What you need to know during Medicare open enrollment

Medicare plans change benefits and costs each year, and new plans may become available. During open enrollment, you can decide if your current plan works best for the coming year, or if you want to change plans.

How open enrollment works

Medicare Annual Open Enrollment is from October 15 to December 7 each year, for coverage that will begin on January 1 the following year.

Enroll sooner rather than later to avoid delays in getting the care you need.

You can visit the Medicare.gov plan finder website to explore your coverage options. Once you’ve selected a plan, you can enroll in any of these ways:

• Contact the plan you want to enroll in directly
• Call 1-800-MEDICARE (TTY: 1-877-486-2048)
• Visit Medicare.gov: review your plan options and/or log in to make changes

There is no fee for changing to a new plan. After enrolling in the new plan for 2027, you will be automatically unenrolled from your 2026 plan at the end of the calendar year. You do not need to notify your 2026 plan of the change.

If you have questions about your coverage, visit Medicare.gov or call 1-800-MEDICARE; (1-800-633-4227/TTY: 1-877-486-2048).

Changes you can make during open enrollment

Between October 15 and December 7, you can:

• Switch from Medicare Advantage to Original Medicare or vice versa
• Switch from one Medicare Advantage plan to another
• Switch from one Prescription Drug Plan (PDP) to another
• Join a Prescription Drug Plan (late enrollment penalty might apply)
• Drop your Part D coverage altogether (Note: re-enrolling in a later year will include a late enrollment penalty if you’re not maintaining other creditable drug coverage)

What’s changing for Part D in 2027?

Part D Out-of-Pocket Limit

Even with Medicare Part D coverage, you may still have to pay out of pocket for your medications. In 2027, the annual out-of-pocket limit for covered Part D prescription drugs is $2,400, compared to $2100 in 2026. Once you reach this limit, you will not pay additional out-of-pocket costs for covered Part D medications for the rest of the year.

Remember:

• The limit applies only to medications covered by your Part D plan
• Your monthly Part D premium does not count toward the limit
• What you pay for medications that your plan does not cover does not count toward the limit
• The limit does not apply to medications covered under Part B

Learn more about the Medicare Part D Cap: Understanding the Medicare Part D Cap.

Part D deductible

As a reminder, your deductible is the amount you may need to pay for covered care before your plan begins paying for certain services. The Medicare Part D maximum deductible is $700 in 2027, compared to $615 in 2026. However, a plan may charge a lower deductible or no deductible. Check each plan’s deductible and whether it applies to all of your medication

Medicare Prescription Payment Plan

The Medicare Prescription Payment Plan is a voluntary payment option for people with Part D coverage. It allows you to spread your out-of-pocket prescription costs across monthly payments during the plan year.

The program:

• Is available to people with Medicare Part D coverage
• Spreads prescription costs throughout the year
• Does not reduce the total amount you owe
• Can be joined by contacting your Part D or Medicare Advantage plan with drug coverage
• Is a good fit for people with high prescription costs that cause them to hit the $2400 out-of-pocket cap early in the year

Learn more about the Medicare Prescription Payment Plan: Understanding the Medicare Prescription Payment Plan.

Other Part D protections

Other protections that may affect what you pay include:

• A $35 monthly cap for each covered insulin product
• $0 cost sharing for recommended adult vaccines covered by Part D
• Extra Help for eligible people with limited income and resources

Learn more about the Extra Help Program: Extra Help Program for People on Medicare.

Should I change my Part D plan?

Start by thinking about your healthcare needs.

Did you start a new medication or treatment? Think about any changes to your health and consider them in your decisions.

It’s a good idea to review the 2026 coverage changes in your current plan

You should get a letter from your current plan called an “Annual Notice of Change/Evidence of Coverage” by the start of the open enrollment period. If you did not receive this letter, call your plan right away.

The letter explains some of the important changes to your plan, including changes to the name of the plan, to the premium, drugs covered by the plan (called a “formulary”), the cost of the drugs, and any restrictions that limit access to drugs.

It is very important to read this letter as these changes can impact the cost of your drugs.

The letter is important, but it might not include all the details you need to figure out how changes in your plan will affect the medications you use. Below, we give you advice about comparing plans and asking important questions to make sure you choose the best plan for your needs in the coming year. 

A list of covered drugs (the plan’s formulary) may be included in the Annual Notice of Changes/Evidence of Coverage letter. If you didn’t receive a copy of the formulary, call the plan directly. They can send you a copy, or you can ask them to tell you if your prescription drugs are covered and if there are any changes. The phone number for the plan’s customer service department is listed in the letter you received. 

Learn more to make an informed decision:

Get detailed information about your plan’s formulary and how your medications will be impacted by:

• Visiting the plan’s website
• Calling your plan directly
• Using the Medicare.gov health and drug plan finder
• or by calling 1-800-MEDICARE (TTY: 1-877-486-2048)

Comparing Part D plans

How does your current plan compare to other plans?

It’s important to compare your plan with other plans in your area. Your health and prescription needs may change over time, and Medicare Part D drug coverage plans change each year. Other plans may provide you with better or less costly coverage for the drugs you need.

Often the single most important factor in choosing a plan is comparing the drugs you take to the plan’s formulary to see if a plan covers the drug you need.

The best way to compare your current plan with other plans is to use the Medicare Plan Finder at Medicare.gov. This tool will allow you to complete either a personalized or general search for drug coverage and estimate costs for plans in your area in 2027. Estimates are based on drug prices on the date you compare plans, but your actual out-of-pocket costs may vary.

The Medicare plan finder can also help you estimate your total monthly costs over a 12-month period for each of the plans that you are considering.

Use the open enrollment period to reflect on your personal health and your financial budget. Then, compare plans and find the plan that best meets your health and prescription drug needs at a cost you can afford. 

Look closely at covered drugs  

Drugs that are covered by your Part D drug plan are called the plan’s “formulary.” If a drug is not on a plan’s formulary, which means it is not covered, you will have to pay full price.

The money you pay for drugs that aren’t covered won’t count toward the total amount that you must spend to qualify for catastrophic coverage. That is why it is important to make sure that your drugs, especially the most expensive ones, are on the formulary of the plan you select. You, your authorized representative, or your doctor can ask for a “coverage determination” (also called an exception) to get your plan to cover a drug when it is not on the plan’s formulary. 

Questions to ask when comparing Part D plans

Consider the following when you compare plans:

What prescription medications are needed for your current health condition(s)?

• Are these medications covered by the plan? (this is referred to as the plan’s formulary) 
• What will your medication cost? Health plans group covered medications into tiers on their formulary. Your tier affects what you pay: lower-tier drugs usually cost less, while higher-tier and specialty medications may cost more and have additional coverage rules or restrictions.
• Does the plan list different coverage for forms of the drug (ex., injectable vs. pill)?
• Are your primary care physician and specialists you may need in the plan’s network?

Does the plan have certain policies in place that may restrict access to the medications you need?

For example:

• Does the plan require your healthcare provider to justify why you need a certain drug before the plan will pay for it (called prior authorization)?
• Does the plan require your healthcare provider to prescribe a different drug in the same class of drugs first (called step therapy)?
• Does the plan only let you buy a certain amount of a drug at a time (called quantity limits)?

Does the plan cover other procedures or surgeries you may need in the future?

What other services does the plan cover?

Consider the following when you evaluate your budget (note that premiums/deductibles/cost-sharing requirements often change with plans from one year to the next): 

• What is the monthly/annual premium for the plan?
• What is the annual deductible?
• What will be your share of the costs for medications and services? (copays or coinsurance)

Can I change Medicare coverage outside of open enrollment (October 15- December 7)?

You may have another opportunity to make a change if:

• You move out of your plan’s service area
• You lose employer prescription drug coverage
• You enter, live in, or leave certain facilities
• You qualify for Extra Help
• Another qualifying situation applies (learn more about which situations apply here)

The rules and the time you have to make a change depend on your situation. Learn about Medicare Special Enrollment Periods or contact Medicare to ask which rules apply to you.

Get local help choosing a plan

Every state has a State Health Insurance Assistance Program (SHIP) that offers free one-on-one counseling and assistance to people with Medicare and their families. SHIP offices are located throughout each state. To find contact information for the SHIP office closest to your community, visit ShipHelp.org.

Medicare Advantage open enrollment

People with Medicare Advantage plans can also switch plans during the Medicare Advantage open enrollment period from January 1 to March 31, 2027.

During this period, you can:

• Switch from your Medicare Advantage plan (with or without drug coverage) to Original Medicare, or 
• Switch from your Medicare Advantage plan (with or without drug coverage) to another Medicare Advantage plan (with or without drug coverage)

Note: If you join a plan that does not offer coverage for prescription drugs, you must join a separate stand-alone Part D plan if you want prescription drug coverage.

Should I keep my Medicare Advantage plan or change it?

After reviewing your plan and your healthcare needs, decide whether your current coverage still works for you.

Consider staying with your current plan if:

• Your medications remain covered
• Your doctors and pharmacies still work with the plan
• Your costs remain manageable
• The plan continues to meet your healthcare needs

Consider comparing other plans if:

• A medication is no longer covered
• Your prescription costs increased
• Your premium or deductible increased
• Your doctors, hospital or pharmacy are no longer in network
• Coverage requirements have changed
• Your health or medication needs have changed

Exceptions to open enrollment 

In general, you can only switch to another standalone Medicare Part D plan from October 15 to December 7 each year. However, if you are enrolled in a Medicare Advantage plan, you may use the open enrollment period from January 1 to March 31 to switch to another Medicare Advantage plan with drug coverage, or switch to Original Medicare and enroll in a prescription drug plan.

There are a few special exceptions that allow you to change to a new plan in 2027, such as if you move out of the service area, lose your employer drug coverage, enter or leave a nursing facility, or if you qualify for Extra Help. That is why it is so important to review your options before enrolling.

There is also a special enrollment period for plans that receive the highest possible quality rating from the Centers for Medicare & Medicaid Services (CMS), called “5-star” plans.

Read more: Medicare.gov special enrollment periods

Special enrollment period for “5-star” plans 

CMS rates plans for quality using a star system. The best possible score is five stars. The Medicare.gov plan finder includes the “Overall Plan Rating” in the listing for each plan. You can sort the plans in your area based on “Overall Plan Rating” to easily find those with a 5-star rating.

If a 5-star plan is available in your area, you can switch to it one time between December 8, 2026, and November 30, 2027. Your new coverage usually begins the first day of the month after the plan receives your request.

Use the Medicare Plan Compare tool to find plans in your area and review each plan’s “Overall Plan Rating.”

Five-star plans are not available everywhere. A 5-star rating also does not mean the plan will meet all your needs. Before you switch, make sure the plan:

• Covers your medications
• Includes your doctors, hospitals and pharmacies
• Has costs you can afford
• Provides the benefits and services you need

Read more: Medicare.gov special enrollment periods, scroll to “Other special situations,” then select “I want to join a plan with a 5-star rating.”

Enrolling in Medicare Part D late  

You can enroll in or switch Medicare Part D plans each year during the annual Open enrollment period.

If you do not sign up when you are first eligible and do not have other prescription drug coverage that is at least as good as Medicare’s, you may have to pay a late enrollment penalty. The longer you go without this coverage, the higher the penalty may be. In most cases, the penalty is added to your monthly Part D premium for as long as you have Medicare drug coverage.

If you qualify for Extra Help, you can enroll in Part D at any time and will not have to pay a late enrollment penalty.

Keep notices that show whether your current prescription coverage is creditable. Learn more about the Part D late-enrollment penalty or call Medicare at 1-800-MEDICARE (1-800-633-4227) if you have questions.

What to expect after you enroll in prescription coverage

You should have received a welcome letter and a prescription card from your healthcare plan after you enrolled. If you have not received that letter, contact the plan right away to confirm that you are enrolled. 

If you have not gotten a prescription card, contact your plan immediately. If you need to get your prescription filled before your card arrives, bring the letter you received from the plan that confirms you have enrolled with you to the pharmacy.  

If you don’t have a letter, ask your pharmacist to call 1-800-MEDICARE (TTY: 1-877-486-2048). The customer service representative should be able to tell the pharmacist which plan you are enrolled in.

If you continue to have problems, you should contact your local SHIP office. You can locate your local SHIP office by visiting ShipHelp.org or by calling 1-800-MEDICARE (TTY: 1-877-486-2048). 

What if you are prescribed a drug that is not covered by your plan?

Contact your plan and ask whether a covered alternative is available. You or your prescriber may also ask the plan to cover the medication through a coverage determination or formulary exception.

The plan must decide within 72 hours (or 24 hours for an expedited review) if they will cover the drug. If they decide not to cover the drug, they must send you a written notice.

If the plan denies the request, read the written notice and follow the instructions and deadlines for an appeal. Your doctor or other prescriber may be able to provide information to the plan explaining why you need the medication.

Note: If your drug is not on the formulary, but you are able to get it covered by the plan under the plan’s exceptions process, the money you spend on the drug is counted toward qualifying for catastrophic coverage. 

Need help with a Medicare denial or appeal? Visit PAF’s Learn About Medicare for Medicare rights and appeals education.

Get help

I need help paying for care

Charitable patient assistance programs, like Patient Advocate Foundation’s TotalAssist, provide grants to eligible people with serious or chronic conditions.

Depending on the fund, help may be available for:

• Medication copays
• Coinsurance
• Deductibles
• Health insurance premiums and
• Certain treatment-related costs

Check the fund for your condition to learn what it covers and whether you may qualify.

I need a different kind of help

Health insurance can be confusing. You do not have to figure it out alone.

Find other help and support

A note about this information

This page provides general education to help you review and compare Medicare plans. It does not recommend a specific plan. Plan choices, costs, coverage, networks, financial help and eligibility can vary. Review the official plan and documents or contact Medicare or a Medicare Advantage plan if you have questions.