Get Ready for AEP: What Medicare Advantage Members Need to Know Now

If you have a Medicare Advantage plan, the Annual Enrollment Period (AEP) is one of the most important times of the year for your coverage. Knowing what AEP is — and what actions you can take — can help ensure your plan continues to meet your health and budget needs.

What is the Annual Enrollment Period?

The Annual Enrollment Period runs from Oct. 15 through Dec. 7 each year. During this time, Medicare beneficiaries can review their current coverage and make changes for the upcoming year. Any changes you make will take effect on Jan. 1.

What changes can you make?

During AEP, you have several options:

• Switch Medicare Advantage plans (Part C)
• Return to Original Medicare (Part A and Part B)
• If you’re currently in a plan without Part D, you can join one with Part D coverage
• Change or update your current Part D plan

If you’re new to Medicare Advantage

If this is your first AEP as a Medicare Advantage member, it’s a great opportunity to make sure you fully understand your plan and how it works.
What to focus on:

• Learn your benefits — Many plans offer extras like dental, vision, fitness programs or over-the-counter allowances
• Understand your costs — Review premiums, copays, deductibles and out-of-pocket maximums
• Check your provider network — Make sure your doctors and preferred hospitals are included
• Review prescription drug coverage — Confirm your medications are covered and affordable

Helpful tip:
Take time to read your Evidence of Coverage (EOC) so you know exactly what services are included and how to use them.

If you’ve had your plan for a while

Even if you’ve been in your plan for years, AEP is still important. Plans — and your needs — can change from year to year.
What to review:

• Changes to your current plan — Look for updates in premiums, benefits or coverage
• Your health needs — Have your doctors, medications or conditions changed?
• Prescription drug formularies — Medications covered can change each year

Helpful tip:
Carefully review your Annual Notice of Change (ANOC) to see what’s changing for the upcoming year.
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Understanding your prescription drug coverage (Part D)

Prescription drug coverage is an important part of many Medicare Advantage plans. During AEP, it’s especially important to review your drug coverage carefully — because formularies, costs and pharmacy networks can change each year.

What is a formulary?

A formulary is the list of prescription drugs your plan covers. Medications are typically grouped into “tiers,” which affect how much you pay:

• Lower tiers: Usually generic drugs with lower copays
• Higher tiers: Brand-name or specialty drugs with higher costs

Why it matters: Even if your medication is still covered, a change in tier can affect how much you pay.

What to check during AEP

Taking time to review your medications can help prevent surprises in the new year:

Make sure your drugs are still covered

• Check each medication you take
• Confirm it’s still on your plan’s formulary
• Note any new restrictions

Review your costs

• Have copays or coinsurance changed?
• Is your drug in a different tier?
• Are lower-cost alternatives available?

Check for coverage rules

Some medications may have additional requirements, such as:

• Prior authorization
• Step therapy
• Quantity limits

Confirm your pharmacy network

• Is your preferred pharmacy still in-network?
• Does your plan offer mail-order options?

Watch for changes that may affect you

Even small changes can impact your routine and budget. For example:

• A medication may no longer be covered
• Your pharmacy may no longer be in-network
• A drug may now require approval before coverage

Be sure to review your Annual Notice of Change (ANOC) for updates.

Tips to help you save on medications

• Ask about generic or lower-cost alternatives
• Use preferred or mail-order pharmacies when available
• Talk to your doctor if costs increase
• Explore financial assistance programs if needed

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Tips for making the most of AEP

• Start early so you have time to compare plans
• Make a list of your medications and providers
• Check if your doctors and prescriptions are still covered
• Look at total costs — not just monthly premiums
• Reach out for help if you have questions 

Don’t miss the deadline

Changes must be made by Dec 7. If you miss AEP, your ability to make changes may be limited unless you qualify for a Special Enrollment Period.

Taking time during AEP to review your Medicare Advantage plan — whether you’re new or have been enrolled for years — can give you confidence that your coverage continues to support your health, prescription needs and financial well-being in the year ahead.