- A Medicare Advantage or Part D plan can change its premium, drug list, network and copays every January, even if you do nothing.
- The Annual Notice of Change your plan sends each fall lists those changes in advance.
- Medicare Open Enrollment runs October 15 to December 7. Check your medicines and doctors before it closes.
Harold put the envelope on the pile. It came in late September, it said “Annual Notice of Change” in plain black type, and it looked like every other piece of insurance mail he had ever received: long, gray and written for someone else.
He was 71, he liked his Medicare plan, and nothing in his life had changed. The same doctors, the same pharmacy on the corner, the same two prescriptions he had taken for years. Open Enrollment came and went that fall and Harold did nothing, because he saw nothing to do. He assumed that no news from the plan meant no changes in the plan.
In the second week of January, he stood at the pharmacy counter and heard a number he did not recognize. His blood pressure medication, which had cost him $9 a month, now rang up at $47. The pharmacist turned the screen so he could see: the plan had moved the drug to a higher tier. Two weeks after that, a letter from his cardiologist’s office explained that the practice no longer took his plan. The visit he had scheduled for February would be out of network.
Harold called the plan, a little embarrassed, and the representative was patient. Every one of those changes, she explained, had been printed in the notice he had received in September. The notice had not been a reminder or a brochure. It had been the plan telling him, in writing and in advance, what next year would look like.
He had kept the same plan. He had not kept the same coverage. And the window to do something about it had closed on December 7.
Harold is a composite character and the prices are invented for this article. What he ran into, a plan that changes while its name stays the same, is exactly what the yearly enrollment period exists to handle.
Keeping your plan is not the same as keeping your coverage. The plan can change its terms every January, whether or not you do anything.
The calendar, in one glance
The yearly Medicare enrollment window opens this month. If you have Medicare, here are the dates that matter, in order.
These dates are for Medicare. If you buy coverage through HealthCare.gov or a state marketplace, you are on a different calendar. Our guide to the three dates that decide when marketplace coverage begins explains that one.
What stays the same, and what can move
Medicare Advantage and Part D plans are run by private insurers, and they can adjust their terms every year. Original Medicare, run by the federal government, works differently. Here is the contrast that Harold missed.
The drug list deserves special attention. A medicine can stay on your plan’s formulary and still cost you more, because the plan moved it to a different tier or added a requirement such as prior approval. That is exactly what happened to Harold’s blood pressure pill, and it is the kind of change that does not show up in the plan’s name or its monthly premium.
What is different for drug coverage in 2027
Part D, the Medicare prescription drug benefit, now has a yearly cap on what you pay out of pocket for covered drugs. The cap is adjusted each year. Published figures for the 2027 plan year show it rising:
Three points keep this straight. Once your spending on covered drugs reaches the cap, you pay nothing more for those drugs for the rest of the year. Your monthly premium does not count toward the cap. And drugs that are not on your plan’s list do not count either, which is why checking the list matters before you enroll.
There is one more change that affects shoppers. A temporary federal program that had been helping hold down premiums for stand-alone drug plans ends after 2026, so the price of your current drug plan may move more than usual. If large pharmacy bills early in the year are a strain, ask your plan about the Medicare Prescription Payment Plan, which spreads your out-of-pocket drug costs across monthly bills instead of one payment at the counter. It does not lower the total, only the timing.
Where you fill prescriptions can matter as much as which plan you pick. We compare the options in when 90-day mail-order supplies save money and when they do not.
Where to look inside the notice
Most of the notice is boilerplate, and that is part of why it ends up on the pile. You can skip the legal language and go straight to three places. Near the front there is usually a summary of changes, which lists premiums, deductibles and copays side by side for this year and next. Further in, a section on the drug list tells you whether your medicines were removed, moved to another tier or given new restrictions. And somewhere in the pages about your network you will find a statement about providers and pharmacies that are leaving.
If a plan no longer covers a drug you take, do not assume you are stuck. Ask the plan about a transition fill, which can give you a short supply while you sort things out, and ask your prescriber whether a similar medicine on the list would work. You can also ask the plan for an exception, a formal request to cover a drug that is not on the list or to waive a restriction. Your doctor usually has to support the request.
Ten minutes with the summary page is often enough to tell whether the plan still fits. If nothing in it touches your medicines or your doctors, you can reasonably stay put. If something does, the review below is where you find out whether it is worth moving.
A five-part review that takes one evening
Original Medicare or Medicare Advantage: a caution about switching back
Many people on Original Medicare buy a Medigap policy to cover the gaps. If you leave a Medicare Advantage plan later and return to Original Medicare, be aware that in many states Medigap insurers can review your health history and may charge more or decline to sell you a policy, outside certain protected situations. Rules differ by state. Before you give up a Medicare Advantage plan, find out whether you could get the supplement you would want.
Timing of your enrollment in the first place also matters. If you delayed Part B or Part D, our explanation of why the Part B late enrollment penalty follows you for life and our guide to how working past 65 affects Part B decisions cover those rules.
If you miss December 7
Free help, and one warning
You do not need to pay anyone to compare plans. 1-800-MEDICARE (1-800-633-4227) answers questions about plans and enrollment. Your State Health Insurance Assistance Program, known as SHIP, offers free one-on-one counseling from trained volunteers and staff. And if your income and resources are limited, ask Social Security about Extra Help, a program that lowers Part D costs.
Three questions people ask
Do I have to do anything if I am happy with my plan?
Generally no, because most plans renew automatically. It is still worth reading the Annual Notice of Change, so that a change in cost, drugs or network does not arrive as a surprise in January.
Is a $0 premium plan the cheapest one?
Not necessarily. Your yearly cost depends on your medicines, your doctors and the plan’s cost sharing. Compare the estimated yearly cost, not only the monthly premium. We walk through the same trap for marketplace plans in “You Didn’t Change Your Health Plan. So What Changed?”
Is the drug cap the same as my plan’s out-of-pocket maximum?
No. The Part D cap applies to covered prescription drugs. A Medicare Advantage plan has a separate yearly limit for Part A and Part B services.
Harold did eventually fix his situation. He used the special rules available to him, switched his drug coverage, and found a plan that kept his cardiologist. It took three phone calls and one afternoon. He keeps the September envelope on top of the pile now, and he opens it the day it comes.
Sources to review: Medicare.gov, Plan Finder; Medicare.gov, Joining a plan and Open Enrollment; Social Security, Extra Help with Part D costs; SHIP National Technical Assistance Center; CMS announcements for the 2027 Medicare Advantage and Part D plan year; your plan’s Annual Notice of Change.
This article is educational information, not legal, medical or financial advice, and it is not affiliated with Medicare or any insurer. Names and prices are hypothetical. Costs, rules and deadlines can change and include exceptions, so confirm current details on Medicare.gov or by calling 1-800-MEDICARE.