I started taking a new prescription this year. Do I need to change my Medicare plan?

Question

Mike Cooper · Accepted Answer

Did you know?  Prescription formularies (i.e., the list of medications your plan does/does not cover) can change year over year?  What's covered this year... might not be covered next year.  If it is covered, the price you're used to paying... could change.

It's always best to have your agent verify your latest list of prescriptions during the Annual Enrollment Period (AEP).  This takes place 10/1 - 12/7 each year.

NOTE: A growing trend with carriers is refusing to pay agents commissions on Prescription Drug Plans (PDPs)...  That said, make sure your agent cares more about your best interests than the commissions.

Gary Church · Answer

Not necessary! It would depend on the prescription and the tier level. Is your drug in the MAPD formulary? If it's a PDP, I would recommend reviewing your plan every AEP, from October 15th to December 7th.

Answered by Gary Church on September 14, 2025

Broker Licensed in Ca, AZ, NV & TX

Answered by Gary Church Medicare Insurance Agent

Mike Alexander · Answer

No but you wil need to check and aee if you plan will cover that drug or use an alternative like good rx

William Lawler · Answer

Hello, Bill Lawler here. The question was, you started taking a new medication this year, and do you have to change Medicare plans? Probably not. If your particular medicine is not covered by your current plan, you can always ask your doctor to file an exception. That would allow your health care company to cover that medicine. Only then would you consider changing plans. I'm here to help.

Ann Sanfelippo · Answer

Not necessarily, but it’s important to review your current coverage. You should check whether the new prescription is on your plan’s drug formulary and what tier it’s in, since that affects your cost. If the medication is covered and affordable, you may not need to change anything. If it’s not covered or is very expensive, you can compare other Part D or Medicare Advantage plans during the next enrollment period to see if switching would lower your costs.

Answered by Ann Sanfelippo on February 3, 2026

Broker Licensed in FL, AL, AZ & 14 other states

Answered by Ann Sanfelippo Medicare Insurance Agent

Pamela Masters · Answer

Not necessarily. Check with your plan to see if that medication is covered in the dose you take. That’s the first step. If it’s not covered then ask your doctor to request an exception from your plan. If the plan denies the coverage then during AEP ( annual enrollment period from Oct 15-Dec 7) it would be a good idea to check other plans to see if they cover it for next year.

Answered by Pamela Masters on September 29, 2025

Broker Licensed in NC

Answered by Pamela Masters Medicare Insurance Agent

Ray McCauley · Answer

NOT NECESSARILY, CHECK YOUR CURRENT PLAN AND SEE IF THAT DRUG IS COVERED. IF ITS NOT YOU WILL WANT TO LOOK AT A PLAN THAT DOES

Richard Moreno · Answer

No, you do not have to change plans as long as it is covered and part of the plan’s formulary. However, you may need to compare the price and tier of your new medication to other plans and see if making a switch to another plan may be less costly for the medication if all other plan coverage the same or better overall. You may need to wait till Annual enrollment to do so unless you qualify for a special enrollment period.

Answered by Richard Moreno on April 13, 2026

Broker Licensed in TX, CA, FL, LA, NM & OH

Answered by Richard Moreno Medicare Insurance Agent

Kelsey Hentzen · Answer

This is a great question. It is always good to have your Part D looked at especially if you are on a new medication. Each year, your prescription coverage can change. You should receive and ANOC (Annual Notice of Change) from the carrier you selected for your part D. This has information on prescription drug changes for the next year.

Answered by Kelsey Hentzen on September 30, 2025

Broker Licensed in KS & MO

Answered by Kelsey Hentzen Medicare Insurance Agent

Lilyana Uzdenova-Gomez · Answer

You can verify if your new medication is covered by calling your current insurance carrier or by going to their website and searching their formulary. You can also go to the medicare.gov website and enter your medication info into the appropriate window to verify coverage. After you verified the coverage and the tier you can calculate your yearly expense for that medication and decide if switching to another carrier makes sense. Some carriers may cover the same medication at a lower cost in the same drug tier, or even in a different tier with significant difference in cost. 
  Keep in mind that if you have an MAPD, changing your plan due to drug costs will lead to the changes in overall benefits. Consider if those overall changes are worth the savings in drug costs. If unsure, consult a trusted advisor with expertise in locally available plans.

Sandy Johnson · Answer

Not necessarily. If the new medication doesn't raise your overall drug cost, then no. But if the new prescription raises your cost significantly, speak with a licensed Medicare Agent to research if a different plan is a solution or if that medication would be about the same regardless of your plan. Furthermore, have a licensed Agent to give you an annual review each year to set cost expectations.

Answered by Sandy Johnson on February 23, 2026

Broker Licensed in LA, AL, AR & 11 other states

Answered by Sandy Johnson Medicare Insurance Agent

Nicholas Depke · Answer

Not necessarily, but it is absolutely worth checking. Every Part D drug plan and Medicare Advantage plan with drug coverage has its own formulary, which is the list of covered medications, and your new prescription may or may not be on your current plan's formulary at a tier you can afford. The best thing to do is run a formulary check on your current plan right away to see how your new medication is covered and what your cost sharing looks like. If your plan does not cover it well, you may qualify for a Special Enrollment Period depending on your situation, and the Annual Enrollment Period each fall from October 15 through December 7 is always an opportunity to switch to a plan that better covers your medications. Do not wait until the bills start adding up to take a look at this, because the difference in cost between a plan that covers your drug well and one that does not can be significant.

Answered by Nicholas Depke on March 26, 2026

Broker Licensed in NE, AZ, FL & 15 other states

Answered by Nicholas Depke Medicare Insurance Agent

Michael White · Answer

Starting to take a new prescription in itself is not necessarily reason to change your plan. I would advise reviewing your plan as well as the new medication to make sure that it is covered by your plan and or if there might be a better plan for covering it if necessary. Always review with a licensed agent when possible!

Answered by Michael White on September 16, 2025

Broker Licensed in IN, AL, CO & 16 other states

Answered by Michael White Medicare Insurance Agent

Joel Hill · Answer

Starting a new prescription doesn’t always mean you have to change your Medicare plan—but it’s a good reason to review your coverage.
	•	Every Medicare Advantage and Part D drug plan has its own formulary (list of covered drugs).
	•	If your new prescription is covered and affordable under your current plan, you may not need to make any changes.
	•	If it’s not covered, requires high copays, or has restrictions (like prior authorization), then reviewing other plan options could save you money.

Joseph Lipski · Answer

You do not have to change your Medicare plan, providing the new medication is on your carriers formulary.  It is always a good idea to review your plan each year.

Grant Evans · Answer

That is a tough question because it would depend on the medication. It is always best to have an agent look over your current medications and doctors to ensure that you are in the best plan for the upcoming year.

Answered by Grant Evans on September 4, 2025

Broker Licensed in PA, FL, NC, OH, SC & WV

Answered by Grant Evans Medicare Insurance Agent

Steve Houchens · Answer

Where or not you need to change plans would depend on if your plan didn’t cover the new medication and another plan did. You would simply need to check if your medication is covered in the formulary or not.

Answered by Steve Houchens on September 4, 2025

Agent Licensed in KY & TN

Answered by Steve Houchens Medicare Insurance Agent

Barbara Patterson, CFP · Answer

No you should check with your current plan to see if they cover it.  Most plans cover many different drugs.

Deb Haley · Answer

It's always a good idea to revisit your plan selections during the annual enrollment period when you can make those types of changes. Your prescription coverage may be included with your current Medicare Advantage plan or if you are on a supplement plan and have a standalone Part D for your drug coverage you can change just your part D plan if you find another plan has more favorable pricing. The only time you can change your party coverage is during the annual enrollment period which is from October 15th through December 7th.

Answered by Deb Haley on September 15, 2025

Broker Licensed in MA, AZ, CA & 11 other states

Answered by Deb Haley Medicare Insurance Agent

Sabrina Mitter · Answer

Yes! With all the changes in plans each year you should always shop to make sure you have the correct and best plan for you. When your medications and health history change than you should really shop to make sure you are getting the lowest cost possible for your medication.

Answered by Sabrina Mitter on March 2, 2026

Agent Licensed in OH

Answered by Sabrina Mitter Medicare Insurance Agent

Andrew Kramer · Answer

That depends on the medication. But first of all, you didn't say whether your current plan covers that new Rx? Is it a brand name or generic? In either case, you can check the 2026 formulary of your plan, when it is available after Oct 1st, to see if it's in the formulary.

Answered by Andrew Kramer on September 4, 2025

Agent Licensed in FL

Answered by Andrew Kramer Medicare Insurance Agent

Mark Boone · Answer

You do not automatically need to change your Medicare plan, but you should review it to ensure your new prescription is covered cost-effectively. You can contact a licensed certified Medicare agent in your area that can help you compare plans and see if a new plan is right for you.

Answered by Mark Boone on March 2, 2026

Agent Licensed in MN, FL, MI & NC, OH, SC & VA

Answered by Mark Boone Medicare Insurance Agent

Nora Alishahi · Answer

Depends how your actual plans cover that prescription. You can wait to AEP to make changes if needed

Peggy Elliott · Answer

If your coverage under your existing Medicare plan takes care of the prescription drugs that you started taking this year, then there's really no reason to change unless you want to look to see whether there's a different plan that offers better coverage, etc. Other than that, yes, you can stay with the plan that you have. Thank you.

Elliot Andrews · Answer

Whenever you are written a new prescription you should check with your insurance provider to make sure it is covered. With Medicare insurance you may find that a certain prescription is not covered and may need to look into changing carriers to cover that specific drug if needed. If the prescription is already covered you do not need to make any changes.

Answered by Elliot Andrews on January 19, 2026

Agent Licensed in IN, FL, MI & OH, SC, TX & WA

Answered by Elliot Andrews Medicare Insurance Agent

Akia Alexis · Answer

Not necessarily,  you do want to be sure that drug is on the plan you currently have Formulary and if there is a drug deductible associated with the new medication.

Sue Mendoza · Answer

A licensed health insurance agent can review your medicines with you to see if you need to change plans. Most likely you will not need to change.

Pedro Rodriguez · Answer

English 
65+ and just started a new prescription? Not every Medicare plan covers the same drugs.  Check your plan’s formulary (drug list) — if your medicine isn’t covered or costs too much, you can switch during enrollment periods to save money and stay covered. 

Español 
¿65+ y empezaste una nueva medicina este año? No todos los planes de Medicare cubren los mismos medicamentos. Revisa el formulario (lista de medicinas) de tu plan — si tu medicina no está cubierta o es muy cara, puedes cambiar de plan en los períodos de inscripción para ahorrar y mantener tu cobertura.

David Cranford · Answer

Not necessarily. Check with the plan to make sure the prescription is in the formulary and in what tier is listed. Don't be too quick to change your Medicare Plan. The prescription coverage is just one feature. Keeping your doctors and knowing what hospitals are in the plans providers are also important.

Answered by David Cranford on December 15, 2025

Agent Licensed in OK, FL, IL, OH, TN & TX

Answered by David Cranford Medicare Insurance Agent

Kyle Nystrom · Answer

Maybe. It might be covered better elsewhere, especially if it's a specialty/exotic medication.

If you're on a Medicare Supplement plan with a separate Prescription Drug Plan (PDP), check how that plan covers your new drug by looking for your plans Formulary document.

If you're on a Medicare Advantage plan that also covers drugs (MAPD), check your Summary of Benefits, the plans Formulary, and/or the Evidence of Coverage documents for your plan.

Also worth checking are services such as mailed prescriptions and/or GoodRx or similar.

An agent will be able to guide you through finding these pieces of documentation and making a choice if better coverage is found.

Troy Albrecht · Answer

If your current prescription coverage is not covering a new medication well, it is certainly worth comparing your options during Open Enrollment (October 15th-December 7th annually) to see if a switch makes sense for the following year.

If the drug is not being covered by the current plan, you can work with your doctor to request a formulary exception from the carrier if it is medically necessary. You can contact your current carrier to determine if the denial is due to needing prior authorization, needing to try an alternative first, it is not on the formulary or etc.

Michele Spencer · Answer

You need to review your plan EVERY YEAR and especially for 2026. The list of covered drugs and prices will change from year to year. And if you miss doing an annual review, you may be stuck with the plan you have until the following open enrollment.

Answered by Michele Spencer on September 5, 2025

Agent Licensed in IN, KY & OH

Answered by Michele Spencer Medicare Insurance Agent

Nancy Nowell · Answer

The short answer is maybe.  Maybe not.

You should always review your Medicare plan each year during Annual Enrollment Period (Oct 15-December 7) for plan changes and options, for medication coverage and cost, as well as other benefit or coverage changes. 

If your current plan offers the best coverage at the lowest cost, then don't change. 
If there is a different plan which offers better coverage at lower cost, then change plans during Annual Enrollment Period, for the next year.  

An independent advisor should be able to review your current plan vs all options and help you identify the best available coverage, specifically for you.

LeShawn Fernandez · Answer

It depends on whether your meds are on the formulary and your medical needs. Please contact me if you need some additional questions answered. Thank you!

I started taking a new prescription this year. Do I need to change my Medicare plan?

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