Toni Says

by Toni King

Get ready… Medicare Open Enrollment begins October 15

 

Hello Toni:

I applied for a Medicare Part D plan in July and was denied. Medicare told me to apply during Open Enrollment. Help! The Part D plan I'd had since turning 65 canceled my policy for 2026, and I didn't enroll in another one during last year's Open Enrollment, so I've been without a stand-alone Part D plan all of 2026. Now I've been prescribed an expensive brand-name cancer prescription that I'm paying 100% out of pocket.

Please explain what I should do during Medicare's fall enrollment."

Corey from Columbus, Ohio.


Hello Corey:

In one of the most important Medicare rules, the Center for Medicare and Medicaid Services (CMS) advises America to watch for changes Part D plans for this year’s Medicare Open Enrollment (OEP).

It is equally important for those on Medicare to compare plans during Medicare’s Open
Enrollment Period (OEP) and change to a different stand-alone Part D or Medicare Advantage plan if their prescriptions are not covered. It is wise to verify every year that your prescription drugs are covered on your Medicare Prescription Drug plan. Medicare Advantage or stand-alone Prescriptions Drug plans can change their drug formulary (a list of generic and brand-name prescription medications covered by the plan) each year. If your prescription drugs are not covered for the next year, you may have to pay 100% of that prescription yourself.

Corey, because you did not enroll in a stand-alone Medicare Part D plan during last year’s
Medicare OEP, then this year’s Medicare OEP, which is from Oct. 15- Dec.7 (Pearl Harbor Day), will be when you can enroll for your Medicare Part D to begin Jan. 1, 2027. Unfortunately, Corey, you will receive a Part D penalty for not enrolling at the right time.

Below are the changes that a Medicare beneficiary can make during Medicare’s Open
Enrollment Period (OEP):

  • Enroll in a stand-alone Medicare Part D Prescription Drug Plan, if you are like Corey and have let your Part D plan lapse or if never enrolled in a stand-alone Part D plan when your Medicare began.

  • Enroll in a stand-alone Medicare Part D Prescription Drug Plan, which can automatically disenroll you from a Medicare Advantage plan (if you need to disenroll from a Medicare Part C Advantage plan and return to Original Medicare).

  • Change from one Medicare Part D Prescription Drug Plan to a new Medicare Part D Prescription Drug Plan. (Corey failed to enroll in a new Part D plan during last year’s 2025 Medicare OEP. Had he enrolled, he would have avoided a penalty.)

  • Enroll in a Medicare Advantage Part C Plan with prescription drug benefits.

  • Change from one Medicare Advantage Part C Plan (with or without a Prescription Drug plan) to a new Medicare Advantage Part C Plan.

  • Enroll in a stand-alone Medicare Part D Prescription Drug Plan to return to Original Medicare and purchase a Medicare Supplement.

  • Enroll in a Medicare Part D Prescription Drug Plan and return to Original Medicare only.

Medicare’s OEP is the time when one can enroll or change either a standalone Medicare Prescription Drug (Part D) plan or a Medicare Advantage (Part C) plan with or without a  prescription drug plan. Note that enrolling in a Medicare Supplement or changing Medicare Supplement plans is not included in Medicare’s OEP without underwriting;  you have to answer health questions.


Toni King is an author and columnist on Medicare, Social Security, and long-term care issues. She has spent nearly 30 years as a top sales leader in the field. If you have a Medicare question, email info@tonisays.com or call 832-519-8664.