Every fall the mail piles up and most families let it pass. The plan renews itself, and the bill changes anyway. Here is our video conversation written out – the dates, the one notice that actually matters, and what to check before you decide to stay put.
In this article
Open Enrollment Dates
The September Notice
Checking Medications and Costs
The Assisted Living Pharmacy
Temporary Medication Supplies
Special Enrollment Periods
What to Recheck When Switching Plans
What to Do This Week
A notice from your mother’s Medicare plan arrived in September. If nobody opens it, what could change when she picks up her prescriptions in January?
The same medicine could cost more, or have different coverage rules. Even if her plan worked well this year, it’s worth checking next year’s details.
Even if she keeps the same plan?
Yes. Coverage usually renews automatically if the plan continues and she remains eligible. But the benefits and costs can change. And if the plan is ending or moving members to another plan, that notice needs attention too.
Open Enrollment Dates
When can people make those changes?
October fifteenth through December seventh, 2026. Changes made during that period generally take effect January first, 2027.
Can I mail the application on December seventh?
If you’re applying by mail, the plan needs to receive it by the deadline. Don’t wait until the last day to send it. Apply early and keep your confirmation.
What can families change during this period?
A Medicare Advantage plan or a Part D drug plan, or the choice between Original Medicare and Medicare Advantage. This isn’t the initial enrollment period for Parts A and B. Advantage is a private-plan way to get A and B benefits, and most Advantage plans also include drug coverage.
The September Notice
Who sends the notice you mentioned?
Her Medicare Advantage or Part D plan. It’s called the Annual Notice of Change, or ANOC.
What does it tell us?
It explains changes to premiums, cost sharing, and benefits for January. It usually arrives in September. But you’ll still need to check the detailed drug list and provider information.
What if we can’t find it?
Call the plan and ask for another copy. Check her online account or electronic notices too.
Why check every year if the plan has been working?
Because the premium, drug costs, and coverage rules can change. Doctors and pharmacies can change their contracts too. The ones contracted with a plan are its network.
Checking Medications and Costs
Where should we start?
The monthly premium matters, but look at her medications, doctors, and pharmacy alongside it. A lower premium doesn’t necessarily mean lower costs overall.
How do we check her medicines?
Write down each drug and strength, then check the plan’s 2027 drug list, called its formulary. Make sure you have the right form of the medication too.
What if a medicine isn’t listed?
Check other plans, and ask her prescriber whether an exception request may be appropriate. Her clinician should decide whether a different medicine would work for her.
Doesn’t the annual drug-cost cap cover everything after a certain point?
For 2027, the annual out-of-pocket limit for covered Part D drugs is twenty-four hundred dollars. That’s up from twenty-one hundred in 2026. Premiums and non-covered drugs don’t count. A drug that’s off the list may become covered through an approved exception, so ask before assuming.
If the drug is on the list, are we all set?
Check the cost too. Plans place drugs in tiers, or cost categories. A tier or the way your share is calculated can change. Look up the estimated cost for each medication.
What else should we look for?
Rules like prior authorization. That’s when the plan needs information from her clinician before it agrees to cover the drug. There may also be quantity limits or a requirement to try another drug first.
What if she’s waiting for approval and running low?
Contact her pharmacy, prescriber, and plan right away. Ask about a temporary supply, an exception, or an expedited review if it’s urgent. Don’t assume a delay means there’s no way to get the medication, and don’t stop it without medical advice.
Should we check the pharmacy too?
Yes. Is it in the network next year? And is it a preferred pharmacy? Costs can differ even between pharmacies in the same network.
What about her doctors?
With Medicare Advantage, confirm participation with both the plan and the provider. With Original Medicare, check whether the provider accepts Medicare. Then compare the premium, expected drug costs, and medical costs together.
The Assisted Living Pharmacy
It sounds like the pharmacy needs extra attention in assisted living.
It does. A home may coordinate deliveries, packaging, and medication records through one pharmacy. Our home has a pharmacy we work with too. It may not be the pharmacy the family normally uses.
What if that pharmacy isn’t in the new plan’s network?
Prescriptions filled there may not be covered, or the cost may be different. Confirm with the plan and pharmacy, then work with the home on how she’ll get her medication.
Can we ask the plan to add the pharmacy?
You can ask. Part D has pharmacy-access requirements, but a family’s request doesn’t automatically put a particular pharmacy in the network. The pharmacy and plan need to work through the contracting terms.
Are nursing homes and assisted living treated differently here?
Yes. Part D has a specific definition of a long-term care facility. Ordinary assisted living shouldn’t be treated as if it were a nursing home. Don’t assume the home’s pharmacy is covered just because the home uses it.
Can the pharmacy join the network?
There is a rule requiring plans to accept pharmacies that meet their standard terms and conditions. But you still need to verify that a contract is in place. The family doesn’t make that contract.
Could the home work with a different pharmacy?
That depends on the home. Ask about delivery, packaging, and medication records. Check plans that include the current pharmacy too, but don’t make that your only consideration.
And if the current pharmacy won’t work?
Ask the home and pharmacist to help find an alternative. Even if family members can bring medication in, it has to fit the home’s storage and administration procedures.
Should we also check the clinician who visits the home?
Absolutely. Get the name of the visiting doctor or nurse practitioner. Check the Advantage network if that’s her coverage, or whether the clinician accepts Original Medicare.
Temporary Medication Supplies
January arrives, and a medicine she’s been taking isn’t covered under the new rules. What now?
She may qualify for a transition fill, a temporary supply while the issue is addressed. It can apply to new members and to current members affected by changes to their drug coverage.
How much medication does that provide?
The basic requirement is at least a plan-approved month’s supply. You’ll often hear thirty days, but the approved supply and prescription length can affect the details.
Where does the ninety-day number come from?
The first ninety days of coverage under a new plan are the window for getting that temporary supply. That doesn’t mean ninety days of medication. It’s also not accurate to say nursing homes get ninety days while assisted living gets thirty.
Once the temporary supply runs out, is that automatically the end?
No. Contact the plan and prescriber as soon as she gets it. Work on an exception or an appropriate treatment alternative. If the issue isn’t resolved in time, ask whether another temporary supply is available.
So getting a temporary fill doesn’t mean the problem is settled.
Right. Use that time to arrange ongoing access. Checking in the fall can help you address these questions earlier.
Is there a tool families can use to compare coverage?
Medicare’s Plan Finder, at Medicare dot gov slash plan dash compare. Use the 2027 information and enter the drugs, strengths, and exact pharmacy. If the facility’s pharmacy isn’t listed, confirm directly with the pharmacy and plan.
So start by asking the home for the pharmacy’s name.
Yes. That name and an up-to-date medication list make the conversation much more useful.
Special Enrollment Periods
Does moving into assisted living mean she can change plans whenever she wants?
Not by itself. Certain changes, like a move or living in a qualifying institution, may create a Special Enrollment Period. Each situation has its own rules.
What about a move into assisted living?
An ordinary assisted living move doesn’t automatically create the institutional enrollment opportunity. But moving outside her plan’s service area, or to an address with new plan options, may qualify her under the moving rules. Check with the plan before the move.
And if she’s in a nursing home or inpatient rehabilitation hospital?
For a qualifying institution, the opportunity lasts while she lives there and for two full months after the month she leaves. Outpatient rehab is different. Ask the facility to confirm what applies.
What if she has Medicaid or receives Extra Help?
There is a monthly opportunity, but it doesn’t let everyone switch to any plan. It mainly allows a standalone drug-plan election, including leaving an Advantage plan with drug coverage for Original Medicare and a standalone Part D plan. Some full-benefit dual enrollees have a separate opportunity for an integrated D-SNP. Get help checking eligibility before changing coverage.
What’s Extra Help?
A program that helps eligible people with Part D premiums and prescription costs. SHIP or Medicare can explain the eligibility and application process.
What to Recheck When Switching Plans
If we’re switching plans, what else should we check?
The Medicare Prescription Payment Plan. It’s an optional program that started in 2025. Instead of paying the pharmacy your share for covered Part D drugs, you pay the plan through monthly bills.
Can you give an example?
Suppose your share at the pharmacy would be six hundred dollars. If you’re participating, you pay zero at the counter and receive monthly bills from the plan. But it’s not simply six hundred divided into twelve equal payments. The bills depend on when you join and your drug costs.
Who might find that helpful?
Someone facing high prescription costs early in the year. It spreads payments out; it doesn’t lower the total. If she needs help reducing costs, check programs like Extra Help too.
How does she sign up?
Contact her drug coverage plan by phone or online. If she’s already participating and stays in the same plan, participation generally renews automatically. She doesn’t have to reapply every year just because the calendar changes.
What if she changes plans?
She needs to opt in with the new plan. Check even if the insurance company stays the same but the plan changes. Any balance owed to the previous plan still needs to be paid.
Can she change Medigap during fall enrollment too?
Medigap supplements Original Medicare, and it has separate rules. Fall enrollment doesn’t give everyone the right to buy it without medical underwriting. The basic federal Medigap enrollment window lasts six months, starting when she’s at least sixty-five and enrolled in Part B.
Is it impossible to get Medigap after that?
No. But health questions, different premiums, or a denial may be possible. Certain situations carry guaranteed-issue rights, and states may offer other protections. Check first, especially before leaving Advantage for Original Medicare.
Are there any options after January starts?
If she’s in Medicare Advantage, January first through March thirty-first, 2027, allows one switch to another Advantage plan, or a return to Original Medicare with the option to join a standalone drug plan. It isn’t an open window for everyone to make any change.
What to Do This Week
What should families gather this week?
The change notice, a current medication list, and the names of her pharmacy and clinicians. With her permission or appropriate authority, ask the home for an updated list. The medication administration record, or MAR, can also help.
Once we have those documents?
Use them in a counseling appointment to check next year’s coverage and likely costs. You don’t have to decide on the spot just because someone recommends a plan.
Have the rules for agent appointments changed this year?
Yes. Some changes for 2027 plan marketing begin October first, 2026. For example, the required forty-eight-hour wait after agreeing on the scope of a marketing appointment is being removed. That doesn’t mean you have to enroll right away. Take the time you need to understand the coverage.
Where can people get free help?
SHIP, the State Health Insurance Assistance Program. It’s federally supported and offers free, unbiased counseling. It doesn’t sell insurance.
How do we contact SHIP?
Visit SHIP help dot org or call eight seven seven, eight three nine, two six seven five. In Maryland, you can ask the Department of Aging to connect you with your local SHIP at one eight hundred, two four three, three four two five.
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