Covered California’s 2026 open enrollment continues into January, but December 31 matters for people who want coverage in place for January or who need to finalize changes for the new year. Prescription coverage deserves its own check before a plan is selected.
A lower monthly premium does not answer whether a plan works well for the prescriptions a household uses. Covered California tells consumers to check each plan’s formulary and to ask the health insurance company which pharmacies can be used for pharmacy benefits. For caregivers managing several prescriptions, that review is easier when it happens before the year changes.
Quick Answer
Before December 31, compare the medications you currently use with the 2026 plan you are considering. Covered California says each health plan has its own formulary, and prescription drugs are grouped into tiers that affect cost. Also ask the plan which pharmacies are in network for pharmacy benefits. Confirm any medication-specific coverage rules with the insurer. Use the pharmacy to verify current prescription details and refill timing, and involve the prescriber if the plan’s coverage would require a treatment decision.
Why December 31 Matters for 2026 Coverage
Covered California announced on December 22, 2025 that the 2026 open-enrollment period continues through January 31, but people who want coverage in place for January need to enroll by the end of the year. Existing Covered California enrollees also had until December 31 to make changes to their coverage for 2026.
If prescriptions are used every month, plan selection should include a pharmacy-benefit check rather than focusing only on the premium or medical provider network.
Check Whether Each Current Prescription Appears on the Plan Formulary
Covered California explains that every health plan has its own formulary, or list of covered medications. A medication that is covered under one plan may be placed differently—or may require a different process—under another.
Use the exact medication name and strength from the current prescription label when checking. If the plan’s online tool is unclear, contact the insurer directly. Do not switch or stop a medication because of a formulary difference without discussing the treatment question with the prescriber.
Use the exact drug name and strength
Avoid searching from memory when a generic and brand name are both possible.
Check every ongoing prescription
A plan that works for one medication may not work the same way for another.
Look for the drug tier
Covered California plans organize covered drugs into generic, preferred, non-preferred and specialty tiers.
Confirm unclear results with the plan
The insurer is the final source for its own formulary and coverage rules.
Confirm Which Pharmacies Can Be Used for the Plan’s Pharmacy Benefit
Covered California’s prescription guidance tells members to ask the health insurance company which pharmacies they can use to receive pharmacy benefits. This is separate from checking whether the pharmacy is licensed or whether it can technically fill the prescription.
If continuing with Las Palmas Pharmacy is important to you, confirm network participation directly with the plan for the specific 2026 product you are considering. Network arrangements can differ by plan and year.
Do Not Rely on Last Year’s Card
A pharmacy that worked with a plan in 2025 should not be assumed to have the same network status for a different 2026 plan. Verify the exact plan, not only the insurance-company name.
Check Drug Tiers, Deductibles and Other Plan Rules
Covered California groups prescription drugs into four tiers—generic, preferred, non-preferred and specialty—and the patient cost depends on the plan and coverage level. Some plans may also use medication-specific utilization rules described in plan documents.
- Health plan
- Confirms formulary, tier, network, deductible, copay/coinsurance and any coverage-management requirements.
- Pharmacy
- Confirms the current prescription, refill status, dispensing information and whether the prescription can be processed when coverage becomes active.
- Prescriber
- Makes treatment decisions if a covered alternative, prior authorization or other clinical change needs to be considered.
Six Prescription Questions to Answer Before Selecting a 2026 Plan
- Is every ongoing prescription on this plan’s 2026 formulary?
- What tier is each medication in?
- Is Las Palmas Pharmacy in network for this exact plan?
- Does the plan require a deductible before certain prescription benefits apply?
- Are there medication-specific coverage rules I need to address before January?
- Who should I contact if the plan’s formulary does not match the current treatment plan?
Prescription Details
Need the exact medication information before you call the plan?
Las Palmas Pharmacy can help identify the current prescription name, strength, dosage form and refill information in its records so you can compare the correct details with the health plan.
Prepare for the First Refill Under the New Plan
Once the plan is selected, keep the new member information ready and make sure the first premium or other enrollment steps required by the insurer are completed. Covered California advises members with prescription questions to contact their health insurance company and confirm that coverage is active and which pharmacies can be used.
Keep the new plan ID information with the medication list.
Know which prescription is likely to need the earliest January refill.
Confirm pharmacy network status before the refill is urgent.
If the plan requires action from the prescriber, start that conversation before the medication runs low.
Do not discard the current prescription label or written medication list during the transition.
Call the pharmacy if the prescription itself, refill status or transfer history is unclear.
Frequently Asked Questions
Is December 31 the end of Covered California open enrollment for 2026?
No. Covered California said open enrollment for 2026 continued through January 31, 2026. December 31 was important for people who wanted coverage in place for January and for existing enrollees making changes for the new year.
Do all Covered California plans cover the same medications?
No. Covered California says each health plan has its own formulary. All plans include prescription-drug coverage as an essential benefit, but the specific covered drugs, tiers and patient costs can differ.
How do I know whether a pharmacy is in network?
Ask the health insurance company which pharmacies can be used for the pharmacy benefit under the exact plan you are considering. Do not assume network status from the insurer’s name alone.
Can the pharmacy tell me whether a new plan will cover my medication?
The pharmacy can provide current prescription details and may be able to process a claim once coverage is active, but the health plan is the authoritative source for its formulary, network, benefit rules and coverage decisions.
What if my medication is not on the new plan’s formulary?
Contact the health plan to understand its coverage process, then contact the treating prescriber if a clinical decision, authorization request or treatment alternative needs to be considered. Do not stop or substitute a prescription on your own.
What should caregivers have ready when comparing plans?
Keep one current medication list with exact drug names, strengths, dosage forms and schedules. Also note the current pharmacy and prescribers so the caregiver can ask specific formulary, network and coverage questions.
Check the Pharmacy Benefit Before the Calendar Turns
A year-end plan review is more useful when it includes the prescriptions you actually use. Las Palmas Pharmacy can help verify current prescription details; Covered California and the selected health plan remain the sources for enrollment and coverage decisions.
