Medicare Open Enrollment ends December 7. Before keeping or changing drug coverage for 2026, compare your exact prescriptions, pharmacy network, plan rules and expected annual costs—not only the monthly premium.
If you have Medicare drug coverage, November is the time to compare what your prescriptions may actually cost in 2026. Medicare Open Enrollment runs from October 15 through December 7, and changes made during this period generally take effect January 1.
Start with your own medication list and preferred pharmacy. A low-premium plan can still cost more overall if a regular medication is on a higher tier, requires extra approval or costs more at the pharmacy you normally use.
Quick Answer
Before December 7, enter your current prescriptions and preferred pharmacies into Medicare’s Plan Compare tool, then compare each plan’s formulary, drug tiers, pharmacy network, deductible, estimated annual drug cost and coverage rules. For 2026, the maximum Part D deductible is $615 and the annual out-of-pocket limit for covered Part D drugs is $2,100. Those figures do not replace the need to compare the specific medications you take.
What the December 7 Medicare Deadline Means
Medicare Open Enrollment is the annual period when people with Medicare can review and change health or drug coverage. Between October 15 and December 7, available changes depend on your current coverage, and a new selection generally begins January 1.
This is separate from Covered California and the Health Insurance Marketplace. If you already have Medicare, use Medicare resources when reviewing Medicare Advantage or Part D choices.
Start With the Prescriptions You Actually Take
Do not begin by sorting plans by premium. Begin with an accurate medication list. Write down the exact medication name, strength, dosage form and usual quantity for every prescription you expect to continue using.
Medicare’s Plan Compare tool allows you to enter prescriptions and pharmacies so you can compare estimated costs among plans available in your ZIP code. This makes the comparison more useful than looking only at a plan’s advertised premium.
01
Check Every Medication
- Confirm the exact drug appears on the plan’s formulary.
- Check the tier assigned to the medication.
- Look for prior authorization or step therapy.
- Check whether a quantity limit is listed.
02
Check Every Pharmacy You Use
- Confirm the pharmacy participates in the specific plan.
- See whether it is a preferred in-network pharmacy.
- Compare retail and mail-order options when relevant.
- Check specialty-pharmacy requirements for specialty drugs.
Why Pharmacy Network Status Can Change What You Pay
Medicare drug plans contract with in-network pharmacies, and some plans designate preferred in-network pharmacies that may offer lower out-of-pocket costs. “In network” therefore does not always mean “lowest cost.”
Check the pharmacy you actually use for the specific plan. If you use a local pharmacy plus mail order or a specialty pharmacy, review each option and any rules that apply.
Four 2026 Part D Cost Details Worth Recognizing
Part D costs are built from several pieces, so the monthly premium does not tell the whole story. For 2026, Medicare states that no Medicare drug plan may have a deductible higher than $615, although some plans have a lower deductible or no deductible.
Medicare also caps annual out-of-pocket spending on covered Part D drugs at $2,100 in 2026. Once qualifying out-of-pocket spending reaches that amount, catastrophic coverage applies for covered Part D drugs. Plan premiums are separate from this drug out-of-pocket limit.
December 7
Open Enrollment deadline
$615
Maximum Part D deductible in 2026
$2,100
2026 out-of-pocket limit for covered Part D drugs
January 1
New coverage generally begins
The Medicare Prescription Payment Plan is also available to people with Medicare drug coverage. It can spread out-of-pocket prescription costs across the calendar year, but Medicare is clear that it does not reduce the total cost of your drugs.
Look Beyond the Formulary Name: Check the Coverage Rules
A medication appearing on a formulary does not always mean it can be filled without additional steps. Medicare drug plans may use prior authorization, step therapy or quantity limits for certain covered medications.
Prior authorization
The plan may require approval before it will cover a drug under the plan’s rules. Your prescriber may need to provide information showing that the plan’s coverage requirements are met.
Step therapy
The plan may require you to try another covered medication before it will cover a more expensive option. Exceptions may be available in some circumstances when supported by the prescriber.
Quantity limits
The plan may limit the amount of medication it covers during a certain period. If a different quantity is medically necessary, your prescriber may be able to request an exception.
Important Distinction
Your prescriber determines which medication is medically appropriate. The Medicare drug plan determines coverage under its rules. A pharmacy can help identify prescription-processing questions, but the plan is the final source for coverage, network and benefit details.
A California Prescription-Cost Checklist Before December 7
Use this checklist before you decide to keep your current drug plan or switch to another option for 2026.
- Create one current list of every regular prescription you take.
- Confirm every medication appears on the plan’s current formulary.
- Look for prior authorization, step therapy and quantity limits.
- Compare the plan premium, deductible and estimated annual prescription cost together.
- Enter your medications and preferred pharmacies into Medicare Plan Compare.
- Check each medication’s tier and expected copay or coinsurance.
- Confirm whether your pharmacy is in network or preferred in network.
- If changing plans, note what you may need for your first January refill.
Prescription Support
Changing Drug Coverage for 2026?
La Quinta Pharmacy can help with pharmacy-related prescription, refill and insurance-update questions. Confirm plan enrollment and exact benefit decisions with Medicare or the health plan.
If You Switch Plans, Prepare for the First January Refill
If you select new coverage, give the pharmacy updated insurance details before your first refill when possible and check whether any regular medication has a new prior-authorization, step-therapy or quantity-limit requirement.
A transition fill may sometimes be available when new coverage begins and a medication you already take is not covered or has certain restrictions. Ask the plan about its process, and do not stop or change a prescription without guidance from your prescriber.
Where California Medicare Beneficiaries Can Get Unbiased Help
California residents can use the Health Insurance Counseling and Advocacy Program (HICAP) for free, confidential Medicare counseling. HICAP can help with plan comparisons, prescription drug coverage, Extra Help and related Medicare questions. Find a local office through the California Department of Aging or call (800) 434-0222.
For federal plan comparisons, use Medicare Plan Compare. For pharmacy-related prescription, refill or insurance-update questions at La Quinta Pharmacy, call (760) 777-9902.
Frequently Asked Questions
When does Medicare Part D Open Enrollment end?
Medicare Open Enrollment runs from October 15 through December 7 each year. Changes selected during this period generally take effect January 1.
Does the lowest Part D premium usually mean the lowest prescription cost?
Not necessarily. Total prescription cost can also depend on the deductible, drug tiers, pharmacy network, copays or coinsurance and coverage rules.
How do I know if my pharmacy is preferred in network?
Use Medicare Plan Compare or the exact plan’s pharmacy information. Preferred in-network pharmacies may offer lower out-of-pocket costs than other pharmacies in the same network.
What if one of my medications is not on a plan’s formulary?
Contact the plan and your prescriber before making a change. An exception request may be possible in some circumstances. Do not stop or change a prescription without prescriber guidance.
Does the $2,100 Part D limit include my monthly premium?
No. The $2,100 limit applies to qualifying out-of-pocket spending for covered Part D drugs in 2026. Plan premiums are separate.
Make Your Medication List the Center of the Comparison
Before December 7, compare Medicare drug coverage using the prescriptions and pharmacies that matter to you. Check the formulary, tiers, network status, deductible, estimated annual cost and any approval rules that could affect regular refills.
Have a Pharmacy Question?
Ask La Quinta Pharmacy about a prescription, refill, insurance update or new-patient question, or call the pharmacy directly.
