Will my doctors and prescriptions still work next year?
Insights from David Harder, President · Published
Quick answer: maybe not, and the only way to know is to check. Medicare Advantage and Part D plans can change their networks, drug lists, drug tiers and copays every year. Before Annual Enrollment closes on December 7, check your doctors, specialists, hospital, pharmacy and every prescription against next year's plan.
Can my doctor leave my plan's network?
Yes. Networks can change every year. We see people who have seen a specialist for years find out that the specialist is not in network with their carrier next year. Check each doctor, specialist and hospital you want to keep against next year's network, and confirm with the carrier or the office before you decide.
Can my prescription costs change if I keep the same plan?
Yes. Plans update their drug lists every year. A drug can move to a different tier, the copay can change, and the plan's maximum out-of-pocket can change. Your Annual Notice of Change letter shows what changes on January 1.
Does my pharmacy matter?
It can. The same drug can cost different amounts at different pharmacies. Preferred pharmacies often cost less. We look at your specific drugs to find which pharmacy keeps your yearly cost lowest.
What is the 2027 Part D out-of-pocket limit?
For 2027, the most you pay in a calendar year for covered Part D drugs is $2,400. That counts drugs on your plan's drug list filled at a network pharmacy. It does not cover drugs your plan does not cover.
What should I bring so you can check?
A list of every medication with the name, dose and how often you take it, the names of your doctors, specialists and hospital, the pharmacy you use, and your Annual Notice of Change if you have it. Photos of your bottle labels work too.
What if I do nothing?
Your plan usually renews automatically, with next year's changes. If a doctor leaves the network or a drug moves to a higher tier, you may not find out until January. A review now takes the guesswork out.
How Spirit Insurance Group helps
Our licensed, salaried, non-commissioned team in Tulsa checks your doctors, hospital, pharmacy and prescriptions against the plans we represent, so you can see your options before December 7.
Educational information, not a recommendation for a particular plan. Costs and coverage vary by plan; see each plan's Evidence of Coverage. We do not offer every plan available in your area. Currently we represent 7 organizations which offer 60 products in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
