I just want to keep my current Medicare drug plan.  Do I need to notify my plan?

No.  If you are satisfied with your current 2024 Medicare Part D prescription drug plan or Medicare Advantage plan, and understand how your 2024 Medicare plan is changing in 2025, you do not need to do anything during this annual Open Enrollment Period and your 2024 Medicare plan will continue – along with any plan benefit and cost changes through 2025 – this is assuming that your Medicare plan is still being offered next year  (over 7 million people are enrolled in a Medicare plan that will not be continued in 2025).

Important:  Check your plan benefits for changes.
Your Medicare plan benefits change each year so be sure you understand the 2025 changes – such as changes in pharmacy or mail order options, changes in your healthcare network, different coverage costs, monthly premium, deductible, and prescription coverage.

You can use our online PDP-Compare or MA-Compare tools to provide you with a quick overview of how any 2024 Medicare Part D or Medicare Advantage plan is changing in 2025.

Important:  Check your medications.
Are all of your medications still covered in 2025?  Do your covered drugs now have usage management restrictions?  Does your plan offer lower-costing generic alternatives?

Both our Formulary Browser (view all drugs for a single plan) and Q1Rx® Drug Finder (view all plans for a single drug) include formulary data for all stand-alone Medicare Part D prescription drug plans (PDP) and Medicare Advantage plans (MAPD).


Review Question:  How do I enroll into a Medicare Part D or Medicare Advantage plan?

You can enroll into a 2025 Medicare Part D or Medicare Advantage plan by: (1) calling a Medicare representative at 1-800-Medicare, (2) visiting the Medicare.gov website, (3) contacting a local SHIP volunteer, (4) working with a local insurance agent representing your chosen plan, or (5) telephoning a Medicare plan Member Services or Customer Services representative – we provide the telephone numbers for all Medicare plans in our Medicare Part D Plan Finder (choose your state) and Medicare Advantage Plan Finder (enter your ZIP or choose your state and county) – then click on the plan name for more details.


Question:  If all but one of my Part D prescriptions is included on a drug plan’s formulary, will the Medicare drug plan cover my non-formulary drug if I ask for a formulary exception?

Maybe.  You always have the right to request a formulary exception for the coverage of a non-formulary Part D drug.  However, your Medicare Part D plan is not required to grant or approve your formulary exception request.

Important: You will need to work with your doctor or prescriber to help explain to your plan why there is no other formulary drug that treats your condition effectively or why you are not able to use the plan’s generic or alterative formulary medications.  If your formulary exception is denied, you have the right to appeal your plan’s decision.


Question:  If my Medicare drug plan approves my formulary exception request, what will I pay for the non-formulary drug?

The cost of covering a non-formulary drug will depend on your Medicare drug plan.  Your Medicare drug plan has some flexibility with regard to what you will pay for the coverage of a non-formulary drug when your formulary exception request is granted – and your plan may even provide a lower cost-sharing drug tier  for non-formulary generic drugs as compared to brand-name drugs.  Even so, many Medicare Part D plans cover non-formulary drugs (generic or brand) as Tier 4 or Tier 5 drugs with 25% to 50% cost-sharing.  You can click here to learn more about what you will pay for the coverage of a non-formulary drug.

Update:  Our Medicare Plan Finder tools now include cost-sharing information for what your Medicare drug plan will charge if your formulary exception request is granted.  You can click here for more information and examples from our Plan Finder tools.


Question:  If I don’t enroll in a Medicare Part D prescription drug plan when I am first eligible, does that prevent me from joining a drug plan in the future?

No, but you may pay a higher premium each month due to a late-enrollment penalty (LEP).  The Medicare Part D program is voluntary and you are not required to join a drug plan.  However, if you do not join a Medicare drug plan during your 7-month Initial Enrollment Period (IEP) – when you are first eligible for Medicare – you may be assessed a late-enrollment penalty for each month you were without some form of “creditable” prescription coverage (such as, employer coverage or VA drug coverage).  You can click here to learn more.


Question:  How do I estimate my late-enrollment penalty?

Your late-enrollment penalty is calculated as the number of months you were without creditable prescription drug coverage multiplied by 1% of the national base premium ($36.78 in 2025) then rounded to the nearest $0.10.

For example, if you have been without creditable drug coverage for 12 months, your penalty would be around $4.40 per month (12 x $0.3678).  You can click here to see other examples of how the LEP is calculated.

You can estimate your LEP using the above equation, but ultimately, Medicare will calculate your premium penalty and report it to your chosen 2025 prescription drug plan.  If you feel Medicare has calculated the penalty in error, you have the right to appeal your penalty.


Question:  Is the Medicare Part D late-enrollment penalty permanent?

Yes.  The late-enrollment penalty is permanent for most people over 65 and you will pay the penalty as long as you are enrolled in a Medicare Part D prescription drug plan (PDP) or a Medicare Advantage plan that includes drug coverage (MAPD).

However, there are a few exceptions when the late-enrollment penalty is not permanent – for example, if you now qualify for the Low-Income Subsidy (LIS) or Medicare Part D Extra Help program, you will no longer pay a late-enrollment penalty.


Question:  I am 86 and never had drug coverage.  If I decide to join a 2025 Medicare drug plan, what would be my monthly penalty?

$82.00 per month.  Since your Medicare Part D Initial Enrollment Period ended May, 2006 and your prescription coverage would start January, 2025, you were without creditable prescription drug coverage for 223 months.  The number of months is multiplied by 1% of the 2025 national base premium of $36.78, equaling $82.00 per month (rounded to the nearest $0.10).  The $82.00 penalty will be added to the monthly premium of your chosen Medicare drug plan.


Question:  If I get all of my medications through the Veteran’s Administration and don’t join a Medicare prescription drug plan, will I pay a late-enrollment penalty if I decide to join a Medicare drug plan next year?

No.  Your VA prescription coverage is considered creditable and, should you later decide to join a Part D plan to complement your VA drug benefits, you will not be subject to a late-enrollment penalty.

Although VA and Part D drug benefits do not “coordinate”, you can use either your VA coverage or your Part D coverage depending on which coverage is most economical (or simply more convenient).  However, you cannot use both coverage benefits for a single prescription purchase.  You can click here to read more about Part D coverage and VA benefits.


Question:  What is the easiest way to disenroll from my Medicare Part D or Medicare Advantage plan?

Call Medicare.  Usually, you can only drop your stand-alone Medicare Part D prescription drug coverage during the annual Open Enrollment Period (AEP) that continues through December 7th and the easiest way to disenroll or cancel your Medicare Part D plan is to call a Medicare representative at 1-800-633-4227.  You can also disenroll by calling your Medicare plan’s Member Services department (using the toll-free number on your Member ID card).

If you are enrolled in a Medicare Advantage plan, you can disenroll from your plan during the AEP, or you can also drop or change your Medicare Advantage plan during the Medicare Advantage Open Enrollment Period (MA-OEP) that begins on January 1st and continues through March 31st.

Important:  Keep in mind, if you disenroll from your prescription drug plan, you may be subject to a permanent late-enrollment penalty should you ever decide to rejoin a Medicare drug plan in the future.  Please click here to read more about disenrollment.

Tip:  Instead of disenrolling from your Medicare drug plan, consider joining a low-premium Part D plan or a $0 Medicare Advantage plan that includes drug coverage (if available in your area) – and avoid a monthly penalty should you need drug coverage in the future.


Question:  Can you disenroll from your Medicare Advantage plan and have a guaranteed issue right to join (or re-join) a Medicare Supplement?

Yes, but only in two (2) limited situations.  Medicare provides for two “trial” periods when you can leave your Medicare Advantage plan within the first 12 months and join – or return to – a Medicare Supplement, without medical underwriting.

First, if you join a Medicare Advantage plan when you are initially eligible for Medicare (turning 65), you are able to leave your Medicare Advantage plan within the first year and have a guaranteed issue right allowing you to join any Medicare Supplement in your state.

Second, if you leave your Medicare Supplement plan and join a Medicare Advantage plan for the first time, you can use a Special Enrollment Period to leave your Medicare Advantage plan and return to your previous Medicare Supplement within the first 12 months with no medical underwriting.

If you are outside of your initial 12-month trial period, Medigap enrollment rules will vary depending on your state, and you may be subject to medical underwriting, pay a higher premium, have pre-existing medical conditions excluded, or be denied Medigap coverage.  You can click here to read more about your “trial rights”.


Question: What is the Medicare Part D Income-Related Monthly Adjustment Amount (IRMAA)?

IRMAA is an additional monthly Medicare Part D (and Part B) fee paid by  individuals whose modified adjusted gross income (or MAGI) exceeds certain threshold amounts that can change each year.


Question: How is IRMAA determined?

With limited exceptions, your IRMAA for Medicare Part D (and Medicare Part B if you have this coverage) is calculated using your reported income (MAGI) from the most recent tax return sent from the IRS to Social Security.

If you find that your IRMAA has been calculated in error, or you have had significant changes in income since the tax filing reported by the IRS, you have the right to appeal the IRMAA determination.


. . . and A Few Closing Notes

What’s next?
The annual Open Enrollment Period (AEP) continues through December 7th.  During the AEP, you can join, change, or drop your Medicare Part D or Medicare Advantage plan coverage.  After December 7th, most people will only have a limited opportunity to change their 2025 coverage and are “locked in” to their plan until next year’s AEP.

Reminder:  Extra Help recipients may still need to act to keep their 2025 Extra Help status.  Be sure to review any letter that you receive from Medicare or the Social Security Administration.  When in doubt, contact your local Medicaid office for more information or call Medicare at 1-800-633-4227.

Would you like to receive our free Medicare Part D Newsletter?
Click here to receive your own copy of the Medicare Part D Newsletter or go to Q1Medicare.com/Newsletter.  There is no cost and your email information will not be shared with any third parties.

Not sure where to begin with Medicare Part D prescription drug coverage?
If you would like an overview of the Medicare Part D and Medicare Advantage plan program, then you can click here for more information.