Why Annual Open Enrollment Matters for Your Medications
Every year, Medicare plans change. Not just premiums or doctor networks-your medications might suddenly cost more, get moved to a higher tier, or disappear from the formulary entirely. If you don’t review your coverage during Open Enrollment, you could be paying hundreds more for your prescriptions next year than you need to. For many people, this isn’t a hypothetical risk. In 2024, 60% of Part D plans changed at least one drug’s coverage status. One medication you’ve been taking for years could go from $10 a month to $150 overnight. That’s not a mistake-it’s a plan update you missed.
When to Act: The 2025-2026 Medicare Open Enrollment Window
Medicare’s Annual Open Enrollment Period (AEP) runs from October 15 to December 7 every year. Changes you make during this time take effect on January 1. For 2026 coverage, the window closed on December 7, 2025. If you wait until January, you’re stuck with your current plan until next October. There’s no second chance unless you qualify for a Special Enrollment Period-which most people don’t. The deadline isn’t flexible. Missing it means you pay more, get less coverage, or both.
Step 1: List Every Medication You Take
Start with your pill bottles. Write down the exact name, dosage, and how often you take each one. Don’t guess. Don’t skip over vitamins or over-the-counter drugs if your doctor says they’re part of your regimen. Some Part D plans cover certain OTCs, especially for diabetes or heart conditions. Include insulin, GLP-1 drugs like Ozempic or Wegovy, and any specialty medications. If you take ten pills a day, list all ten. This isn’t just paperwork-it’s your leverage. You need this list to compare plans accurately. Without it, you’re flying blind.
Step 2: Get Your Annual Notice of Change (ANOC)
By October 1, your current plan must send you the Annual Notice of Change (ANOC). It’s not optional. It’s required by law. This document tells you exactly what’s changing for 2026: new premiums, higher deductibles, removed pharmacies, and-most importantly-changes to your drug formulary. Look for the section titled “Changes to Your Drug List.” If your medication is no longer covered, moved to Tier 4 or 5, or now requires prior authorization, you’re looking at a potential cost spike. Don’t wait for the mail. Log into your plan’s website or call customer service. Get the ANOC early. Compare it to last year’s version side by side. If your insulin went from Tier 2 to Tier 3, that’s a red flag.
Step 3: Use the Medicare Plan Finder Tool
Go to Medicare.gov and use the Plan Finder tool. Enter your zip code, your medications, and your preferred pharmacy. The tool will show you every plan available in your area that covers your drugs. It calculates your estimated annual cost-not just the monthly premium, but also deductibles, copays, and what you’ll pay if you hit the coverage gap. You’ll see how much you’d pay under each plan for your exact drug list. The difference between plans can be over $1,000 a year. One beneficiary in Florida saved $1,200 just by switching from a plan that put Ozempic on Tier 4 to one that covered it on Tier 2. That’s not luck. That’s using the tool.
Step 4: Check Your Pharmacy Network
It’s not enough that your drug is covered. Is your pharmacy in the network? Many plans have preferred pharmacies with lower copays. If your local CVS or Walgreens is no longer preferred, you might pay $30 more per script. Some plans use mail-order only for maintenance drugs. If you hate waiting for shipments, that’s a dealbreaker. Call your pharmacy and ask if they’re in-network for each plan you’re considering. Don’t assume. In 2024, 32% of Reddit users complained about pharmacy removals during AEP. You don’t want to be one of them.
Step 5: Compare Medicare Advantage vs. Original Medicare + Part D
Medicare Advantage (Part C) plans bundle your hospital, doctor, and drug coverage into one. They cap your out-of-pocket costs at $8,000 in 2025. But they limit which doctors you can see-only 43% offer out-of-network care. Original Medicare (Parts A and B) lets you see any provider who accepts Medicare, but you need a separate Part D plan for drugs. If you take multiple medications, Advantage plans often have lower overall costs because they include drug coverage. But if your favorite specialist isn’t in-network, you’re paying more to see them. Look at total cost: premiums + drug copays + doctor visits. Don’t just pick the cheapest monthly premium. A $7 plan with $120 copays on your insulin isn’t a bargain.
What’s New for 2026
Two big changes are coming. First, all Medicare Advantage plans must now cover Part B drugs administered in outpatient settings-like chemotherapy or IV infusions-without extra charges. Second, the Medicare Plan Finder tool now includes a “total cost” calculator that estimates your annual drug spending based on your exact medications. This is a game-changer. You no longer have to guess. You can plug in your drugs and see which plan saves you the most. Also, the $35 monthly cap on insulin is now permanent. If you’re on insulin, you’re protected. But that doesn’t mean other drugs are cheap. Specialty drugs like those for multiple sclerosis or rheumatoid arthritis are still expensive. Check if your plan puts them on the specialty tier. Those can cost $500+ per month.
Common Mistakes and How to Avoid Them
- Mistake: Assuming your plan won’t change. Solution: Review your ANOC every year-even if you like your plan.
- Mistake: Choosing based on premium alone. Solution: Use the Plan Finder to calculate total annual cost for your drugs.
- Mistake: Not checking pharmacy networks. Solution: Call your pharmacy and confirm they’re in-network.
- Mistake: Missing the December 7 deadline. Solution: Set a calendar reminder for October 15 and another for December 1.
- Mistake: Ignoring supplemental benefits. Solution: If you have Medicaid or need dental/vision, check if your Advantage plan includes them-and whether you qualify.
Who Can Help
You don’t have to do this alone. State Health Insurance Assistance Programs (SHIP) offer free, personalized counseling in every state. They have over 9,400 trained counselors who know Medicare inside and out. They can help you read your ANOC, use the Plan Finder, and explain formulary tiers. Call 1-800-MEDICARE or visit medicare.gov/shipto find your local SHIP office. Many offer phone appointments or in-person help. Don’t wait until the last week. Counselors get swamped in November.
What Happens If You Do Nothing
If you don’t change your plan, you’ll automatically be re-enrolled in your current one for 2026. But that doesn’t mean it’s still the best option. Plans raise premiums, drop drugs, and shrink networks every year. The average beneficiary who doesn’t review their plan pays $532 more per year on prescriptions than those who do. For someone on three specialty drugs, that number can jump to $2,000. You’re not saving time by skipping this step-you’re paying for it.
Final Tip: Don’t Wait Until December
Start in October. Gather your meds. Read your ANOC. Use the Plan Finder. Talk to your pharmacist. Call SHIP. By November, you should have a shortlist of two or three plans. Compare them. Pick one. Enroll by December 7. The process takes about 3.7 hours total-less time than a doctor’s appointment. But it can save you thousands. Your medications matter. Your budget matters. This is the one time each year you can take control of both.
Can I change my Medicare drug plan after December 7?
No, you cannot change your Part D or Medicare Advantage plan after December 7 unless you qualify for a Special Enrollment Period. These are rare and usually only apply if you move out of your plan’s service area, lose other coverage, or enter a nursing home. For most people, December 7 is the last day to make changes for the next year. Missing it means you’re locked in until next October.
What if my medication is removed from the formulary?
If your drug is removed, you’ll pay full price unless you switch plans during Open Enrollment. Some plans offer a temporary 30-day transition refill, but that’s it. You can request a formulary exception from your plan, but approval isn’t guaranteed. The best move is to find a new plan that covers your drug before December 7. Use the Medicare Plan Finder to search for plans that include your exact medication on a lower tier.
Do all Medicare Advantage plans include drug coverage?
Almost all do-90% of Medicare Advantage plans in 2025 include Part D drug coverage. But not all are the same. Some have higher copays, stricter prior authorization rules, or limited pharmacy networks. Always check the formulary. Even if a plan says it includes drugs, it might not cover the ones you take-or it might cost more than a standalone Part D plan. Compare using your exact medication list.
Is the Medicare Plan Finder tool reliable?
Yes, it’s the official government tool and the most accurate source for comparing plans. It pulls data directly from CMS and all Medicare-approved plans. Beneficiaries who use it are 3.2 times more likely to find a lower-cost plan than those who don’t. But make sure you enter your medications exactly as they appear on your prescription label. Typos or missing dosages can lead to wrong results. Double-check your entries before submitting.
What if I’m on Medicaid too?
If you’re dual-eligible (Medicare and Medicaid), you still need to review your plan during Open Enrollment. Some Medicare Advantage plans offer extra benefits like dental or transportation, but eligibility rules can be confusing. Medicaid may cover some drugs your Medicare plan doesn’t, but you can’t rely on that. Use the Plan Finder and select “dual eligible” in the filters. SHIP counselors can help you navigate this-call them. You might qualify for a Special Needs Plan (SNP) designed for dual-eligible beneficiaries, which often has lower costs and better drug coverage.
