The return of Jimmy Walker and Joe Namath to our TVs every fall coincides with the Medicare Annual Enrollment Period, which begins October 15 and ends December 7. This is when Medicare enrollees can review and update their Part D or Medicare Advantage plan choice for the upcoming year. Here are the highlights regarding prescription coverage:

The Medicare Prescription Payment Plan (M3P), which began in 2025, will continue to be offered. It helps individuals on Medicare with high prescription costs “smooth out” their overall expense over the 12 months of their Part D plans.

There are still two ways prescription costs could be calculated: with or without “smoothing.” If a member elects the smoothing option, the plan will bill the member for the monthly prescription cost instead of paying for each prescription at the pharmacy. Effective in 2026, Part D plans will be required to automatically renew people who opted-in to the M3P in 2025.

Smoothing affects those individuals who have Rx costs over $175 per month. For people taking generics, M3P will likely not affect their pharmacy experience, as they will still have zero or low dollar co-pays. Insulin will be the lesser of either $35 co-pay for a 30-day supply or 25% of the maximum fair price established under the Medicare Drug Price Negotiation Program.

The true out-of-pocket (TrOOP) that someone with a Part D plan will pay in 2026 for covered medications is $2100. Prescriptions filled using an online discount program or at an international pharmacy do not count toward the TrOOP. Roughly six percent of Medicare enrollees with Part D plans were projected to meet the 2025 TrOOP of $2000.

The “donut hole” and its coinsurance structure were eliminated from the Medicare program in 2025 and will not return.

Between watching Joe Namath commercials, it is important for Medicare enrollees to read their Annual Notice of Change (ANOC) documents sent in September, check the formulary to make sure their prescriptions will still be covered, and finally, seek assistance if needed.

The licensed insurance agents at On Point insurance Agency (InsuranceOnPoint.com) are here to help review options and make 2025 Part D prescription drug plan choices.