Dear Toni: 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 period. I do not 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 open enrollment, so I have been without a stand-alone Part D plan all year.
I need your help because I have been prescribed an expensive brand-name cancer prescription that I am having to pay for 100 percent out of pocket. Please explain what I should do. — Corey, Columbus, Ohio
Dear Corey: The Centers for Medicare & Medicaid Services advises everyone to watch for changes to Part D plans, which will be mailed out in September, and to research on medicare.gov after Oct. 1 to determine which stand-alone Part D plan best meets their prescription drug needs for 2027.
It is wise to verify every year that your prescription drugs are covered on your Medicare Part D plan. Medicare Advantage or stand-alone prescription 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, you may have to pay 100 percent of that prescription cost.
Because you did not enroll in a stand-alone Medicare Part D plan last year, Corey, this year’s open enrollment period (Oct. 15-Dec.7) will be your opportunity to enroll in Part D coverage to begin Jan. 1. Unfortunately, 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 the open enrollment period:
— Enroll in a stand-alone Part D prescription drug plan, if you have let your Part D plan lapse or never enrolled in a stand-alone Part D plan when your Medicare coverage began.
— Enroll in a stand-alone Part D plan, which can automatically disenroll you from a Medicare Advantage plan (if you need return to original Medicare).
— Change from one Part D plan to another.
— Enroll in a Medicare Advantage Part C plan with prescription drug benefits.
— Change from one Advantage plan (with or without a prescription drug plan) to another.
— Enroll in a stand-alone Part D plan to return to original Medicare and purchase a Medicare supplement.
— Enroll in a Part D plan and return to original Medicare only.
Toni King is an author and columnist on Medicare and health insurance issues. If you have a Medicare question, email info@tonisays.com or call 832-519-8664.
