Prescription medications are one of the most consistent healthcare expenses many seniors face. Every refill is a reminder that Medicare doesn’t cover everything — and understanding your prescription drug plan is key to managing those ongoing costs.
If you’re enrolled in a Medicare Part D plan or a Medicare Advantage plan with prescription drug coverage (Part C), it’s important to review your benefits every year. Each plan decides which drugs it covers and how much you’ll pay — and those details can change annually.
Before the new year begins, take a few minutes to review your plan. Here are four key questions to ask to make sure your Medicare prescription drug coverage still fits your needs.
Where to Find Medicare Part D Plan Updates
Each fall, your Medicare drug plan will send you two important documents:
Evidence of Coverage (EOC): Explains your plan’s benefits, costs, and coverage rules.
Annual Notice of Change (ANOC): Details any changes to your plan’s benefits, costs, or service area that take effect on January 1.
You may also receive a drug list (formulary) that outlines which medications are covered. These materials are your best source for understanding your coverage for the upcoming year.
Once you’ve reviewed these documents, keep the following questions in mind.
1. Does Your Medicare Plan Still Cover Your Prescriptions?
Drug coverage can change from year to year. That’s why it’s crucial to confirm that your medications will still be covered next year.
Here’s what to do:
Check your plan’s formulary (drug list) for each prescription you take.
Look in your Evidence of Coverage for commonly covered drugs.
Visit your plan’s website or contact customer service to view the full, updated list.
Tip: If your medication is no longer covered, talk to your doctor. They may request an exception for coverage or prescribe an alternative drug that’s included in your plan. If neither option works, it might be time to compare other Medicare Part D plans during Medicare Annual Enrollment (October 15 – December 7).
2. Will Your Prescription Drug Costs Change?
Even if your medications remain covered, your out-of-pocket costs may not stay the same. Medicare drug plans can adjust their premiums, deductibles, copays, or coinsurance rates each year.
Here’s what to check:
Copay and coinsurance amounts: These can go up or down.
Deductible and premium changes: Check your ANOC for updated amounts.
Drug tier placement: Plans often group drugs into tiers — lower tiers usually cost less. If your medication moves to a higher tier, you may pay more.
Savings Tip: Ask your doctor or pharmacist if a generic version of your prescription is available. Generics typically cost less and may be fully covered by your plan.
3. Is Your Pharmacy Still In-Network?
Your plan’s pharmacy network may also change each year. Using an in-network pharmacy usually means lower drug prices.
Make sure to:
Verify your preferred pharmacy is still part of your plan’s network.
Check whether your plan offers preferred pharmacies with additional savings.
Explore mail-order pharmacy options or 90-day refills that can reduce costs and add convenience.
Switching to a network pharmacy or using mail delivery can help you maximize your savings and avoid surprise costs at the counter.
4. Do You Have Any Special Health Needs?
If you take medications for chronic conditions or use drugs that have higher risks of misuse, your plan may include utilization management restrictions.
These restrictions can include:
Prior authorization: The plan must approve the prescription before it’s filled.
Step therapy: You may need to try a lower-cost drug before moving to another medication.
Quantity limits: The plan may limit how much of a drug you can receive at once.
Review your Evidence of Coverage and Annual Notice of Change carefully to see if any restrictions affect your prescriptions. If you have questions, contact your plan’s customer service for clarification.
Don’t Forget: Review Your Medicare Drug Coverage Every Year
Prescription drug coverage under Medicare Part D isn’t static — it can change annually. Reviewing your plan each fall helps you stay informed about costs, covered medications, and pharmacy networks, so there are no surprises in the year ahead.
If you discover that your plan no longer meets your needs, you can make changes during the Medicare Annual Enrollment Period (October 15 – December 7).
Staying proactive ensures you’re getting the best value and coverage for your prescription medications.