Every fall, Medicare Advantage and Part D plans send members an Annual Notice of Change. It's easy to set aside. But if yours says a doctor you see is leaving the network, or a drug you take won't be covered the same way next year, you still have time to do something about it.
This guide walks through what to check, what your options are, and the dates that matter. There's also a free printable checklist to keep track of every doctor and prescription.
How do you confirm the change?
Start with your Annual Notice of Change (ANOC). It lists what will be different on January 1, including the network and the drug list. Then check the details yourself, because a notice can be easy to misread and networks can change after it was printed.
- Look at next year's provider directory and drug list. The drug list is also called a formulary. Your plan's website or member services can point you to next year's versions.
- Call your doctor's billing office. Ask: "Will you be in network with my plan on January 1?" The billing office usually knows before anyone else.
- Use the Medicare Plan Finder or call 1-800-MEDICARE. The Plan Finder on Medicare.gov lets you enter your drugs and see how plans in your area cover them.
What if your doctor or hospital is leaving the network?
If a doctor or hospital you count on won't be in your plan's network next year, you have a few paths. Which one fits depends on how much that doctor matters to you and what kind of coverage you have now.
Switch plans during Annual Enrollment
From October 15 to December 7, you can switch to a plan where your doctors are in network. The new plan starts January 1. This is the simplest fix, and the one most people use.
Use Medicare Advantage Open Enrollment (Jan 1 – Mar 31)
If you're in a Medicare Advantage plan, you get one more chance early in the year. Between January 1 and March 31, you can make one switch to another Medicare Advantage plan, or go back to Original Medicare.
Ask about mid-year network changes
If a plan's network changes in a big way during the year, Medicare may allow a Special Enrollment Period so you can change plans outside the usual dates. Ask your plan or call 1-800-MEDICARE if this happens to you.
Consider Original Medicare
With Original Medicare, you can see any provider in the country that accepts Medicare, so networks aren't a concern. But think it through before you leave a Medicare Advantage plan. In many states, buying a Medigap (Medicare Supplement) policy later may mean answering health questions, and you could be turned down or charged more. Talk it over first so the choice still works if your health changes.
What if your drug isn't covered or costs more next year?
Drug lists change every year. A drug can leave the list, move to a higher-cost tier, or pick up new rules like prior authorization. Here are your options.
Switch to a plan that covers it
During Annual Enrollment, look for a plan that covers your drug at your dose. Check the tier and any limits, not just whether the drug is on the list.
Ask about a similar covered drug
Your doctor may be able to switch you to a similar drug that is on your plan's formulary and works the same way for you. It's worth asking before you change plans over one prescription.
Ask for a formulary exception
If you need the drug you take now, your doctor can ask your plan to cover it anyway. This is called a formulary exception. Your doctor explains why the covered alternatives won't work for you, and the plan decides.
Know about the transition supply
If you join a new plan, or your drug drops off your plan's list, plans generally provide a temporary transition fill early in the year. That gives you time to switch drugs or ask for an exception without a gap. Ask your plan how its transition supply works.
The 2027 out-of-pocket cap
For covered Part D drugs, what you pay out of pocket is capped at $2,400 in 2027, up from $2,100 in 2026. The standard deductible is $700. Once you reach the cap, you don't pay anything more for covered drugs for the rest of the year.
The Medicare Prescription Payment Plan
This option lets you spread your out-of-pocket drug costs into monthly payments instead of paying it all at the pharmacy counter. It's optional, and it doesn't lower what you owe. It only changes when you pay. Ask your plan if it would help you.
What should you check before you switch?
Don't fix one problem by creating another. Before you pick a new plan, check all three:
- Doctors. Every doctor, specialist and hospital you use is in the new plan's network on January 1.
- Drugs. Every prescription is on the new plan's list, at your dose, with the tier and limits you expect.
- Pharmacy. Your pharmacy is in network, and ideally a preferred pharmacy.
Then compare the total yearly cost, not just the monthly premium. Add up the premium, deductibles, copays and the most you could pay out of pocket. A plan with a lower premium can cost more over a full year.
A licensed agent can run this check with you against the plans available in your area, so you're not comparing lists by hand.
What are the key dates?
- Oct 15Annual Enrollment opens
- Dec 7Last day to switch
- Jan 1New plan starts
- Jan 1 – Mar 31Medicare Advantage Open Enrollment
The big one is December 7. After that, most people keep the plan they have, changes and all, unless they qualify for another enrollment period. If you're reading this during Annual Enrollment, there's still time.
Reviewing more than your doctors and drugs? The Medicare AEP Checklist covers everything else worth checking this fall.
Free printable: My Doctors & Drugs Check
Write down every doctor and prescription, then check each one against next year's plan. No email needed. Print it or save it as a PDF.
| Name | In network now? | In network Jan 1? | Confirmed with office on (date) |
|---|---|---|---|
| Drug & dose | On next year's list? | Tier | Prior auth / limits? | Notes |
|---|---|---|---|---|
- Is my doctor in network on January 1?
- Is my drug on next year's formulary, and at what tier?
- Is there a covered drug that works the same way?
- What's my total yearly cost: premium, deductibles, copays and max out-of-pocket?
Reviewing everything else in your plan this fall? Use the free Medicare AEP Checklist.
Common questions
My doctor is leaving my Medicare Advantage plan. Can I switch plans?
Yes. During Annual Enrollment, October 15 to December 7, you can switch to a plan where your doctor is in network, and the new plan starts January 1. If you're in a Medicare Advantage plan, you also get one switch between January 1 and March 31.
What if my prescription isn't on my plan's drug list next year?
You can switch during Annual Enrollment to a plan that covers it, ask your doctor about a similar drug that is covered, or have your doctor ask the plan for a formulary exception. Plans generally provide a temporary transition fill early in the year while you sort it out.
What is a formulary exception?
It's a request, made by your doctor, asking your plan to cover a drug that isn't on its drug list, or to cover it on better terms. Your doctor explains why the covered alternatives won't work for you, and the plan decides.
What's the most I'll pay for prescriptions in 2027?
For covered Part D drugs, out-of-pocket costs are capped at $2,400 in 2027, up from $2,100 in 2026. The standard deductible is $700.
What happens if I miss December 7?
Most people keep the plan they have for the next year, changes included. If you're in a Medicare Advantage plan, you can still make one switch between January 1 and March 31. Some situations, like a big mid-year network change, may allow a Special Enrollment Period.
Will my plan renew automatically if I do nothing?
In most cases, yes. If your plan is still offered next year, you stay in it, with all the changes listed in your Annual Notice of Change. That's why it's worth reading the notice and checking your doctors and drugs before December 7.
Keep learning
- Free printableMedicare AEP Checklist
Seven things to review during Annual Enrollment, October 15 – December 7, with a free one-page printable.
- Free printableTurning 65 but still working? The Medicare decisions that can cost you thousands
Employer size, the HSA 6-month lookback, the 8-month clock, and IRMAA — the timing that keeps you out of trouble.
Sources
- Medicare.gov — Joining a plan (Annual Enrollment and Medicare Advantage Open Enrollment)
- Medicare.gov — What Medicare drug plans cover (formularies and exceptions)
- Medicare.gov — How much does Medicare drug coverage cost? (2027 $2,400 cap, $700 deductible)
- Medicare.gov — Medicare Prescription Payment Plan
- CMS — Announcement of CY 2027 Medicare Advantage Capitation Rates and Part C and Part D Payment Policies