend, too, and there has been some discussion about allowing those affected by changes in plan networks during the year to re-enroll during a special enrollment period. One example of these developments is the Medicare Advantage Participant Bill of Rights Act of 2014 that was introduced in the U.S. Congress this summer.

Thinking Ahead Isn’t That Hard To Do
There are a lot of things clients can project a year in advance when deciding if they should take a second look at their coverage during AEP.

• Residence or relocation. Many retirees formulate plans to travel significantly when they leave the 40-hour workweek. This can look different for many people, from purchasing a recreational vehicle and traveling the country to buying a home in a warmer climate for their winter address. Retirees who are planning on making changes like these would do well to take a closer look at their healthcare coverage through Medicare to make sure it will provide for their needs no matter where they end up spending their newly discovered free time.

For example, one customer worked with us to ensure his Medicare transition was smooth as he moved from one state of residence to another state to be closer to his children. He also got a fresh opportunity to select coverage as the move triggered a special enrollment period.