Let’s face it – life gets busy sometimes. Insurance, rightly so, is not always top of mind priority. For those on Medicare, it’s easy to miss the mailing from your Part D provider that comes in late September each year about the plan benefits for the following calendar year. Even if you do not miss it, you may put it aside, planning to re-evaluate in a month or two, then time passes by and the enrollment ends without you taking any action.
Well, the reality is, there is an annual election period for Part D. It runs October 15-December 7, and if you don’t make a change to your plan during that time period, you are likely stuck. That’s right, stuck. Like, for the whole year, stuck (When is the Medicare Open Enrollment Period?).
This has become particularly problematic in recent years, as recent significant changes to the Part D program overall have driven significant changes to the layout of individual Part D plans and premiums. For example, there are several plans that had a $10/mo national average premium in 2024 that, for 2025, have seen the national average jump to $40+/mo. This is obviously disconcerting when you do not realize that large of a price hike is happening, then it hits you out of nowhere in January.
If this does happen to you, your options are very limited, unfortunately. The bottom section of this article contains more information about a few options that may help you if you find yourself in this situation. But the biggest piece of advice for someone who finds themself in this situation is to not let it happen again – make a point to check your Part D plan each year. It is super-easy to do and takes 5 minutes or less once you know how to do it. Of course, if you have a Medicare broker, they should do this for you at no cost and proactively. That’s part of the free service we do annually for our Medigap clients.
Does This Apply to Other Medicare Plans?
So, what about other types of plans, like Medigap or Medicare dental/vision plans. Contrary to popular misconception, those plans do not have an annual enrollment period. The “open enrollment” for Medigap is when you turn 65, not annually (Medigap Open Enrollment). You can change Medigap plans any time of the year for any reason. In most states, you do have to go through medical underwriting to change plans however.
So, if your Medigap plan happened to go up as of January 1st, you can still re-evaluate that and potentially change it (Medigap chart). And, if there are lower premium options, it would likely be wise to do so.
The best time of year to change a Medigap plan is actually any time BUT the Medicare annual election period, as turnaround times are usually 2-3x as long and, anecdotally speaking, underwriting can be more stringent or unpredictable. So, bottom line, if your rate goes up and you want to explore changing your Medigap plan, it’s easy to do (Get Medigap quotes online here).
How To Check Your Part D Plan Annually
As mentioned above, checking on your Part D plan each year is an essential habit to get into. The plans should not even be viewed as continuous plans from year to year; instead, we advise our clients to view each year like a completely new plan. Plans often have new co-pay structures, new formularies, new pharmacy networks and almost always have new premiums (step-by-step guide to comparing Part D plans).
With that in mind, checking your Part D plan annually is crucial. If you have a broker, he/she should be doing that for you or at least offering to do it. That is a service we offer our clients annually, and any broker who is proficient at their job should be doing the same.
But if you don’t want to rely on your broker or just want the knowledge of how to do it on your own, it is now very easy to do. We’ve included step-by-step instructions below:
- Go to Medicare.gov.
- If you have a login on that site, login to your account. Once you login, you will see a message that says “welcome back *your name*”. Below that, you will see your current plan information explicitly spelled out, including premium and plan details. If you do not have a login already, it would be wise to create on, as it makes managing your Medicare much easier.
- If you do NOT have a login on the Medicare.gov site, you should create one. But if you do not want to create one, you can still get information about your current plan. On Medicare.gov, scroll down to click the “find plans now” button.
- Enter your zip code on the next screen and click “continue”.
- Select Medicare drug plan (Part D) and click “find plans”.
- Select “I don’t get help from any of these programs” and click “continue”.
- If you want to see costs for your specific medications, you can choose to do so by answering the question on the next screen.
- If you choose “no”, you will be presented with a list of the different Part D plans on the next screen. You can find your current plan to review the detailed information about premium, deductibles, and co-pays.
Options If You Forget to Change Part D Plans During the Annual Election Period
If you do not make a change to your Part D plan during the annual election period, you are, in general, stuck for the full calendar year with your current Part D plan. There are, however, a few possible exceptions that would enable you to make a change outside of the annual election period:
- One option would be to contact Medicare (1-800-MEDICARE) to request an exception. There is a special election period option for those that have been misled by their current insurance provider, but Medicare is the only one that can grant that special election period.
- Another option is to just contact your current Part D provider and see if you can cancel it or stop paying the premiums (although that would obviously leave you without drug coverage for the year and would also generate a late enrollment penalty from Medicare).
- Lastly, there are several other special election periods that are available if you fall into one of a few unique situations. A few examples of this are: loss of employer group health coverage, change in permanent residence, or enrollment in a 5-star Part D plan. Medicare can give guidance on whether one of these special election periods would apply to you.
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65Medicare.org is a leading, independent Medicare insurance agency for people turning 65 and going on Medicare. If you have any questions about this information, you can contact us online or call us at 877.506.3378.