Drug Plan Enrollment Information

There is a lot to know about what you can do to review your drug plan options and how agents like us are permitted to help:

• October 15 to December 7 (the Annual Enrollment Period, or AEP) is the only time of year you may change your drug plan, barring special circumstances, like moving to a new state, and a few others.

• The Annual Enrollment Period is for those already covered by Medicare looking to join or change plans.  If you are new to Medicare due to turning 65 or retirement, your birth month or retirement date determines your enrollment period.  Please call us to discuss your enrollment deadlines.

• No action is required if your drug plan is renewing and you want to keep it.  It will renew automatically.  ​Changes made during AEP take effect on January 1.

• If your drug plan is terminating, you get extra time to choose a new one.  If you enroll by December 31, your new plan will start Jan 1.  If you enroll in January or February, your new plan will start the first day of the next month.  One caution: if you enroll after the new year starts, you will not have drug coverage for one or two months.

• We are available to help with drug plan reviews, but in a different way than in past years.  Medicare made changes to the drug plan program that put more financial burden on the insurance carriers.  To cut costs, some carriers no longer work with agents on drug plan enrollments.

• Medicare rules do not allow agents to provide any information on drug plans they don't represent.  We want you to have all plan options  available to you, not just the few that still work with agents, so we do drug plan reviews a bit differently.

• We are permitted to discuss all of your drug plan options while you are logged in to your Medicare.gov account.  We are not providing plan information, just interpreting what you see in your own account.  Medicare has made big improvements to their drug plan finder tool, so it is much easier to use than in past years.  We ask that you log in to your account, look at your options there, and call us while you're logged in if you need assistance.

• Drug plan assistance is a service we provide to our Medicare supplement clients only (or those willing to become one).  If you don't have your supplement with us but would like a review of both plans, we're happy to help.  If you're only looking for drug plan assistance, please contact your Medicare supplement agent.

• If you make a drug plan change, you will not need to cancel your current plan.  Once Medicare processes your new enrollment, they will notify your current plan you’re leaving as of January 1.  You’ll get a cancel letter from the plan you’re leaving, and a welcome letter and ID card from your new plan.

• With some of the higher premium plans you’ll reach the out-of-pocket max ($2,100 in 2026) before you spend that much at the pharmacy.  Here’s how: once your drug plan’s deductible is met, all plans must count at least 25% of the retail value of your covered drugs toward your OOP max, even if your copay or percentage is less than 25%.

For example, say you take a brand name drug with a $400 retail cost, and your plan has a $50 copay for it.  You will get $100 (25% of $400) credited toward the $2,100 max, even though you only paid $50 for the drug.

Depending on the plan and the drugs prescribed, some may reach reach the $2,100 max with less than $1,000 spent on drugs.  This is why you may see a high premium plan have the lowest annual cost in your Medicare account.

Complicated?  Definitely.  This is why using your Medicare.gov account is so important.  It has all of these calculations built in when it ranks the plans by total cost.  All you need to do is make sure the drug list on your account is accurate and let them do the math and rank all plans from low to high total cost.

• Your Medicare supplement plan does not have an annual enrollment season.  We review those at your policy’s anniversary date, as that is when most get their annual premium increase.  If your policy anniversary is during AEP, and if it looks like there may be a lower premium available, we can review your plan with you.

• AEP is the only time of year that a Medigap policy holder can change to a Medicare Advantage plan (barring special circumstances).  MA plans work differently than Medigap plans do.  If you want to consider one, we’re happy to schedule an appointment to help you enroll, but first please check with any doctors you don’t want to lose to ask which MA plans they intend to take next year, if any, and how your treatment there might change if you made this change.