UNITED STATES—Dear Toni: Last week the Toni Says Medicare column was about changes to stand-alone Medicare Part D plans beginning Jan. 1. This caught my attention because I applied for a Medicare Part D plan in July and was denied. Medicare advised me to apply for a Part D plan during Medicare’s Open Enrollment. Help! I don’t know what to do!
The Part D plan that I had been with since turning 65 decided to cancel the policy for 2026. I did not enroll in another plan during 2025’s Medicare Open Enrollment, so I have been without a stand-alone Part D plan all of 2026.
I need your help because I have been prescribed an expensive brand-name cancer prescription that I am having to pay 100% out of pocket. Please explain what I should do during Medicare’s fall enrollment time. Thanks, Toni -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) which will be mailed out in September, and to research on www.medicare.gov after Oct. 1 which stand-alone Medicare Part D plan best meets their prescription drug needs for 2027.
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.
Remember, with Medicare, what you don’t know WILL hurt you!
Toni’s “Medicare First Steps”, available at www.tonisays.com details, various situations during Medicare’s Open Enrollment Period, such as “still working past 65” or “doctor not accepting my Medicare Advantage plan.” Email your Medicare questions to info@tonisays.com or call 832-519-8664.
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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.
