The 2025 Medicare Review Checklist — Coverage, Costs & Deadlines

Step 1: Review Your Current Medicare Coverage

Looking at your Medicare coverage is like using a telescope 🔭 — you need to focus on both the big picture and the tiny details to see everything clearly. Many seniors assume their coverage stays the same year after year, but Medicare plans can change every January. What worked last year may not be your best option in 2025.

The first checkpoint in your review is simple:
👉 Are you in Original Medicare, Medigap, or Medicare Advantage — and is it still the right fit?

✅ Understanding What You Have Now

💬 Testimonial – Clara, Recently Retired Librarian
“Before, I thought every plan in my county offered the same coverage. After reviewing my checklist, I learned plans can change benefits ZIP code by ZIP code. Now I make sure my doctors and prescriptions are still covered where I live.”

To follow Clara’s example, start by gathering the paperwork you already have:

📂 Essential Documents to Gather

• Your Medicare card (Parts A & B)
• Any Medigap (supplement) ID card
• Part D prescription drug plan card (if you have one)
• Recent Explanation of Benefits (EOB) statements
• Last fall’s Annual Notice of Change (ANOC) from your plan
• Current monthly premium and deductible information

These papers are your telescope lens, helping you zoom in on what you truly have.

💡 Why Your Plan May Have Changed Without You Knowing

Insurance companies adjust their Medicare plans every single year. A retired couple in the Midwest discovered during Annual Enrollment Period (AEP) that their trusted heart specialist was no longer in-network. Another senior noticed her blood pressure prescription went from $15 to $45 a month after a formulary change.

⚠️ Common Changes That Catch Seniors Off Guard

• Doctors or specialists quietly leaving the network
• Prescriptions moving to a higher (more expensive) tier
• Deductibles, copays, or coinsurance increasing
• Added benefits being reduced or removed

🔍 Questions to Ask About Your Current Coverage

Before you look at new options, take a hard look at your current plan. Use this mini-checklist:

❓ Critical Review Questions

• Are all my doctors still accepting my plan?
• Have my prescription copays gone up?
• Did my plan add or remove benefits for 2025?
• Is my monthly premium increasing?
• Am I paying for benefits I don’t even use?

📌 Local Note: Even within the same county, plans can vary by ZIP code. For example, seniors in ZIP 29582 (North Myrtle Beach, SC) may have different provider networks than those in ZIP 29526 (Conway, SC) — even though they’re just a few miles apart. That’s why checking your coverage every year matters.

Step 2: Compare Original Medicare and Medicare Advantage Options

Building your Medicare coverage is like constructing a house 🏡 — you need the right foundation and the features that matter most. Some seniors prefer the sturdy “brick-and-mortar” of Original Medicare plus a Medigap supplement, while others like the “all-in-one” convenience of a Medicare Advantage plan that bundles everything together.

The key is knowing what you need before you start comparing.

📊 What to Gather Before Reviewing Your Medicare Coverage

Here’s a simple grid to help you organize what you’ll need:

🏥 Original Medicare vs. Medicare Advantage: The Real Differences

• Original Medicare (Parts A & B):
  • Accepted nationwide by any provider that takes Medicare
  • Great for snowbirds ⛱️ who split time between Florida (ZIP 33101) and South Carolina (ZIP 29582)
  • Requires adding a Part D drug plan and possibly a Medigap supplement to cover the 20% Medicare doesn’t pay
• Medicare Advantage (Part C):
  • Bundles hospital, doctor, drug coverage, and often extras like dental, vision, or hearing
  • Lower premiums, sometimes even $0
  • But requires you to stay in a provider network — and may need referrals for specialists

Key Comparison Points

• Network flexibility vs. coordinated care
• Nationwide coverage vs. ZIP-based service areas
• Separate plans vs. all-in-one bundle
• No prior authorization vs. plan approvals required

👉 A simple checklist today can prevent costly mistakes tomorrow — Palmetto Mutual’s advisors will walk you through line by line.

✅ Quick Decision Points

Before you decide, ask yourself:

Consider These Factors

• Do I travel frequently or split time between states?
• Are my doctors tied to a specific health system or network?
• Do I take multiple prescriptions every month?
• Is it more important to have predictable costs or maximum flexibility?
• Do I need dental, vision, or hearing benefits included?

📌 Local Note: In South Carolina, seniors in ZIP 29405 (North Charleston) may see Advantage plans offering grocery cards and transportation benefits, while those in ZIP 29560 (Johnsonville) may have fewer options but lower Medigap rates. These ZIP-by-ZIP details can make a big difference.

Step 3: Check Prescription Drug (Part D) Coverage for 2025

Your Part D drug coverage is like sunscreen 🧴 — it only protects you if you reapply it regularly. Too many seniors skip this step, only to discover in January that their prescriptions now cost double. Formularies (the list of covered drugs) change every year, so you must check to make sure your medications are still protected for 2025.

💬 Story – Deborah, Former CNA
“I thought my plan would stay the same from year to year. I skipped my review and suddenly my copays doubled. After checking my coverage, I qualified for Extra Help and brought my costs back under control. I’ll never skip the checklist again.”

🔄 Understanding Formulary Changes

Every October, Part D and Medicare Advantage plans release their new drug lists for the coming year. What was once a Tier 2 drug (moderate cost) could move to Tier 3 (higher copay), or disappear completely.

📌 Example: In ZIP 29572 (Myrtle Beach, SC), one common blood pressure medication moved from Tier 2 to Tier 3 in 2024 — raising monthly copays from $10 to $30.

⚠️ What Can Change in Your Drug Plan

• Tier placement (affects your copay)
• Prior authorization requirements
• Quantity limits on prescriptions
• Step therapy (must try cheaper drugs first)
• Complete removal from the formulary

💰 Checking Your Prescription Costs

The easiest way to see your 2025 costs is to use the Medicare Plan Finder or ask a licensed advisor to run your exact prescriptions.

📌 Example: A senior in ZIP 29812 (Barnwell, SC) needing insulin compared plans and found one that saved her nearly $2,000 a year just by switching.

Cost Factors to Review

• Monthly premium changes
• Annual deductible ($545 standard in 2025)
• Copays for each tier of medication
• Donut hole (coverage gap) rules
• Catastrophic coverage thresholds

📝 Extra Help and Low-Income Subsidies

Many seniors qualify for Extra Help but don’t realize it. This program can:

• Pay most or all of your Part D premium
• Lower your deductibles
• Reduce copays to just a few dollars

📌 Example: Seniors in ZIP 29501 (Florence, SC) living on Social Security often qualify, yet many don’t apply.

Step 4: Review Your Out-of-Pocket Costs and Premiums

Budgeting for Medicare is like following a decision tree 🌳 — each choice leads to a different financial outcome. If you only look at your monthly premium, you might miss the hidden branches: copays, coinsurance, or surprise bills. The goal is to see your true annual costs for 2025, not just the number on your bill.

💬 Dual-Quote Shock Example
“Two seniors in ZIP 29812 (Barnwell, SC) got quotes on the same day: one for $116, one for $134. Same Plan G, same age — the only difference was which carrier they called.”

📊 Breaking Down Your True Medicare Costs

Your costs go far beyond the premium. Here’s where to start:

Start Here — What Type of Coverage Do You Have?

👉 If you have Original Medicare:

• Part B premium: $185/month (2025 standard)
• Part B deductible: $240/year
• 20% coinsurance for most services
• Part D premium (varies by plan and ZIP code)
• Medigap premium (varies by carrier and health rating)

👉 If you have Medicare Advantage:

• Plan premium (many are $0)
• Copays for doctor visits and tests
• Coinsurance for major services
• Out-of-pocket maximum (caps your costs)
• Prescription copays (built-in Part D coverage)

🎯 Understanding IRMAA Surcharges

If your income was higher two years ago, you may pay extra on Part B and Part D. This is called IRMAA (Income-Related Monthly Adjustment Amount).

📌 Example: A retired executive in ZIP 29577 (Myrtle Beach, SC) didn’t realize her Part B premium included a $300+ surcharge until an advisor reviewed her Social Security letter.

2025 IRMAA Brackets (Individual)

• Under $103,000 → No surcharge
• $103,001–$129,000 → +$69.90/month
• $129,001–$161,000 → +$174.70/month
• $161,001–$193,000 → +$279.50/month
• $193,001–$500,000 → +$384.30/month
• Above $500,000 → +$419.30/month

💡 Hidden Costs to Watch For

Many seniors forget about everyday health expenses Medicare doesn’t fully cover:

Often Overlooked Expenses

• 🦷 Dental, 👓 vision, and 👂 hearing services
• 💊 Over-the-counter medications
• 🩼 Medical equipment (like walkers or braces)
• 🚗 Transportation to doctor appointments
• 🏡 Long-term care services

📌 Local Note: In ZIP 29440 (Georgetown, SC), a senior paid nearly $800/year out-of-pocket for hearing aids — even though her Advantage plan advertised “hearing benefits.” Always check the fine print.

Step 5: Confirm Your Doctors, Hospitals, and Networks

Your Medicare network is like Velcro 🎛️ — it only works if both sides stick together. Even if your plan looks good on paper, it won’t matter if your doctor or local hospital no longer accepts it. Before January 1, you need to confirm your providers are still in-network for 2025.

✅ Verifying Provider Participation

💬 Testimonial – Connie, Backyard BBQ Grandpa
“I almost turned down the Medicare Savings Program because I thought it was a handout. I learned it’s actually built into Medicare to lower costs. If I hadn’t asked questions, I would’ve paid hundreds more each month. Don’t let pride keep you from savings.”

Never assume your doctors are still covered just because they were last year. Provider networks change often, especially for Medicare Advantage plans.

How to Verify Coverage

• 📞 Call each doctor’s billing office directly
• 🖥️ Check your plan’s online provider directory
• 🏥 Confirm hospitals and outpatient centers separately
• 📝 Verify referral requirements for specialists

📌 Example: In ZIP 29501 (Florence, SC), a major hospital left one Medicare Advantage network mid-year, leaving many seniors scrambling for coverage.

🔍 Understanding Network Types

Not all networks work the same way.

Medicare Advantage Network Options

• HMO (Health Maintenance Organization):
  • Must use in-network providers (except emergencies)
  • Requires choosing a primary doctor and referrals
  • Lower premiums but less flexibility
• PPO (Preferred Provider Organization):
  • Can see out-of-network doctors at higher cost
  • No referral requirements
  • Higher premiums but more freedom

👉 If you travel often or split time between states, PPO or Original Medicare may fit better.

🚑 Emergency and Urgent Care Coverage

Emergencies don’t wait for your ZIP code.

• Original Medicare covers you anywhere in the U.S.
• Medicare Advantage covers urgent and emergency care outside your service area, but regular visits may not be included.

📌 Example: A snowbird with a plan in ZIP 29464 (Mount Pleasant, SC) discovered her routine doctor visits in Florida weren’t covered — but ER visits were.

Step 6: Look at Extra Benefits Like Dental, Vision, and Hearing

When reviewing Medicare, don’t forget the “extras” — things Original Medicare doesn’t cover, but many Advantage plans do. For seniors, these extras can feel like finding hidden treasure in your plan. Benefits such as dental, vision, hearing, fitness, and even meal delivery can add real value if you know to look for them.

📅 Annual Medicare Review Steps in 2025

Here’s a simple timeline + checklist so you don’t miss any updates:

🦷 Dental, Vision, and Hearing Benefits

💬 Real Quote – Martha, Retired Teacher
“I didn’t realize my Medicare Advantage plan included $2,000 in dental coverage until I’d already paid out of pocket for my crown. Now I check every benefit before assuming I have to pay.”

Typical coverage levels you may see in South Carolina and North Carolina ZIP codes:

📝 Typical Coverage Levels

• Dental: $500–$3,000 annual maximum
• Vision: Eye exam + $100–$300 allowance for glasses
• Hearing: Exam + $500–$2,000 per hearing aid

📌 Example: Seniors in ZIP 29582 (North Myrtle Beach, SC) often see plans offering generous dental benefits, while those in ZIP 28358 (Lumberton, NC) may find stronger hearing coverage instead.

🏃 New Wellness Benefits for 2025

Medicare Advantage continues expanding perks beyond basic care. These “wellness extras” can save you money and make daily life easier.

🌟 Enhanced Benefits to Look For

💬 Mental health and counseling programs

Free or low-cost gym memberships (like SilverSneakers)

Over-the-counter (OTC) cards ($25–$150/quarter)

🚐 Transportation to medical appointments

🍲 Meal delivery after hospital stays

📱 Telehealth services with expanded coverage

Step 7: Make Sure You Understand Enrollment Deadlines

Medicare deadlines are like a fire drill 🔔 — you need to know exactly when and how to act, because missing the signal could leave you unprotected. Every year, millions of seniors either miss or misunderstand their enrollment windows. Knowing the dates for AEP, OEP, and Special Enrollment Periods (SEPs) helps you avoid penalties and gaps in coverage.

💬 Story – Denise, Snowbird Veteran
“I spend winters in Florida and summers in South Carolina. I thought my Medicare Advantage plan worked the same in both states — until a doctor visit down south wasn’t covered. After reviewing my checklist, I switched to a plan with nationwide access. Now I don’t have to worry when I pack my bags.”

🗓️ Key Medicare Enrollment Periods

📍 Annual Enrollment Period (AEP) — October 15 to December 7

• Switch from Original Medicare to Medicare Advantage
• Change between Medicare Advantage plans
• Add, drop, or change Part D prescription coverage
• Return from Medicare Advantage back to Original Medicare

📍 Medicare Advantage Open Enrollment (OEP) — January 1 to March 31

• Switch between Medicare Advantage plans
• Drop Medicare Advantage and go back to Original Medicare
• Add or drop Part D coverage (if returning to Original Medicare)
  ⚠️ You cannot join Medicare Advantage for the first time during OEP.

🎯 Special Enrollment Periods (SEPs)

You don’t always have to wait until fall. Certain life events open a Special Enrollment Period:

✅ Common SEP Qualifiers

• Moving to a new service area (e.g., from ZIP 29505 Florence, SC → ZIP 28379 Rockingham, NC)
• Losing employer or union coverage
• Qualifying for Extra Help with drug costs
• Entering or leaving a nursing home
• If your plan leaves your area or loses its Medicare contract

⚠️ Penalties for Missing Deadlines

Missing a deadline can cost you for the rest of your retirement.

❌ Late Enrollment Penalties

• Part B: 10% premium increase for each year delayed
• Part D: 1% of the national average premium per month delayed
• Penalties last as long as you have Medicare
• No penalty if you had creditable coverage (like employer insurance)

📌 Example: A senior in ZIP 29407 (West Ashley, Charleston, SC) delayed Part D by one year and now pays 12% higher premiums for life.

Step 8: Watch Out for Common Mistakes During Plan Changes

Switching Medicare plans is like trying to spot the difference in two nearly identical photos 👀 — one choice saves you money, the other drains your wallet. Many seniors get tripped up by small details during plan changes that end up costing thousands. Knowing what to look for can help you avoid expensive mistakes.

💬 Cost Example – Near Me Comparison
“Just outside ZIP 29817 (Hampton, SC), Plan G runs about $120/month — but cross into ZIP 29836 (Estill, SC) and you could be looking at $137 for the same coverage.”

🚫 Mistakes That Cost Seniors Money

Here are the most common traps seniors fall into during Medicare plan changes:

Top 5 Costly Errors

1. Choosing by Premium Alone
   • Low premium ≠ low total cost
   • Check deductibles, copays, and out-of-pocket maximums
2. Not Checking Prescription Coverage
   • Formularies change every year
   • Same plan name ≠ same drug coverage
3. Ignoring Network Changes
   • Doctors and hospitals leave networks regularly
   • Coverage on paper may not work in your ZIP
4. Skipping Star Ratings
   • 4⭐ or higher plans usually offer better service
   • 5⭐ plans allow year-round enrollment in many areas
5. Falling for High-Pressure Sales
   • Medicare does not cold-call you
   • Never give personal info to unexpected callers

🎭 How to Spot Misleading Marketing

Not all ads are honest. Be cautious if you see:

🚩 Red Flags to Watch For

• “Free” benefits that aren’t truly free
• Promises that sound too good to be true
• Pressure to sign up immediately
• Agents who won’t put details in writing
• Claims that “everyone in your area is switching”

📋 Checklist Before You Switch

Before signing anything, run through this quick review:

Final Verification Steps

• ✅ Confirm all your doctors accept the new plan
• ✅ Make sure all prescriptions are covered
• ✅ Understand your true out-of-pocket costs
• ✅ Check the plan’s star rating
• ✅ Get enrollment confirmation in writing

📌 Local Note: In ZIP 29576 (Murrells Inlet, SC), many seniors switched to a plan for the “free dental” — only to learn cleanings were covered, but crowns weren’t. Always check what “free” really means.

Step 9: Use Free Resources to Compare Medicare Plans

Free Medicare resources act like a gatekeeper 🚪 — they help you get the right information while keeping out misleading sales pitches. Instead of relying only on mailers or TV ads, you can use trusted tools and local programs to compare your options without pressure.

🖥️ Medicare.gov Plan Finder

💬 Testimonial – Connie, Widow Who Walks Daily
“I stayed in a plan for years because I thought it was against the law to switch. When I learned you can change during certain times of year, I finally found coverage that fit better. Now I walk every day with peace of mind — and lower copays.”

The official Medicare Plan Finder helps you:

🔎 Plan Finder Features

• Enter your exact prescriptions
• Include your preferred doctors and hospitals
• Compare total yearly costs, not just premiums
• Filter by ⭐ star ratings
• See which plans offer extra benefits like dental, OTC cards, or transportation

📌 Example: A senior in ZIP 29588 (Myrtle Beach, SC) used the tool and discovered a plan saving her $600/year on prescriptions alone.

📞 SHIP Counseling Services

State Health Insurance Assistance Programs (SHIPs) provide free, unbiased Medicare counseling. Whether you live in a city or a rural county, SHIP counselors are trained to give clear answers.

📋 How SHIP Helps

• One-on-one counseling sessions
• Group workshops at senior centers or libraries
• Phone support in multiple languages
• Help filing appeals or complaints
• Assistance applying for Extra Help with drug costs

📌 Example: In Florence County, SC (ZIP 29506), the local SHIP office holds monthly Medicare workshops at the library, walking seniors through Part D reviews step by step.

🏪 Community Resources

Sometimes the best help is right around the corner.

🏡 Where to Find Local Support

• Area Agencies on Aging — regional offices offering Medicare help
• Senior centers — often host enrollment events in October and November
• Libraries — many offer Medicare 101 workshops
• Faith-based organizations — some churches sponsor free info sessions
• Community health centers — provide Medicare counseling alongside medical care

📌 Example: In Georgetown, SC (ZIP 29440), the Howard Senior Center runs a Medicare help desk every fall where seniors can bring prescriptions and get live plan comparisons.

Step 10: Get Help Before Making Your Final Medicare Decision

Making your Medicare choice is like giving it the dollar test 💵 — will this decision save you money over the entire year, or cost you more than you expect? Don’t just look at the monthly premium. Add up everything: copays, prescriptions, deductibles, and even travel costs. The right choice should fit both your health needs and your budget.

📅 Deadlines & Review Dates Every Senior Should Track

Here’s an annual review checklist by month so you never miss a step:

💰 Calculating Your True Annual Costs

Think of it like balancing your household budget — you wouldn’t just check the electric bill, you’d look at groceries, gas, and everything else. Medicare works the same way.

🧾 The Complete Cost Formula

👉 Original Medicare + Supplements:

• Part B premium × 12
• Medigap premium × 12
• Part D premium × 12
• Deductibles (Part B + Part D)
• 20% coinsurance on services
• Dental/vision/hearing out-of-pocket

👉 Medicare Advantage:

• Plan premium × 12
• Copays for doctors and specialists
• Prescription drug copays
• Out-of-pocket maximum (worst case)
• Value of extra benefits (dental, vision, OTC card, etc.)

🎯 Making Your Final Choice

Every senior’s needs are different:

• A retired miner in West Virginia with chronic health issues might prioritize the lowest out-of-pocket maximum.
• A healthy senior in Oregon may prefer a plan with wellness extras like gym memberships and preventive care.
• In ZIP 29527 (Conway, SC), many retirees choose Advantage plans with $0 premiums, while in ZIP 28306 (Fayetteville, NC), Medigap Plan G often wins because of provider flexibility.

✅ Decision Factors by Priority

Do you rely on local family support?

Healthcare Needs

Chronic conditions requiring specialists

Prescription medications

Planned surgeries or procedures

Financial Situation

Living on a fixed income

Emergency savings available

Eligibility for subsidy programs

Lifestyle Factors

Do you travel frequently?

Do you split time between states?