2024 Medicare prescription drug annual open enrollment
Medicare open enrollment for prescription drug coverage (Part D) is from October 15 to December 7, for coverage that will begin on January 1, 2025. Certain people with Medicare can also change plans at other times. (See the chart below for more information.)
Plans make changes to benefits and costs, and there are also new plans in many areas of the country. With these different changes, your current plan may or may not be the best plan for you in 2024.
The information below will help you prepare for open enrollment.
If you have more questions after reading this information, refer to your plan’s website. You can also use the Medicare Prescription Drug Plan Finder at Medicare.gov or call 1-800-MEDICARE; (1-800-633-4227/TTY: 1-877-486-2048)
Enrollment timeline
| October 15 – December 7, 2024 | October 15 – December 7, 2024 | January 1 – March 31, 2025 | |
|---|---|---|---|
| Medicare Part D | Medicare Advantage | Medicare Advantage | |
| If you have Medicare Part A OR Part B, but not both: | Add prescription drug coverage | Not available | Not available |
| If you have Medicare Part A AND Part B (i.e., Original Medicare) and prescription drug coverage: | Maintain Original Medicare and maintain or change your prescription drug plan | Join a Medicare Advantage plan with or without prescription drug coverage | Not available |
| If you have Original Medicare and no prescription drug coverage: | Maintain Original Medicare and add prescription drug coverage | Join a Medicare Advantage plan with prescription drug coverage | Not available |
| If you have a Medicare Advantage plan, with or without Medicare prescription drug coverage: | Switch to Original Medicare, with the option of joining a prescription drug plan | Switch to another Medicare Advantage plan with or without prescription drug coverage | Switch to another Medicare Advantage plan (with or without drug coverage) or switch to Original Medicare (with or without prescription drug coverage) |
Medicare Part D plans will all change
All Medicare Part D plans will change in 2025. Use the open enrollment period to compare plans and find the plan that best meets your prescription drug needs at a cost you can afford.
The following things may change from your current plan:
- the monthly premium
- the annual deductible
- your share of the costs (copays or coinsurance)
- the list of the drugs it covers (formulary) and tier placement
- use of policies that may restrict access to certain drugs, such as:
- requiring your doctor to justify why you need a certain drug before the plan will pay for it (called prior authorization)
- requiring your doctor to prescribe a different drug in the same class of drugs first (called step therapy)
- only letting you buy a certain amount of a drug at a time (called quantity limits).
Your plan may also decide not to participate in 2025. If you are one of the few people whose plan is not participating in 2025, your plan should send you a letter in October explaining that you will need to select a new plan.
Confirming changes in your 2025 plan
You should get a letter from your current plan called an “Annual Notice of Change/Evidence of Coverage” by the start of the open enrollment period. This letter explains some of the important changes to your plan, including changes to the name of the plan, to the premium, the drugs covered (formulary), the cost of the drugs, and any restrictions used that limit the access to drugs. It is very important to read this letter as these changes can have a large impact on the cost of your drugs.
If you did not receive the Annual Notice of Change/Evidence of Coverage letter, call your plan immediately.
While important, this letter probably does not have all the details you need to determine if your current plan is the best plan for you in 2025. You also need to know how these changes apply to the drugs you use. You can find this information by looking on the plan’s website or in the Medicare Prescription Drug Plan Finder at Medicare.gov or by calling the plan or 1-800-MEDICARE; (1-800-633-4227/TTY: 1-877-486-2048).
You may have received a summary of the formulary (this is the list of covered medications) with the Annual Notice of Change/Evidence of Coverage letter. If you did not receive a copy of the formulary, call the plan and they will send you a copy or tell you if your drugs are covered. The phone number for the plan’s customer service department is included in the letter you received. You may also get information about the formulary from the plan’s website, by using the Medicare Prescription Drug Plan Finder at Medicare.gov, or by calling 1-800-MEDICARE (TTY: 1-877-486-2048).
Comparing your plan to other plans
It’s important to compare your plan with other plans in your area. Other plans may provide you with better or less costly coverage for the drugs you need. Often the single most important factor in choosing a plan is comparing the drugs you take to the plan’s formulary to see if the plan covers the drug you need.
The best way to compare your current plan with other plans is to use the Medicare Plan Finder at Medicare.gov. This tool will allow you to complete either a personalized or general search for drug coverage and estimate costs for plans in your area in 2025. The Medicare Plan Finder will also allow you to compare coverage and costs with other plans in your area. Estimates are based on drug prices on the date you compare plans, but your actual out-of-pocket costs may vary.
The Plan Finder can also help you estimate your total monthly costs over a 12-month period for each of the plans that you are considering.
Understanding the formulary
You must pay the full cost for any drug not on the formulary. The money you pay for these drugs does not count toward the total amount that you must spend to qualify for catastrophic coverage. That is why it is important to make sure that your drugs, especially the most expensive ones, are on the formulary of the plan you select. You, your authorized representative, or your doctor can ask for a “coverage determination” (exception) to get your plan to cover a drug when it is not on the plan’s formulary.
Keeping your current plan in 2025
If you want to keep your current plan, you don’t need to do anything. You will stay enrolled in your current plan unless you sign up for a new plan.
Timing, costs, and how to change your current plan
You can enroll in a new plan by contacting the plan you want to enroll in or by calling 1-800-MEDICARE (TTY: 1-877-486-2048) or by visiting Medicare.gov.
You can change your plan for 2025 by enrolling in a new plan between October 15 and December 7, 2024. However, it is best to make the change as early as possible to ensure that you can get the prescriptions you need without delay on January 1, 2025.
There is no fee for changing to a new plan. After enrolling in the new plan for 2024, you will be automatically unenrolled from your 2024 plan at the end of the calendar year. You do not need to notify your 2024 plan of the change.
Changing from Medicare Advantage to Original Medicare
You can switch plans during the Part D open enrollment period between October 15 and December 7, 2024. You can also switch plans during the Medicare Advantage open enrollment period from January 1 to March 31, 2025. During this period, you can switch from your Medicare Advantage plan with or without drug coverage to Original Medicare (or another Medicare Advantage plan with or without drug coverage) but you must also join a separate stand-alone drug plan if you want prescription drug coverage. The booklet Medicare & You 2025 has important information about Medigap protections for people switching from Medicare Advantage plans to Original Medicare.
Changing your mind about your new plan
In general, you can only switch to another standalone prescription drug plan from October 15 to December 7 each year. If you are enrolled in a Medicare Advantage plan, you may use the open enrollment period from January 1 to March 31 to switch to another Medicare Advantage plan with drug coverage or switch to Original Medicare and enroll into a prescription drug plan.
There are a few special exceptions that allow you to change to a new plan in 2025, such as if you move out of the service area, lose your employer drug coverage, enter or leave a nursing facility, or if you qualify for Extra Help. That is why it is so important to review your options before enrolling. There is also a special enrollment period for plans that receive the highest possible quality rating from CMS.
Special enrollment period for “five-star” plans
CMS rates plans for quality using a star system. The best possible score is five stars. In October 2024, CMS will release a list of five-star prescription drug plans and Medicare Advantage plans for 2025. The Medicare Plan Finder includes the “Overall Plan Rating” in the listing for each plan. You can sort the plans in your area based on “Overall Plan Rating” to easily find those with a five-star rating.
Under the special enrollment period for five-star Medicare Advantage and standalone prescription drug plans, you can switch into a five-star plan at any time during the plan year. This enrollment period will start on December 8, 2024, after the open enrollment period ends. You can make this change only once during the plan year.
Very few plans receive the five-star rating and there may not be a five-star plan in your area. The five-star plans in your area may not be the best options for you in terms of cost, network providers, and coverage. You should compare the five-star plans to your current plan to make sure that you have the same coverage and access to your doctors and other health providers before making the switch to a new plan.
Qualifying for the Extra Help (Low-Income Subsidy) program in 2025
Updated in September 2024
The 2024 federal poverty level (FPL) guidelines determine the income level requirements for people applying for the Extra Help program. If you are below 150 percent of FPL ($22,590) and have resources below $17,220 as an individual or if you are married and your household income is below 150 percent FPL ($30,660) and have resources below $34,360, you might qualify for Extra Help. These limits may increase in early 2025 when the 2025 FPL is announced.
If you applied and qualified for Extra Help at any time and are receiving Extra Help now, Social Security may have contacted you to review your eligibility status for 2025. In late August 2024, Social Security mailed letters to people who were selected for review and included a form to complete called “Social Security Administration Review of Your Eligibility for Extra Help” (Form SSA-1026). You had 30 days to complete and return this form. Any changes in the amount of Extra Help you will receive will be effective in January 2025.
| October 15 – December 7, 2024 | January 1 – March 31, 2025 | |
| People who no longer qualify for Extra Help in 2025: | Add, switch, or drop a prescription drug plan or a Medicare Advantage plan or return to Original Medicare. | Add, switch, or drop a prescription drug plan or join a Medicare Advantage plan during this special enrollment period for this group or return to Original Medicare. |
| People who qualify for Extra Help in 2025: | Switch to another Medicare drug plan or Medicare Advantage plan at any time, as long as they continue to get Extra Help. Coverage will begin the first day of the month after you ask to join a plan. | Switch to another Medicare drug plan or Medicare Advantage plan at any time, as long as they continue to get Extra Help. Coverage will begin the first day of the month after you ask to join a plan. |
If you qualified for Extra Help in 2024, but were not selected for a review, you will not receive a form from Social Security and there should be no change in the amount of Extra Help you receive. If you are unsure of your Extra Help status, call 1-800-MEDICARE (TTY:1-877-486-2048).
If you have been notified by Social Security that you are no longer eligible for Extra Help in 2025, you will still be enrolled in your plan. After January 1, 2025, you will have to pay monthly premiums and your share of the drug costs. However, during a one-time special open enrollment period, you can change Part D plans between January 1 and March 31, 2025. This will be an important opportunity for you to change to a new plan if you find that your existing plan is not your best option.
If you automatically qualified for Extra Help in 2024, you will automatically qualify in 2025 if you:
- Receive both Medicare and Medicaid
- Have your Medicare Part B premiums paid by your state because you belong to a Medicare Savings Program
- Receive both Medicare and Supplemental Security Income (SSI)
Medicare beneficiaries who automatically qualified in 2024, but who will not automatically qualify in 2025, should have received a notice on grey paper from Medicare (labeled CMS Publication No. 11198) in September 2024. The notice explains why you no longer automatically qualify and will encourage you to complete an enclosed Social Security application for Extra Help as soon as possible. The application for Extra Help should be returned to Social Security in the postage paid envelope provided.
Extra Help benefit in 2025
Starting in 2025, all individuals eligible for Extra Help receive the full benefit of the subsidy rather than some individuals only receiving partial financial assistance.
Drug cost changes in Extra Help
Your copays will increase or decrease if you have a change in your income or assets, or if you enter or leave a nursing facility or other institution. If you continue to automatically qualify for Extra Help and your copays are changing in 2025, you should have received a letter on orange paper from Medicare (labeled CMS Publication No. 11199) in October telling you your new copay amounts.
Enrolling in Medicare Part D late
You can enroll in a plan during the Annual Open Enrollment. You may have to pay a premium penalty if you did not have coverage that is at least as good as Medicare’s coverage (“creditable coverage”) during the first/initial period that you were eligible to enroll. The penalty amount is calculated based on the number of months you were eligible but did not enroll. If you have to pay a premium penalty, most people will have to pay it for the rest of their life.
The penalty will be added to your monthly Medicare private Part D plan premium. If you qualify for Extra Help with your Medicare prescription drug coverage, you can enroll anytime and pay no late enrollment penalty.
Getting help choosing a plan
Every state has a State Health Insurance Assistance Program (SHIP) that offers free one-on-one counseling and assistance to people with Medicare and their families. SHIP offices are located throughout each state. To find contact information for the SHIP office closest to your community, visit ShipHelp.org or call 1-800-MEDICARE (TTY: 1-877-486-2048).
What to expect after you enroll
You should have received a welcome letter and a prescription card from the plan after you enrolled. If you have not received that letter, contact the plan right away to confirm that you are enrolled.
If you have not gotten a prescription card, contact your plan immediately. If you need to get your prescription filled before your card arrives, bring the letter you received from the plan that confirms you have enrolled with you to the pharmacy.
If you don’t have a letter, ask your pharmacist to call 1-800-MEDICARE (TTY: 1-877-486-2048). The customer service representative should be able to tell the pharmacist which plan you are enrolled in. If you continue to have problems, you should contact your local SHIP office. You can locate your local SHIP office by visiting ShipHelp.org or by calling 1-800-MEDICARE (TTY: 1-877-486-2048).
What to do if your drug is not on your plan’s formulary
The plan must decide within 72 hours (or 24 hours for an expedited review) if they will cover the drug. If they decide not to cover the drug, they must send you a written notice. You also have a right to appeal their decision.
Note: If your drug is not on the formulary, but you are able to get it covered by the plan under the plan’s exceptions process, the money you spend on the drug is counted toward qualifying for catastrophic coverage.
