Why Annual Open Enrollment Matters for Your Medications
Every year, Medicare plans change. Not just premiums or doctor networks - but the exact medications they cover, how much you pay for them, and which pharmacies you can use. If you’re taking even one prescription, skipping this year’s open enrollment could cost you hundreds - or even thousands - of dollars in 2026.
Medicare’s Annual Open Enrollment Period (AEP) runs from October 15 to December 7. That’s your only chance to switch plans for the next calendar year. Changes take effect on January 1. If you don’t act by December 7, you’re locked into your current plan - even if your insulin just jumped from $35 to $150 a month.
The numbers don’t lie. According to CMS, 60% of Part D plans change at least one medication’s coverage status each year. That means your Tier 2 drug could become Tier 4. Your preferred pharmacy might disappear. Your deductible could double. And if you don’t check, you won’t know until you’re at the counter trying to fill your prescription.
Step 1: List Every Medication You Take
Start with your medicine cabinet. Write down every pill, injection, inhaler, or patch you use - even over-the-counter ones if your doctor says they’re part of your treatment. Include the exact name, dosage, and how often you take it.
Don’t guess. Look at the bottle. If you’re on Ozempic, write “semaglutide 1 mg,” not “weight loss shot.” If you take metformin 500 mg twice daily, write that down. Formularies list drugs by generic names. If your plan says it covers “metformin” but you’re on the extended-release version, it might not cover yours.
Pro tip: Use your pharmacy’s app or print a recent receipt. Most have a full list of your current prescriptions. This step takes 15 minutes. Skipping it is the #1 reason people overpay.
Step 2: Get Your Annual Notice of Change (ANOC)
By September 30, your current plan should mail you the ANOC. If you haven’t received it by October 10, call them. Don’t wait. This document tells you exactly what’s changing for 2026.
The ANOC highlights three things you care about:
- Which drugs were added or removed from the formulary
- Which drugs moved to a higher cost tier (meaning higher copays)
- Changes to your pharmacy network - including which ones are now “preferred” or removed entirely
For example, a beneficiary in Texas found out her glimepiride moved from Tier 2 ($15 copay) to Tier 4 ($98 copay). She switched plans and saved $1,000 a year. If she’d ignored the ANOC, she’d have paid $816 more just for that one drug.
Keep the ANOC next to your medication list. You’ll need to compare it to other plans later.
Step 3: Use the Medicare Plan Finder Tool
Go to Medicare.gov/plan-compare. It’s free. It’s official. And it’s the only tool that shows you real cost comparisons based on your exact drugs.
Here’s how to use it right:
- Enter your ZIP code
- Input all your medications - exactly as you wrote them down
- Select “Show only plans with drug coverage” if you’re not in a Medicare Advantage plan
- Click “Compare Plans”
The tool shows you the total estimated cost for each plan: monthly premium + what you’ll pay for each drug + deductible + out-of-pocket max. It doesn’t just show the cheapest premium - it shows the cheapest total cost for your meds.
One Dallas man saved $1,200 in 2025 just by switching from a $42/month plan that covered his Eliquis at Tier 4 to a $28/month plan that covered it at Tier 2. He didn’t know the difference until he used the tool.
Pro tip: Use the “Total Cost” calculator if it’s available. It estimates your annual spending based on your drug list. That’s the number that matters.
Step 4: Check Your Pharmacy Network
It’s not enough that your drug is covered. You need to be able to get it where you go.
Many plans have preferred pharmacies - CVS, Walgreens, Walmart - where you pay less. If your local pharmacy isn’t preferred, you could pay $70 for a 30-day supply instead of $35.
On the Plan Finder tool, click “View Pharmacy Network” for each plan. Search for your pharmacy by name or ZIP code. If it’s not listed, or marked “non-preferred,” skip that plan - unless you’re willing to pay more.
Also check if your pharmacy offers mail-order. Some plans give you a 90-day supply at a lower cost if you use mail-order. If you take 3+ meds, that can save you $200+ a year.
Step 5: Look Beyond the Drug List
Medicare Advantage plans (Part C) bundle your hospital, doctor, and drug coverage. They also offer extras: dental, vision, fitness memberships, even transportation to appointments.
But here’s the catch: those extras often come with strings. Some plans only cover dental if you’ve had a clean exam in the last year. Others give you a $500 vision benefit - but only if you use a specific provider.
If you need help with transportation to get your meds, check if your plan offers non-emergency medical transport. If you’re on insulin, look for plans that cover free glucose monitors.
Don’t assume the plan with the lowest premium is best. A $10/month plan with no transportation benefit might cost you $400 in Uber rides to the pharmacy.
What’s New in 2026 for Medication Coverage
This year, two big changes affect your drug costs:
- Insulin is capped at $35/month - no matter which plan you’re on. This applies to all Medicare Part D plans and Medicare Advantage plans with drug coverage.
- The donut hole is gone. In 2025, the coverage gap was fully closed. That means once you hit your deductible, you pay no more than 25% for brand-name drugs - no more $200 bills in the gap.
But here’s what’s not fixed: specialty drugs. Insulin is protected. GLP-1s like Ozempic and Wegovy are not. Some plans still charge $800+ a month for these. The Plan Finder tool will show you which plans cover them at the lowest tier. Don’t skip this.
Also, starting January 1, 2026, all Medicare Advantage plans must cover Part B drugs given in outpatient settings - like infusions for arthritis or cancer. If you get these treatments, your plan might now cover them without extra cost-sharing.
Common Mistakes That Cost Thousands
Most people make these three errors:
- They only look at the monthly premium. A $0 premium plan might charge $150 per pill. Always check total cost.
- They assume last year’s plan is still good. 78% of Medicare Advantage plans changed their provider networks between 2023 and 2024. Your doctor might not be in-network anymore.
- They wait until December. The last week of enrollment is chaos. Call centers are overwhelmed. You might miss the deadline.
One woman in Florida waited until December 6 to switch. Her new plan didn’t cover her heart medication. She had to pay $420 out of pocket for one prescription - and couldn’t change it until next year.
What If You Miss the Deadline?
You can only switch Medicare Advantage plans once between January 1 and March 31 - and only if you’re already in one. You can’t switch Part D plans during that time unless you qualify for a Special Enrollment Period.
Qualifying events include:
- Moving out of your plan’s service area
- Loss of employer coverage
- Qualifying for Medicaid
- Living in a long-term care facility
If none of these apply to you, you’re stuck until next October. No exceptions. No mercy. So mark your calendar. Set a reminder. Tell a family member.
Free Help Is Available - Use It
You don’t have to do this alone. Every state has SHIP - State Health Insurance Assistance Programs. They offer free, one-on-one counseling from trained experts.
SHIP counselors have helped over 9,400 people in 2024. They’ll walk you through your ANOC, use the Plan Finder tool with you, and even help you fill out the enrollment form. No sales pitch. No pressure. Just facts.
Call 1-800-MEDICARE or visit shiptacenter.org to find your local counselor. Most offer phone or video appointments. Some even come to your home.
Final Checklist Before December 7
Before you submit your enrollment, check this:
- ✅ All my medications are covered - and at the lowest tier possible
- ✅ My pharmacy is preferred - or I’m okay with paying more
- ✅ My total estimated cost for the year is lower than my current plan
- ✅ I’ve confirmed my new plan starts January 1
- ✅ I’ve received a confirmation email or letter from Medicare
If you answered yes to all five, you’re done. You’ve saved money. You’ve protected your health. You’ve taken control.
Frequently Asked Questions
Can I switch Medicare Advantage plans during open enrollment?
Yes. During the Annual Open Enrollment Period (October 15 to December 7), you can switch from Original Medicare to a Medicare Advantage plan, switch between Medicare Advantage plans, or go back to Original Medicare. All changes take effect January 1. You can only make one switch during this time, so make sure it’s the right one.
What if my medication is not on the formulary?
If your drug isn’t covered, you have two options: switch to a plan that covers it, or request a formulary exception. To request an exception, your doctor must submit a letter saying the drug is medically necessary and that alternatives either don’t work or cause side effects. The plan must respond within 72 hours. If denied, you can appeal. Don’t assume your drug is off-limits - many plans cover it with prior authorization.
Is there a penalty for dropping Part D coverage?
Yes. If you drop your Part D plan and don’t have other creditable drug coverage (like from an employer), you’ll pay a late enrollment penalty when you rejoin. The penalty is 1% of the national base premium for each month you went without coverage. For 2025, that’s $34.70 x 1% = $0.35 per month, per month without coverage. Over a year, that adds up to $4.20 extra per month - forever.
How do I know if my plan’s pharmacy network is changing?
Your Annual Notice of Change (ANOC) will list any pharmacy network changes. You can also check the Medicare Plan Finder tool by searching for your pharmacy. If it’s no longer listed as “preferred” or is missing entirely, your plan’s network has changed. Call your plan directly to confirm - don’t rely on third-party websites.
Can I enroll in a new plan after December 7?
Only if you qualify for a Special Enrollment Period. These are rare and based on life events like moving out of state, losing employer coverage, or becoming eligible for Medicaid. If you don’t qualify, you must wait until next year’s Open Enrollment Period. Missing the deadline means paying your current plan’s rates for the entire year.