AEP is officially in the rear-view, and now it’s all about making sure your 2026 coverage starts smooth on Jan 1 and knowing your options if something isn’t right.
1) Look for your plan welcome kit & Evidence of Coverage (EOC)
Your plan mails an EOC each fall that spells out what’s covered, copays, rules (like prior auth), and extras (dental/vision/OTC). Keep it handy for January appointments and refills.
Broker tip: If anything looks different from what you expected, send your broker a photo of the page, we’ll translate the fine print.
2) Refill meds early in January (and know your rights)
Most Part D plans must give you a one-time transition fill (typically a 30-day supply) during your first 90 days in the new plan if a medication you’ve been taking isn’t on the formulary or needs prior auth/step therapy. Use that time to work with your doctor and the plan on an exception or alternative.
Also new-year basics to expect:
- Some plans have a 2026 Part D deductible up to $615 (many set lower). You’ll pay full price until you meet it.
- There’s a hard cap on Part D out-of-pocket costs: once you hit $2,100 in 2026, you owe $0 for covered Part D drugs the rest of the year.
- If big early-year refills strain your budget, you can opt into Medicare’s Prescription Payment Plan to spread eligible drug costs into monthly bills.
3) Double-check doctors, pharmacies, and extras
Before your first 2026 visit or refill, confirm your primary care, specialists, and pharmacy are in-network on your new plan, networks and preferred pharmacies change year-to-year. Your plan portal and EOC list them.
4) If your new plan isn’t a fit, you still have options
- Medicare Advantage Open Enrollment Period (MA-OEP): If you’re already in a Medicare Advantage plan, you can switch to a different MA plan or go back to Original Medicare once between Jan 1–Mar 31. Changes take effect the first of the month after the plan gets your request.
- 5-Star SEP: If a 5-Star plan is offered where you live, you can use a one-time Special Enrollment Period Dec 8–Nov 30 to move to it.
- Life-event SEPs: Moving, losing other coverage, or certain plan issues can open a Special Enrollment Period at any time, ask your broker if one applies to you.
5) Quick January to-dos
- Carry your new ID card to appointments and the pharmacy once it arrives (your plan can give temporary details if you need a refill before the card shows).
- Update your medication list (name/dose/frequency) and share it with your doctors and your broker.
- Schedule preventive care, your plan’s EOC lists covered screenings and wellness visits.
Want a second pair of eyes on your 2026 setup?
Email your broker your plan name and medication list. We’ll confirm your doctors and pharmacies, check drug tiers and deductibles, and walk you through options like the Payment Plan or SEPs so your January 1 start is seamless.