If you help a parent, spouse or other family member manage prescriptions, Medicare Open Enrollment is the time to check whether their 2026 drug coverage still fits the medications they actually use.
For caregivers, Medicare Open Enrollment is less about comparing plan names and more about checking whether a loved one’s day-to-day prescription needs will still be covered in the new year. A plan that worked well in 2025 may change its drug list, cost-sharing, coverage rules or pharmacy network for 2026.
Quick Answer
Medicare Open Enrollment runs from October 15 through December 7, 2025, and changes made during this period generally take effect January 1, 2026. Caregivers should compare each current prescription against the plan’s 2026 formulary, check tiers and coverage rules such as prior authorization, verify that the preferred pharmacy remains in-network, and review estimated costs before the December 7 deadline.
Why Caregivers Should Review Part D Before December 7
Medicare health and drug plans can change from one year to the next. CMS specifically advises people with Medicare to review plan materials such as the Annual Notice of Change and Evidence of Coverage because costs, coverage and participating providers or pharmacies may be different for the coming year.
That matters when you manage medications for someone else. A change that looks small on a plan summary can affect where a prescription is filled, how much it costs, or whether a coverage requirement must be completed before the plan pays for it.
Keep the Programs Separate
Medicare Open Enrollment is not Covered California Open Enrollment. Medicare beneficiaries use Medicare’s enrollment rules and Medicare plan resources. Covered California is the state marketplace for people who do not have Medicare.
If the current plan is still offered and continues to meet the person’s needs, Medicare does not require a change. The useful step is to check rather than assume that last year’s coverage will work exactly the same way in 2026.
Start With One Accurate Prescription List
Before opening Medicare Plan Finder or calling a plan, gather the medication information that actually determines coverage. Using a partial list can produce a misleading comparison, especially when a person takes several medications or uses different dosage forms.
Exact medication name
Use the name on the current prescription label rather than relying on memory.
Strength and dosage form
Record details such as 10 mg tablet, inhaler, cream, solution or injection when applicable.
Current directions
Note how often the medication is taken so refill quantity and timing make sense.
Prescriber
Keep the prescribing clinician’s name and office contact information with the list.
Current pharmacy
Include where each prescription is filled, especially if more than one pharmacy is used.
Next refill timing
Know which prescriptions are likely to need attention close to January 1.
A current pharmacy label can help confirm spelling, strength, dosage form and prescription number. If the medication list does not match what is currently being dispensed, resolve the discrepancy before using it for plan comparison.
Check More Than Whether the Drug Appears on the Formulary
A Medicare drug plan’s formulary is its list of covered drugs, but coverage is not always a simple yes-or-no question. Medicare plans may place drugs on different cost-sharing tiers and may apply rules that affect how the prescription is covered.
- Formulary status
- Confirm that the exact medication is included on the 2026 drug list.
- Tier
- Check the medication’s tier because lower and higher tiers can have different copay or coinsurance amounts.
- Prior authorization
- Some prescriptions require plan approval before coverage applies. The prescriber may need to submit supporting information.
- Step therapy
- A plan may require a person to try another covered drug first unless an exception is approved.
- Quantity limit
- A plan may limit how much of a covered medication it will pay for during a defined period.
Medicare Plan Finder allows users to enter prescriptions and pharmacies to compare estimated plan costs. For a final coverage answer, confirm the details with the plan because formularies and plan rules are plan-specific.
Verify the Pharmacy Network Before Assuming Your Routine Can Stay the Same
Medicare drug plans contract with in-network pharmacies, and some plans may only cover prescriptions when they are filled at an in-network pharmacy. A plan may also identify preferred in-network pharmacies that can have lower out-of-pocket costs than other pharmacies in the network.
If staying with Las Palmas Pharmacy matters to the person you care for, verify the pharmacy’s status directly with the plan for 2026. Network participation and preferred status are plan decisions, so the plan is the final source for those details.
Network vs. Preferred Network
“In-network” and “preferred in-network” are not always the same. A pharmacy can participate in a plan’s network without having the plan’s preferred cost-sharing status. Ask the plan how each designation affects the specific prescriptions being reviewed.
Six Questions to Answer Before December 7
Use the same questions for every plan being considered so the comparison stays focused on the prescriptions that matter.
- Are all current prescriptions on the plan’s 2026 formulary?
- What tier is each medication on, and what is the estimated cost?
- Do any medications require prior authorization, step therapy or a quantity limit?
- Is the current pharmacy in-network, and is it a preferred in-network pharmacy?
- Does the plan comparison include every medication, strength and dosage form currently used?
- Are any prescriptions likely to need a refill or new authorization close to January 1?
Prescription Details
Need Help Checking the Medication List?
Las Palmas Pharmacy can help confirm current prescription details, refill timing and pharmacy information while you prepare for a Medicare plan review.
What to Do Before the December 7 Deadline
Medicare says Open Enrollment ends December 7, and the plan must receive an enrollment request by that date for the change to take effect January 1. Waiting until the final day can make it harder to resolve a missing medication or unclear network question before enrollment closes.
- Review the plan’s annual change materials.
Check the Annual Notice of Change and Evidence of Coverage for changes that affect prescriptions, costs or pharmacy access.
- Compare using the complete medication list.
Use Medicare Plan Finder or the plan’s own materials with the exact prescriptions and pharmacies involved.
- Call when something does not match.
Ask the plan about formulary status, tiers, network status and coverage rules. Ask the pharmacy about current prescription and refill information.
- Plan for the January transition.
If coverage is changing, note which prescriptions may need attention early in January and which questions need the prescriber before the next refill.
Know Who Can Answer Each Question
Caregivers can save time by directing each question to the organization that actually controls the answer.
- Medicare / health or drug plan: Plan enrollment, formulary coverage, tiers, prior authorization rules, pharmacy network status and member cost-sharing.
- Las Palmas Pharmacy: Current prescription details, refill timing, transfer information, dispensing questions and the pharmacy information needed for a plan comparison.
- Prescriber: Questions that require changing the medication, dose, dosage form or treatment plan, plus clinical support for coverage exceptions when appropriate.
- California HICAP: Free, confidential and unbiased Medicare counseling for beneficiaries, families and caregivers across California. HICAP can be reached at 1-800-434-0222.
A caregiver may also need the Medicare member’s permission before a plan, pharmacy or clinician can discuss protected personal information. Ask the organization what authorization it requires rather than assuming caregiver status automatically provides access.
Frequently Asked Questions
Common questions caregivers ask while reviewing Medicare prescription coverage for 2026.
When does Medicare Open Enrollment end in 2025?
Medicare Open Enrollment runs from October 15 through December 7, 2025. Medicare says the plan must receive an enrollment request by December 7 for a coverage change made during this period to take effect January 1, 2026.
Does someone need to change Medicare Part D plans every year?
No. If the current plan is still offered and continues to meet the person’s needs, a change is not required. CMS recommends reviewing the Annual Notice of Change, Evidence of Coverage and next year’s plan information because costs, coverage and participating pharmacies can change from year to year.
How can a caregiver check whether a prescription is covered in 2026?
Use the exact medication name, strength and dosage form when checking Medicare Plan Finder or the plan’s 2026 formulary. Also review the tier and any prior authorization, step therapy or quantity-limit rules. Contact the plan when a final coverage determination is needed.
Why does pharmacy network status matter for Part D?
Medicare drug plans use pharmacy networks. Some plans may require an in-network pharmacy for coverage, and preferred in-network pharmacies may have lower cost-sharing. Verify the pharmacy’s 2026 status with the plan rather than assuming it will be the same as 2025.
What if a current medication will require prior authorization in January?
Contact the health or drug plan to confirm the requirement and ask what process applies. The prescriber may need to provide clinical information. Do not stop, substitute or change the medication on your own because an insurance rule is changing.
Can Las Palmas Pharmacy tell me which Medicare plan to choose?
Las Palmas Pharmacy can help with prescription details, refill timing and pharmacy information that may be useful during a comparison, but the pharmacy does not choose a Medicare plan for the patient. Medicare Plan Finder, the plan itself, 1-800-MEDICARE and California HICAP are appropriate resources for plan-selection questions.
Reviewing a Family Member’s Prescriptions?
Las Palmas Pharmacy can help you confirm current prescription details, refill timing and pharmacy information before Medicare Open Enrollment ends December 7. For plan coverage and enrollment decisions, verify the final details with Medicare or the health or drug plan.
