Can You Change Your Part D Plan Anytime?

Medicare Part D provides prescription drug coverage for those enrolled in Medicare. It helps manage the costs of self-administered prescription drugs, which Original Medicare Parts A or B typically do not cover. While you can change your Medicare Part D plan, changes are generally restricted to specific periods, not anytime.

Standard Enrollment Periods

The primary opportunity for most Medicare beneficiaries to make changes to their Part D prescription drug plan occurs during the Annual Enrollment Period (AEP). This period begins on October 15 and concludes on December 7 each year. During the AEP, individuals can enroll in a Part D plan for the first time, switch plans, or disenroll entirely. Any selections or changes made become effective on January 1 of the following year.

Special Enrollment Periods

Special Enrollment Periods (SEPs) allow you to change your Part D plan outside the Annual Enrollment Period, triggered by certain life events. The duration of an SEP typically ranges from two to three months, depending on the qualifying event.

One common event triggering an SEP is moving to a new service area where your current plan is not available, or if new plan options become available. If you notify your plan before moving, the SEP can begin the month before your move and last for two full months after. If you notify your plan after moving, the SEP generally starts the month you inform them and continues for two more full months.

Another qualifying event is losing other creditable prescription drug coverage, such as from an employer or union. This SEP usually lasts for two full months after your creditable coverage ends or after you are notified it is no longer creditable, whichever is later. It is important to receive a notice from your former plan about the creditable status of your coverage to avoid potential late enrollment penalties.

Individuals who qualify for Medicare’s Extra Help program, also known as the Low-Income Subsidy (LIS), receive an ongoing SEP. This allows them to switch Part D plans once per calendar quarter during the first three quarters of the year, and again during the Annual Enrollment Period. Extra Help provides assistance with Part D costs, including premiums, deductibles, and co-payments.

Furthermore, if your current Part D plan leaves your service area or Medicare terminates its contract, you will also be granted an SEP.

Key Information for Comparing Part D Plans

When comparing Part D plans, consider several key factors to ensure the new plan aligns with your needs.

Formulary

A primary consideration is the plan’s formulary, a comprehensive list of prescription drugs covered by the plan. Verify that all your current medications are included and understand their assigned tiers, as different tiers dictate varying out-of-pocket costs. Some plans may organize drugs into several tiers, with lower tiers typically having minimal or zero co-pays.

Financial Aspects

Examine several cost components. These include the monthly premium, the regular fee paid to the insurance company. Deductibles represent the amount you must pay out-of-pocket for covered medications before the plan begins to contribute; for example, the maximum deductible a plan can charge in 2025 is $590. Co-payments are fixed dollar amounts paid for each prescription, while co-insurance is a percentage of the drug’s cost.

Coverage Phases

After meeting the deductible (if applicable), you enter the initial coverage phase where you pay co-pays or co-insurance. As of 2025, once your out-of-pocket spending on covered drugs reaches $2,000, you will pay nothing for covered medications for the remainder of the year, as the coverage gap (also known as the “donut hole”) has been eliminated.

Pharmacy Network

The plan’s pharmacy network is another element to consider. Confirm that your preferred pharmacies, whether local retail stores or mail-order services, are included within the plan’s network. Many plans offer preferred pharmacy options where you might incur lower co-payments or co-insurance compared to standard network pharmacies. Using an out-of-network pharmacy generally means you will pay the full cost of the medication, and these costs may not count towards your deductible or out-of-pocket maximum.

Medicare Star Ratings

Medicare Star Ratings offer a general indicator of a plan’s quality and performance. These ratings, ranging from one to five stars, are assigned by the Centers for Medicare & Medicaid Services (CMS) based on various factors, including customer service, member complaints, and drug safety.

Steps to Change Your Part D Plan