Why Your Medicare Drug Plan Needs an Annual Review (And How to Do It)

Your Medicare drug plan changes every year — costs, covered drugs, and pharmacy networks shift. Here's why an annual review matters and how to do it right.

Author: Lynsey Brennan, Licensed Medicare Advisor | Published July 23, 2026 Reading time: 6 min read

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Quick Answer

Medicare Part D drug plans change their formularies, premiums, and pharmacy networks every January 1st — and your current plan may no longer cover your medications the same way it did last year. The Annual Enrollment Period (October 15-December 7) is your window to compare plans and switch if needed. Skipping this review could mean paying significantly more than necessary for the same prescriptions.

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Key Takeaways

• Medicare Part D plans can change costs, covered drugs, and preferred pharmacies every plan year — your plan from 2025 may look very different in 2026.
• Starting in 2025, the Inflation Reduction Act capped Part D out-of-pocket costs at $2,000 per year — a major change worth factoring into your plan comparison.
• Insulin covered under Medicare Part D is capped at $35/month per prescription (CMS).
• Georgia Medicare enrollees often have multiple Part D and Medicare Advantage plan options — comparing them annually is the only way to know which fits your situation. See our Part D drug coverage guide for a full breakdown.
• You can compare plans using Medicare's plan comparison tool or work with a licensed Medicare advisor.

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Table of Contents

1. Why Your Plan Changes Every Year 2. What Exactly Gets Reviewed 3. Georgia-Specific Considerations 4. The New $2,000 Out-of-Pocket Cap — What It Means for You 5. How to Do the Review Step by Step 6. Common Mistakes People Make 7. When to Call a Licensed Medicare Advisor

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Why Your Plan Changes Every Year {#why-your-plan-changes-every-year}

Medicare Part D plans are required to send you an Annual Notice of Change (ANOC) by September 30th each year. That letter spells out what's different for the coming plan year. The problem is that most people set it aside without reading it — and then get surprised at the pharmacy counter in January.

Insurance carriers can legally change their formularies (the list of covered drugs), their cost-sharing tiers, their preferred pharmacy networks, and their monthly premiums each year. A drug that was Tier 2 (relatively inexpensive) in 2025 might move to Tier 3 or Tier 4 in 2026, which can meaningfully change your monthly costs.

This isn't a loophole or a flaw — it's how Part D is designed. The upside is that you have a guaranteed window each fall to respond to those changes by comparing and switching plans.

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What Exactly Gets Reviewed {#what-exactly-gets-reviewed}

When you sit down to review your drug plan, there are four things worth checking:

1. Your formulary. Are all your current prescriptions still covered? If a drug was dropped from the formulary or moved to a higher tier, your cost may increase substantially.

2. Your pharmacy network. Does your plan still treat your preferred pharmacy as "preferred"? Using an out-of-network or non-preferred pharmacy often means higher copays.

3. Your premium. Even a modest increase in the monthly premium adds up over 12 months.

4. Your total estimated annual cost. This is the number that matters most — add up your premium plus your estimated drug costs at your actual pharmacy. Medicare's plan finder tool at Medicare.gov can calculate this for you automatically if you enter your medications.

If you also carry a Medicare Advantage plan or a Medicare Supplement (Medigap) plan, your drug coverage situation may be different — it's worth reviewing those together. Our Medicare Advantage vs. Supplement comparison can help clarify how these fit together.

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Georgia-Specific Considerations {#georgia-specific-considerations}

Georgia Medicare enrollees have access to a competitive marketplace with multiple standalone Part D plans and Medicare Advantage plans that include drug coverage. The number of plan options available can vary by county — rural counties in south Georgia may have fewer choices than metro Atlanta or Savannah.

One thing Georgia residents should be aware of: not all Medicare Advantage plans in Georgia include Part D drug coverage. If you're enrolled in a Medicare Advantage plan that doesn't include drug coverage (called an MAPD plan), you may need a separate Part D plan — but there are restrictions on when and how you can add one. Always confirm drug coverage is included before you enroll in any Medicare Advantage plan.

For broader Georgia Medicare enrollment data and plan availability by region, see our Florida Medicare data page — Georgia-specific data is available through the same CMS enrollment resources linked there.

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The New $2,000 Out-of-Pocket Cap — What It Means for You {#the-new-2000-out-of-pocket-cap}

Starting in 2025, the Inflation Reduction Act put a hard cap on what you can pay out of pocket for Part D drugs in a calendar year: $2,000 (CMS, Inflation Reduction Act, 2022). Once you hit that threshold, your plan covers 100% of covered drug costs for the rest of the year.

This is a significant change — and it may actually shift which plan makes the most financial sense for you compared to prior years. If you take expensive specialty medications, this cap may mean a plan with a higher premium is still worth it overall. If your drug costs are low, you may be better served by a lower-premium plan.

The $35/month insulin cap also continues under Part D — every covered insulin is capped at $35 per month per prescription (CMS). If you use insulin, this is a meaningful floor regardless of which Part D plan you choose.

See our full breakdown of 2026 Medicare costs to understand how these figures work together.

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How to Do the Review Step by Step {#how-to-do-the-review-step-by-step}

Here's a practical process that typically takes 30-45 minutes:

1. Pull out your current medications list. Include the drug name, dosage, and how often you take it. 2. Read your ANOC letter. Look for changes to your specific drugs, your pharmacy, and your premium. 3. Go to Medicare.gov's Plan Finder or use our plan comparison tool. Enter your ZIP code and medications. 4. Sort results by estimated annual cost — not just monthly premium. A plan with a higher premium sometimes costs less overall if it covers your drugs at lower tiers. 5. Check pharmacy compatibility. Make sure your preferred pharmacy is in-network (and ideally preferred-network) on any plan you're considering. 6. Note the enrollment window. The Annual Enrollment Period runs October 15-December 7 each year. Coverage changes take effect January 1. Review the Medicare enrollment periods page if you have questions about timing.

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Common Mistakes People Make {#common-mistakes-people-make}

• Assuming nothing changed. Plans change every year. Don't assume your plan renewed identically.
• Comparing only by premium. A $0-premium plan can end up costing more if it places your medications on higher tiers.
• Forgetting to check the pharmacy network. A plan may cover your drug but not at your preferred pharmacy.
• Missing the enrollment window. Outside the Annual Enrollment Period, your options to switch are limited. See our Medicare FAQ for details on exceptions.

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When to Call a Licensed Medicare Advisor {#when-to-call-a-licensed-medicare-advisor}

If you're managing multiple medications, have recently been diagnosed with something new, or feel genuinely uncertain about what you're reading, a licensed Medicare advisor can walk through your specific situation with you at no cost to you.

Advisors licensed in Georgia can access the same plan data as Medicare.gov, but can do the comparison with you — explaining trade-offs in plain language and flagging things the online tool doesn't always catch, like prior authorization requirements or step therapy rules on specific drugs.

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Frequently Asked Questions

Q: How often should I review my Medicare Part D plan? A: Every year, during the Annual Enrollment Period (October 15-December 7). Plans change annually, and a review takes less than an hour but can make a real difference in what you pay.

Q: What if I miss the Annual Enrollment Period — can I still switch plans? A: In most cases, no — you'd need to wait until the next Annual Enrollment Period unless you qualify for a Special Enrollment Period. Qualifying events include moving, losing other coverage, or qualifying for Extra Help. See the Medicare enrollment periods page for specifics.

Q: Does my Medicare Advantage plan cover prescriptions, or do I need a separate Part D plan? A: It depends on the plan. Many Medicare Advantage plans include drug coverage (called MAPD plans), but not all. Check your plan's Evidence of Coverage document or call the plan directly to confirm.

Q: Is there any cost to work with a licensed Medicare advisor? A: Working with a licensed Medicare advisor is typically free to you. Advisors are compensated by insurance carriers if you enroll in a plan through them — but they're also required to work in your best interest under CMS marketing guidelines.

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The Bottom Line

Your Medicare drug plan may not be the right fit for you anymore — not because you made a bad choice last year, but because plans change and so do circumstances. Taking an hour each fall to review your coverage is one of the most practical things you can do to make sure your costs stay manageable and your prescriptions stay covered.

If you'd like help doing that review, I'm happy to walk through it with you. Schedule your free Medicare review today — no pressure, just straight answers. You can also reach me directly at 561-247-0678.

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Sources

• CMS Medicare Monthly Enrollment, 2024 — Florida Medicare Advantage enrollment (56.1%)
• CMS, 2024 — National Medicare Advantage enrollment (~54%)
• CMS, November 2025 — 2026 Part B premium ($185/month) and deductible ($257)
• Inflation Reduction Act, 2022 (CMS implementation) — Part D $2,000 out-of-pocket cap (effective 2025)
• CMS — $35/month insulin cap under Medicare Part D
• CMS, 2025 — 2026 Medicare Advantage in-network out-of-pocket maximum cap ($9,350)
• CMS Annual Notice of Change (ANOC) requirements — CMS Medicare Plan Communication regulations
• Medicare.gov Plan Finder — drug plan comparison methodology

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This article is for educational purposes and is not affiliated with or endorsed by the federal Medicare program or any government agency. HealthPlan Connect is a private, licensed Medicare advisory service. FL License #G007269.