Q: Several years ago when my husband and I both retired we signed up for a Medicare plan several of our friends recommended. In the beginning neither of us took prescriptions on a regular basis or had any on-going health conditions so the plan met our needs.

Last year my husband’s health started to deteriorate and we encountered issues regarding one medication the plan would not cover. We also could not consult with a specialist because he was an out of network physician. What are our options?

A: The scenario you described is not all that unusual. It clearly points out the plan a person chooses when they first enroll in Medicare may not necessarily be the plan they should continue with as they go through the aging process.

If an individual’s needs are not being met they have the option of choosing another plan during the annual Medicare Open Enrollment period which runs Oct. 15 through December 7.

During this time frame, a beneficiary may switch from Original Medicare to a Medicare Advantage plan or vice versa. They may also switch from one Medicare Advantage plan to another Medicare Advantage plan. There is also the option of choosing a different Part D plan.

It is extremely important to read all materials received from your current plan during this time period. Look for mailings related to “Evidence of Coverage” and “Annual Notice of Change.” Do not ignore this information. Cost, coverage, providers and pharmacies within the network can change from year to year. What may work for someone one year may not work for them the following year. If a person determines their current plan continues to be their best option they do not need to take any action. Otherwise time should be devoted to finding out what plans are available to them where they reside. There are several ways to obtain this information. Individuals or a responsible family member can meet with a certified and highly trained SHINE counselor. SHINE (Serving Health Insurance Needs of Everyone) is a program to provide community education and one-on- one consultations with individuals to help them evaluate, compare and enroll in a health plan that best meets their personal needs. Counselors are available at local Councils on Aging. Call 1-800-8920890 to find a convenient location. A person also can call Medicare directly at 1-800-MEDICARE or go online to www.Medicare.gov and look for the Find a Plan link.

Are you struggling caring for an older adult or having difficulty locating resources? Our staff is available for a no-cost consultation, set up at your convenience, to help guide you through your caregiving experience. For more details or to schedule an appointment, please call 800-892-0890.

Do you have a question? We encourage inquiries and comments from our readers. Please direct your correspondence to ageinfo@esmv.org or Elder Services of the Merrimack Valley and North Shore, Inc., Age Information Department, 280 Merrimack Street, Suite 400, Lawrence, MA 01843. Joan Hatem-Roy is the Chief Executive Officer of Elder Services of Merrimack Valley and North Shore.

Print this page