Each year, you will be able to choose a new drug plan during the annual open enrollment period. The open enrollment period takes place every year between November 15 and December 31, with enrollment going into effect on January 1st of the following year. Once enrollment starts on January 1st – and you either start with a new plan if you decide to switch, or you decide to keep your current plan – you will not be able to switch plans until the next open enrollment period.

Even if you are satisfied with your current drug plan, there are many reasons you might switch plans during an open enrollment period.

Your drug needs may change or your plan’s coverage may change

In the course of a year, your prescription drug needs may change. For example, your cancer treatment may end or your doctor may change your treatment. During the year, your doctor may also prescribe other drugs for other health problems that are not related to your cancer treatment – such as medicine to treat high blood pressure. You may find that your drug plan isn't the best option for your new drug needs, maybe because your new drugs aren't listed on your plan's formulary. Your drug plan may also change its coverage rules or formulary in a way that affects coverage for your drugs or your out-of-pocket costs.

If your drug needs have changed, and you find that your current plan does not cover your new medicines, you may decide to switch drug plans. Or if you learn that another plan in your area offers lower prices for your new drugs (while also covering the medicines you currently take), you may want to switch plans. If you decide to switch, you will need to review your options and decide on a new plan during the open enrollment period – November 15 to December 31.

Open enrollment period requirements don't apply to some with low incomes

Note that if you are eligible for Medicaid, then you can switch plans on a monthly rather than a yearly basis. And if you are eligible for the special low-income assistance through the Medicare Part D program, then you can switch up to twice a year – once during the open enrollment period and once in between enrollment periods.

Your income may change

If your income has gone down in the course of the year, you may be eligible for special low-income assistance provided through the Medicare Part D program. This assistance gives you extra help for paying the monthly premium as well as lower co-pays for your drugs. Medicare beneficiaries who are eligible for this assistance must choose a plan with a premium that is lower than the average premium. If you qualify for special assistance but your current plan has a premium that is higher than the average, then you must either switch plans or pay the additional premium.

Your plan may leave the Medicare program

The Medicare drug benefit uses private plans to deliver benefits instead of a single government-based plan like the current Medicare Part A and B fee-for-service program. These private plans can decide to join or leave the Medicare program at any time. They also may change their benefits or drug formularies. New managed care options in the Medicare Advantage program may also join or leave the program. For these reasons, the drug plan options in your area may change from year to year. If a plan withdraws from Part D, enrollees would be notified at least 60 days before the plan's withdrawal. This notice would include a written description of other options (other PDPs, MA-PDPs, and original Medicare) within your service area. Enrollees would then have to choose another plan under special enrollment and would not have to wait until the next open enrollment period to switch plans.

Other factors that might make you want to change drug plans

Other factors may also affect your decision to stick with your current drug plan or switch to a new one. For example, the tools used to help Medicare beneficiaries decide on a drug plan and other information to help beneficiaries may get better over time. If that is the case, you might find out later that a different plan would actually meet your needs better than your current plan. If you are happy with your current plan, there might not be a need to change or even look at a different plan. But the new drug benefit is set up so that it that encourages Medicare beneficiaries to shop around and find the best value – just as you would for groceries or a new car. So, it might not hurt to compare plans each year when you have the chance to change, even if you are happy with your current plan.

Last Medical Review: 10/23/2008
Last Revised: 10/23/2008