If your Medicare Advantage or Part D plan is ending at the close of the year, it is important to understand how you are affected and actions you should take to ensure you have needed coverage. If your plan is ending, it should send you a letter in early October explaining that it will no longer be available next year. However, your plan is still responsible for providing coverage for the remainder of the year. You should retain coverage until December 31, 2025.
When to enroll in a new plan
In general, you have two opportunities to enroll in a new plan if your plan is ending at the close of the year:
- Fall Open Enrollment: This period occurs each year from October 15 through December 7. During it, you can join a new Medicare Advantage Medicare Advantage, also known as Part C, Medicare Private Health Plan, or Medicare Managed Care Plan, allows you to get Medicare coverage from a private health plan that contracts with the federal government. All Medicare Advantage Plans must offer at least the same benefits as Original Medicare (Part A and Part B), but can do so with different rules, costs, and coverage restrictions. Plans typically offer Part D drug coverage as part of Medicare Advantage benefits. Medicare Advantage Plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service (PFFS) plans, Special Needs Plans (SNPs), and Medicare Medical Savings Accounts (MSAs). Plan or Part D Part D, also known as the Medicare prescription drug benefit, is the part of Medicare that provides prescription drug coverage. Part D is offered through private companies either as a stand-alone plan, for those enrolled in Original Medicare, or as a set of benefits included with a Medicare Advantage Plan. plan, or switch between Original Medicare and Medicare Advantage. Any change you make during Fall Open Enrollment will take effect January 1.
- Special Enrollment Period (SEP): Because your plan is ending, you have an SEP from December 8, 2025 through February 28, 2026 to change your Medicare health and drug coverage.
- Changes you make from December 8 through December 31 take effect January 1.
- Changes you make during January take effect February 1. Since your plan ended as of December 31, you will be automatically enrolled in Original Medicare Original Medicare, also known as Traditional Medicare, is the fee-for-service health insurance program offered through the federal government, which pays providers directly for the services you receive. Almost all doctors and hospitals in the U.S. accept Original Medicare. as of January 1 so that you still have coverage until you have made a formal decision.
- Changes you make in February take effect March 1. Since your plan ended as of December 31, you will be automatically enrolled in Original Medicare as of January 1 so that you still have coverage until you have made a formal decision.
If possible, you should make Medicare health and drug coverage changes by December 31 to make sure you have coverage that suits your needs when the year begins.
Picking a new plan
If you need help, you may want to consider:
- Differences between Original Medicare and Medicare Advantage
- Keep in mind that if you are considering Original Medicare, you may be eligible for a Medigap. Contact your State Department of Insurance or State Health Insurance Assistance Program (SHIP) to learn more about Medigap A Medigap is a supplemental health insurance policy that is sold by private insurance companies and works only with Original Medicare. Medigaps pay part or all of certain remaining costs after Original Medicare pays first. Depending on where you live and when you became eligible for Medicare, you have up to 10 different Medigap policies to choose from, each with a different set of standardized benefits. rules and regulations in your state.
- Questions you should ask before joining a Medicare Advantage Plan
- Keep in mind that Medicare Advantage Plans typically include prescription drug coverage.
- Questions you should ask when comparing Part D plans
You may also want to use Medicare’s Plan Finder tool on if you need help finding and comparing plans. The Plan Finder tool compares plans based on your health and drug needs and the facilities you use.
Remember: If your plan is ending and you do not make any changes by December 31, you will be automatically enrolled in Original Medicare as of January 1, but you still have until the end of February to make health and drug coverage changes. It is important to know that if you are automatically enrolled in Original Medicare, you may face gaps in prescription drug coverage because you will not automatically receive a new Part D plan.
This coverage gap The coverage gap, also known as the Medicare Part D donut hole, is the phase of Part D coverage after your initial coverage period. As a result of the Affordable Care Act (ACA), the coverage gap was phased out in 2020. Your drug costs may still change when you enter the coverage gap, after your initial coverage period, but you will pay no more than 25% of the cost of your drugs in the coverage gap. does not apply to those with Extra Help. If you have Extra Help Extra Help, also known as the Part D Low-Income Subsidy (LIS), is a federal program administered by Social Security that helps pay for some to most of the out-of-pocket costs of Medicare prescription drug coverage, including coinsurances, deductibles, and premiums. People with Medicare who have income and assets below specified limits are eligible for Extra Help, which has different levels. Depending on your income and assets, you may qualify for either full Extra Help or partial Extra Help. People may also be automatically enrolled in Extra Help if they have certain other types of coverage, even if their income and assets are above the set levels. , your plan ends, and you do not make any changes, you will be automatically enrolled in Original Medicare and a benchmark The Extra Help benchmark amount, also known as the Extra Help Premium Amount, is the amount of money that full Extra Help will pay for the monthly premium of a Part D plan that offers basic benefits. Benchmarks vary by state, and if you enroll in a Part D plan with a monthly premium above your state’s benchmark amount, you will have to pay the difference. Part D plan starting January 1. You will have a monthly SEP to switch plans.