{"id":482,"date":"2025-12-23T19:40:38","date_gmt":"2025-12-23T19:40:38","guid":{"rendered":"https:\/\/blog.tma.gototaia.com\/index.php\/2025\/12\/23\/aeps-over-now-what\/"},"modified":"2025-12-23T19:40:38","modified_gmt":"2025-12-23T19:40:38","slug":"aeps-over-now-what","status":"publish","type":"post","link":"https:\/\/blog.tma.gototaia.com\/index.php\/2025\/12\/23\/aeps-over-now-what\/","title":{"rendered":"AEP\u2019s Over \u2014 Now What?"},"content":{"rendered":"<p><img fetchpriority=\"high\" decoding=\"async\" width=\"1200\" height=\"628\" src=\"https:\/\/trustedmedicareanswers.com\/wp-content\/uploads\/2025\/12\/2025.12.04_December-Medicare-Blog.jpg\" class=\"attachment-full size-full wp-post-image\" alt=\"\" style=\"float:right;margin:0 0 10px 10px\" \/><\/p>\n<p>AEP is officially in the rear-view, and now it\u2019s all about making sure your <strong>2026<\/strong> coverage starts smooth on <strong>Jan 1<\/strong> and knowing your options if something isn\u2019t right.<\/p>\n<p><strong>1) Look for your plan welcome kit &amp; Evidence of Coverage (EOC)<\/strong><\/p>\n<p>Your plan mails an <strong>EOC<\/strong> each fall that spells out what\u2019s covered, copays, rules (like prior auth), and extras (dental\/vision\/OTC). Keep it handy for January appointments and refills.<\/p>\n<p><strong>Broker tip:<\/strong> If anything looks different from what you expected, send your broker a photo of the page, we\u2019ll translate the fine print.<\/p>\n<p><strong>2) Refill meds early in January (and know your rights)<\/strong><\/p>\n<p>Most Part D plans must give you a <strong>one-time transition fill<\/strong> (typically a 30-day supply) during your first <strong>90 days<\/strong> in the new plan if a medication you\u2019ve been taking isn\u2019t on the formulary or needs prior auth\/step therapy. Use that time to work with your doctor and the plan on an exception or alternative.<\/p>\n<p><strong>Also new-year basics to expect:<\/strong><\/p>\n<ul class=\"wp-block-list\">\n<li>Some plans have a <strong>2026 Part D deductible up to $615<\/strong> (many set lower). You\u2019ll pay full price until you meet it.<\/li>\n<li>There\u2019s a <strong>hard cap on Part D out-of-pocket costs<\/strong>: once you hit <strong>$2,100 in 2026<\/strong>, you owe <strong>$0<\/strong> for covered Part D drugs the rest of the year.<\/li>\n<li>If big early-year refills strain your budget, you can opt into Medicare\u2019s <strong>Prescription Payment Plan<\/strong> to spread eligible drug costs into monthly bills.<\/li>\n<\/ul>\n<p><strong>3) Double-check doctors, pharmacies, and extras<\/strong><\/p>\n<p>Before your first 2026 visit or refill, confirm your <strong>primary care<\/strong>, specialists, and <strong>pharmacy<\/strong> are in-network on your new plan, networks and preferred pharmacies change year-to-year. Your plan portal and EOC list them.<\/p>\n<p><strong>4) If your new plan isn\u2019t a fit, you still have options<\/strong><\/p>\n<ul class=\"wp-block-list\">\n<li><strong>Medicare Advantage Open Enrollment Period (MA-OEP):<\/strong> If you\u2019re <strong>already in a Medicare Advantage plan<\/strong>, you can <strong>switch to a different MA plan or go back to Original Medicare<\/strong> once between <strong>Jan 1\u2013Mar 31<\/strong>. Changes take effect the first of the month after the plan gets your request.<\/li>\n<li><strong>5-Star SEP:<\/strong> If a <strong>5-Star<\/strong> plan is offered where you live, you can use a <strong>one-time Special Enrollment Period<\/strong> <strong>Dec 8\u2013Nov 30<\/strong> to move to it.<\/li>\n<li><strong>Life-event SEPs:<\/strong> Moving, losing other coverage, or certain plan issues can open a Special Enrollment Period at any time, ask your broker if one applies to you.<\/li>\n<\/ul>\n<p><strong>5) Quick January to-dos<\/strong><\/p>\n<ul class=\"wp-block-list\">\n<li><strong>Carry your new ID card<\/strong> to appointments and the pharmacy once it arrives (your plan can give temporary details if you need a refill before the card shows).<\/li>\n<li><strong>Update your medication list<\/strong> (name\/dose\/frequency) and share it with your doctors and your broker.<\/li>\n<li><strong>Schedule preventive care<\/strong>, your plan\u2019s EOC lists covered screenings and wellness visits.<\/li>\n<\/ul>\n<p><strong>Want a second pair of eyes on your 2026 setup?<\/strong><\/p>\n<p><strong>Email your broker your plan name and medication list.<\/strong> We\u2019ll confirm your doctors and pharmacies, check drug tiers and deductibles, and walk you through options like the Payment Plan or SEPs so your <strong>January 1<\/strong> start is seamless.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>AEP is officially in the rear-view, and now it\u2019s all about making sure your 2026 coverage starts smooth on Jan 1 and knowing your options if something isn\u2019t right. 1) Look for your plan welcome kit &amp; Evidence of Coverage (EOC) Your plan mails an EOC each fall that spells out what\u2019s covered, copays, rules [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":483,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2,3,5,11,8,12],"tags":[],"class_list":["post-482","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-costs","category-coverage","category-enrollment","category-benefits","category-medicare","category-medicare_advantage"],"_links":{"self":[{"href":"https:\/\/blog.tma.gototaia.com\/index.php\/wp-json\/wp\/v2\/posts\/482","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blog.tma.gototaia.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blog.tma.gototaia.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blog.tma.gototaia.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/blog.tma.gototaia.com\/index.php\/wp-json\/wp\/v2\/comments?post=482"}],"version-history":[{"count":0,"href":"https:\/\/blog.tma.gototaia.com\/index.php\/wp-json\/wp\/v2\/posts\/482\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/blog.tma.gototaia.com\/index.php\/wp-json\/wp\/v2\/media\/483"}],"wp:attachment":[{"href":"https:\/\/blog.tma.gototaia.com\/index.php\/wp-json\/wp\/v2\/media?parent=482"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blog.tma.gototaia.com\/index.php\/wp-json\/wp\/v2\/categories?post=482"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blog.tma.gototaia.com\/index.php\/wp-json\/wp\/v2\/tags?post=482"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}