The Medicare Annual Enrollment Period (AEP) happens every year from October 15 to December 7. During this time, anyone with Medicare can review, switch, or drop their Medicare Advantage and Part D prescription drug plans. Even if you’re happy with your current coverage, AEP is your chance to make sure your plan still meets your health and financial needs for the upcoming year. 

Why AEP Matters 

Healthcare needs and plan details can change every year: 

• Your prescriptions may have changed 

• Your doctor may no longer be in your plan’s network 

• Plan costs and coverage levels can change 

Reviewing your plan during AEP helps ensure you have the right coverage at the best value for your health needs. 

What You Can Do During AEP 

During the Annual Enrollment Period, you can: 

• Switch from Original Medicare to a Medicare Advantage plan (Part C) 

• Switch back from Medicare Advantage to Original Medicare 

• Change from one Medicare Advantage plan to another 

• Join, switch, or drop a Part D prescription drug plan 

Any changes you make will take effect January 1, 2026. 

Big Changes Coming in 2025 and 2026 

Here’s what’s new starting January 1, 2025, and beyond: 

1. $2,000 Out-of-Pocket Cap for Part D 

For the first time ever, your out-of-pocket prescription drug costs will be capped at $2,000 in 2025. In 2026, this cap will rise slightly to $2,100. 

2. Medicare Prescription Payment Plan (M3P Plan) 

This new voluntary program lets you spread out your prescription drug costs throughout the year rather than paying large amounts all at once. This will help people better manage their monthly budgets. 

3. No More 5% Catastrophic Coinsurance 

The previous 5% coinsurance for very high drug costs will be eliminated, meaning once you hit the cap, you won’t have to pay additional costs for covered Part D drugs. 

4. Expanded Extra Help Program 

Starting in 2025, more people will qualify for Extra Help, which lowers Part D premiums and copayments for those with limited income and resources. 

5. Free Adult Vaccines 

Adult vaccines such as shingles and flu shots will now be covered at no out-of-pocket cost, removing a key barrier to preventive care. 

6. $35 Insulin Cap 

Insulin costs will remain capped at $35 per month, making this life-saving medication more affordable for millions of Medicare beneficiaries. 

How to Prepare for AEP 

Here’s a quick checklist to make your AEP process smoother: 

1. Review your current plan – Look at what worked and what didn’t this year. 

2. List your medications and providers – Make sure they’re covered in your plan. 

3. Set a budget – Know what you can comfortably spend on premiums and prescriptions. 

4. Watch for plan updates – Plans send an Annual Notice of Change (ANOC) every September. 

5. Seek guidance if needed – Talk to a licensed Medicare advisor for personalized support. 

Key Dates to Remember 

• October 15 – December 7, 2025: AEP is open. 

• January 1, 2026: New plans and changes take effect. 

Resources and References 

Here are the official sources used to verify all information in this blog: 

1. AEP Dates and Rules – Medicare.gov 
   https://www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/joining-a-plan 

2. $2,000 Out-of-Pocket Cap (2025) – KFF: Medicare Part D in 2025: A First Look 
   https://www.kff.org/medicare/medicare-part-d-in-2025-a-first-look-at-prescription-drug-plan-availability-premiums-and-cost-sharing/ 

3. Cap Increase to $2,100 in 2026, Extra Help, Vaccines, and Insulin – PAN Foundation 
   https://www.panfoundation.org/everything-you-need-to-know-about-medicare-reforms/ 

4. Medicare Prescription Payment Plan – Medicare.gov 
   https://www.medicare.gov/health-drug-plans/part-d/basics/costs 

5. Insulin Savings Program – CMS 
   https://www.cms.gov/newsroom/fact-sheets/insulin-savings-program