Why is the Annual Enrollment Period so Important?

No doubt you are starting to see advertisements on tv or in the mail discussing Medicare Annual Enrollment Period (AEP), which begins October 15th and ends December 7th. As you know, I send out reminders about this time period with paperwork for you to complete and return so that I can help you review all of the plan options on the market, based on your current prescription list.

I do get emails and phone calls from clients saying

• "Do I have to do this?"

• "Can't you just tell me over the phone what plan to go on without me sending in my list?"

• "Nothing has changed, use what you had before."

• "I am on the best plan there is, I don't want to change!".

Here is why I recommend you do this... every year.

"I am on the best plan there is!" 

While this is likely true based on the recommendation I made for you back in the winter of 2024, it is very possible this is not the case for 2026. Even if you are still taking the same two prescriptions in 2026 that you were taking in 2024, how would you feel if your costs doubled? Monthly costs, covered drug lists, drug tiers, pharmacies that are in network, your out-of-pocket costs -- these things do change every year.

I cannot tell you how many times I have received phone calls from clients, concerned because a drug is not covered on their plan. It is almost always because this person opted out of AEP and then was blindsided to find a new prescription was not a covered benefit.

Is it possible that I will review your prescriptions this year and recommend you don't make a change? Absolutely! It could happen and I am happy to leave you where you are. Less work for me and less complication for you! Win-win for both of us.

However, I am not doing my job as your agents if I dont make sure you are aware of the potential repercussions of not participating in the AEP review.

"Nothing has changed, just use what you had before."

Maybe this is true and your prescription list is the exact same as it was when you submitted your prescriptions to us during AEP 2025. But can I guarantee this? No. Can I guarantee your plan will be the exact same for 2026? No, because at the bare minimum, the premium will likely change as will your calendar year deductible.

What I commonly find in this scenario is that more often than not there has been some sort of a change – whether a dosage has gone up or down, a frequency increased or decreased. Any of these little adjustments could easily affect the plan suggestion I would make for you in 2026.

"Do I have to do this?"

Well... no. Of course not, you don't have to do anything you don't want to. If you choose to not participate in AEP, I am fine with that, as long as you fully understand the potential repercussions:

1. Prices on prescription drugs can fluctuate.

2. Monthly premiums generally change each year.

3. Calendar year deductibles generally increase each year.

4. Prescription drug carriers can and do change their formulary list over the course of the year. This includes changing drug tiers or no longer covering drugs.

5. It is possible that your plan that was excellent for you in 2025 could be very costly for you in 2026, or it is possible there could be a plan available to you in 2026 that would be an even better option.

6. (And, it is possible your current plan will still be excellent for you in 2026!)

"Can't you just tell me over the phone what plan to go on without me sending in my list?"

New laws stipulate that I cannot discuss the new prescription drug plans over the phone at all without the phone call being recorded by a 3rd party, and that recording will be stored in their database for 10 years. There is no option for the client or the agent to opt out of that phone call. Therefore, I must have any prescription lists in writing or submitted electronically through my portal to protect the privacy of my clients. This also assures me, and you, that I am looking at the most accurate information possible when I review your options.

"In what situations would you feel comfortable with me opting out of AEP?"

That's a hard question to answer, because I will always worry about you, as my clients!

1. If you take ZERO prescriptions and are on the most-cost efficient plan for you on the market.

2. If you are aware of everything above and still prefer not to make a change.

3. If making a change is something that adds additional stress and worry to your life and you understand the repercussions above.

4. If you simply don't want to, and you understand the repercussions.

Trust me when I say AEP is a lot of work. It is all I do all day, every day from October 1st-December 7th. No kidding! It closely resembles this picture. However, if you fall into one of the categories above and choose to opt out, I will try not to worry too much about you!

Thank you for reading and please subscribe for updates!