Why do my copays or premiums look different in January?

Question

Kathy Detweiler · Accepted Answer

Annual plan changes – Every January, many Centers for Medicare & Medicaid Services Medicare Advantage and Medicare Part D plans update their premiums, copays, deductibles, and drug formularies for the new plan year.

Deductibles reset – Most annual deductibles start over on January 1. Until you've met your deductible, you may pay more for doctor visits, hospital care, or prescriptions.

Premium adjustments – Your monthly premiums for Medicare, Medicare Advantage, Part D, or supplemental coverage may increase or decrease based on the new year's rates.
Prescription drug coverage changes – Your medications may move to a different formulary tier, resulting in higher or lower copays. Pharmacy networks can also change from year to year.

Always read your Annual Notice of Change (ANOC). It explains any changes to your premiums, copays, deductibles, and covered medications before the new plan year begins.

Cheryl Lockhart · Answer

It’s very common for Medicare beneficiaries to notice changes in their copays, deductibles, or premiums when January arrives. This usually happens because Medicare plans reset and update each calendar year.

Many Medicare Advantage and Part D plans make annual changes to costs, including monthly premiums, prescription copays, and deductibles. Even if you stayed on the same plan, the benefits and pricing may not be exactly the same as last year. January 1st marks the start of the new plan year, so deductibles reset and cost-sharing often goes back to the beginning.
Another reason your costs may look different is that prescription drug tiers or pharmacy pricing can change. A medication that was inexpensive last year may move to a different tier or your preferred pharmacy status may have changed.

Additionally, Medicare Part B premiums and deductibles are set by Medicare each year and can increase, which may affect your overall costs even if your plan itself didn’t change.
If your January costs catch you by surprise, don’t panic.  It doesn’t necessarily mean something is wrong. It does mean it is a good time to review your coverage and make sure your plan still fits your needs.

A licensed, independent Medicare agent can help explain these changes and review your options so you’re not paying more than you should.

Enoch Vega · Answer

This is a very common question, and you’re not alone.

Many Medicare plans reset or change on January 1. Even if you stayed on the same plan, things like monthly premiums, copays, deductibles, and drug costs can change at the start of the new year.

Here are the most common reasons:

Plans update their costs each year, including doctor visits, hospital stays, and prescriptions

Deductibles reset in January, so you may pay more at the beginning of the year until it’s met

Prescription drug costs can change, especially if medications move to a different tier

Income-related adjustments (IRMAA) can affect Part B or Part D premiums for some people

Nothing is “wrong” — it’s usually just the new year taking effect.

If something doesn’t look right or feels higher than expected, it’s a good idea to have your plan reviewed. A quick check can confirm whether the change is normal or if there may be a better option for you.

Tom Kowalczyk · Answer

If you are enrolled in a Medicare Advantage (Part C) or a standalone Prescription Drug (Part D) plan, your current benefits, copays, and premiums are valid through the end of the calendar year.

Each year, insurance companies must file their benefits with the Centers for Medicare & Medicaid Services (CMS). These companies often make adjustments based on new laws, regulations, prescription drug pricing, and other factors.

Because of these annual changes, it is important to review your coverage during the Annual Enrollment Period, which runs from October 15th to December 7th. This ensures your plan will continue to meet your needs for the upcoming year.

Mark Summers · Answer

Medicare Advantage plan designs are approved on an annual basis. Each year the insurance company adjusts the plans benefits in an effort to remain solvent. Once approved, the plans copays, premiums, co-insurance, in-network out of pocket maximum, and other benefits and features are effective January first. if the changes are not satisfactory to their clients; a different Medicare Advantage plan may be chosen between 10/15 - 12/07 for effective date 01/01.

Answered by Mark Summers on May 4, 2026

Broker Licensed in OR

Answered by Mark Summers Medicare Insurance Agent

James Wareheim · Answer

It sounds like you have a Medicare Advantage plan, and with Medicare Advantage plans, they can change every year. Open enrollment begins October 15th and ends December 7th. During that time, the insurance companies will come out with either just keeping their plans the same, or they may tweak and make some changes to their existing plan, or they may come out with all new plans. So you have to make a change, or you may have to move over from one plan to another.

It's kind of like group health where it renews annually. The insurance carriers take a look at what's going on, where they need to make changes, where the risks are, where their costs are, and they adjust their plans accordingly. So with Medicare Advantage, it's going to be an annual enrollment period, an annual renewal, and at that time it could change.

What you should be doing is talking to your agent, or a good agent, to go over the possible changes with you so you can make a decision whether you want to stay with the same plan you have with the changes or non-changes, or if you want to switch to another insurance carrier. So there are some options there for you, but yes, it will change. It could potentially change every year. And sometimes they eliminate plans, so you need to make a change to another plan. Or if they change some of the benefits in your plan and you don't like it, yeah, you switch over to another plan if you can.

But again, the key with this is having a good agent that you can communicate with whenever you have questions, and they'll reach out to you if there are any major changes to your plans or an open enrollment period.

Jon Morton · Answer

Each year, co-pays and premiums reset on January 1st. Numerous reasons, including cost of care, utilization, government regulations or policy changes or even type of plan can affect both the co-pays and premiums. For example, changing from an Advantage plan to a Medigap (also called Medicare Supplement) plan will change both of these quite a bit. Higher utilization increases costs, and these can be shared by all members.

Answered by Jon Morton on January 12, 2026

Broker Licensed in NH, FL, MA & ME

Answered by Jon Morton Medicare Insurance Agent

Chris Hajjar · Answer

January is when many Medicare plans begin their new plan year. Your premiums, copays, deductibles, or prescription drug costs may change based on your plan's annual updates. If you're unsure why your costs changed, review your plan documents or contact your plan or a licensed Medicare agent for assistance.

Answered by Chris Hajjar on July 6, 2026

Agent Licensed in MI, AL, FL & 5 other states

Answered by Chris Hajjar Medicare Insurance Agent

Mary Brown · Answer

Copays and premiums can change in January because plans update costs and coverage each year during the Annual Election Period (AEP, Oct 15–Dec 7), so new deductibles, copays, or premiums take effect on January 1.

Answered by Mary Brown on March 30, 2026

Broker Licensed in NJ, DE, FL & NC, OH, PA & TX

Answered by Mary Brown Medicare Insurance Agent

Russell Scott · Answer

MA, MAPD and PDP plans are created and exist on a calendar year basis. That means that every January 1st of each year your plan benefits will update with the changes that we approved for the following year. Members are usually notified of these changes each fall in advance of January.

Answered by Russell Scott on January 12, 2026

Agent Licensed in OK, CO, KS, MO & TX

Answered by Russell Scott Medicare Insurance Agent

C. Faye Ricketts · Answer

Every year around September, you should get an ANNUAL NOTICR OF CHANGE (ANOC) that will explain what’s changing in your plan for the upcoming year. There you will see a side by side comparison of current plan and upcoming changes. Plans can change every year and at that time it’s best to get in contact with your agent to look at the changes and if, desired look at other plans.

Answered by C. Faye Ricketts on February 9, 2026

Agent Licensed in VA, AL, CO & 16 other states

Answered by C. Faye Ricketts Medicare Insurance Agent

Nikki Rowland · Answer

The plans change every year.  You should receive an Annual Notice of Changes around September/ October of each year if you are on a Medicare Advantage Plan.

If you have Original Medicare with a supplement, those premiums change each year as well.

Chad Sickle, RN · Answer

Great question, you are probably noticing your deductibles have started over and your current plan may have changed their copays and your agent didn't inform you or your insurance company didn't clearly communicate the annual notice of changes to you.

Answered by Chad Sickle, RN on February 2, 2026

Broker Licensed in NC & SC

Answered by Chad Sickle, RN Medicare Insurance Agent

Jim Tretola · Answer

You Premiums and copays probably all increased.
You should have seen this in your Annual Notice of Change letter you received in October.
If you use a Broker, they should have discussed it with you.

Tamekia Mckinnie · Answer

At the beginning of every year the co-pay and deductible are reset for the new year. Where as at the end of the previous year once the spending maximums have been achieved the numbers may look different.

Answered by Tamekia Mckinnie on May 25, 2026

Agent Licensed in FL

Answered by Tamekia Mckinnie Medicare Insurance Agent

Andrew Kramer · Answer

This is because Advantage plan co-pays can change from one year to the next. You received your ANOC (Annual Notice of Change) back at the end of Sept. Didn't you look at it?

Steve Houchens · Answer

Because plans are yearly contracts and may change every year.  That’s why it’s important to do a yearly review of your options

Andrew Bartley · Answer

Federal contracts are yearly so every carrier must resubmit and get approved by the government and that's why your plans change every single year

Daniel Brechin · Answer

Annually Medicare programs including supplemental programs and prescription programs are adjusted annually. Plans have to put this out to Congress the prior year. So, plans have to be approved annually at the prior year for the future plan.

Answered by Daniel Brechin on January 12, 2026

Agent Licensed in AL, FL, KY, MS & TN

Answered by Daniel Brechin Medicare Insurance Agent

Mike Alexander · Answer

All plqns change tgeir benefits in Jan of each year ckeck you plan benefits for 2026, you should have received an Anoc letter in Oct with changes to your current plan.

Sherry Rose · Answer

This can vary, depending on what Medicare plan you are on. Please contact our office so we can further assist you.

Why do my copays or premiums look different in January?

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