Written and medically reviewed by Dorcas Morak, Pharm.D
Open enrollment only comes once a year—which is why preparation matters. Whether you’re comparing Medicare Part D plans, Medicare Advantage with drug coverage, or an ACA marketplace plan, the goal is the same: make sure your prescriptions are affordable and covered, and know how to stretch every dollar at the pharmacy.
What Are the Key Dates for Open Enrollment?
The important windows in open enrollment are:
- Medicare Open Enrollment: October 15 – December 7. You can join, switch, or drop Medicare Advantage (Part C) or Part D drug plans.
- ACA Marketplace Open Enrollment: November 1 – January 15 in most states. During this time, you can enroll in a new plan or change existing coverage.
Your Savings Game Plan
- Make a complete medication list Write down all prescriptions, over-the-counter (OTC) medications, and supplements. Include drug name, strength, dosage, and frequency. This list helps you compare plans and gives your pharmacist a clear view for finding lower-cost options.
- Check the formulary Each plan has a formulary (list of covered drugs) organized into cost tiers. Verify coverage for all your medications, especially high-impact ones:
- Blood pressure: lisinopril, amlodipine
- Diabetes: metformin, insulin (e.g., Lantus, Humalog), GLP-1 agonists (semaglutide/Ozempic, dulaglutide/Trulicity)
- Cholesterol: atorvastatin, rosuvastatin
- Depression/Anxiety: sertraline, escitalopram
- Compare real prices at pharmacies Prices can vary dramatically. Use the RxLess® Assurance Plan Real-Time Price Finder to check costs at 70,000+ pharmacies nationwide. Even with insurance, knowing the cash price matters—many generics (like atorvastatin for cholesterol or fluoxetine for depression) are often cheaper with a discount than with insurance copays.
- Decide when to use insurance vs. discounts Choosing a plan sets your coverage for the year, but at each refill you can decide. If your plan’s copay for generic sertraline is higher than the RxLess® Assurance Plan coupon price, simply show the coupon and pay less. For high-cost brand-name drugs (like GLP-1s for diabetes and weight loss), check if manufacturer copay programs apply if you’re commercially insured.
- Ask about lower-cost alternatives Talk with your prescriber about generic or therapeutic equivalents:
- Statins: atorvastatin vs. rosuvastatin
- SSRIs: sertraline vs. escitalopram
- Inhalers: Symbicort vs. generic budesonide/formoterol Including these options on your med list helps you verify coverage during plan comparisons.
What to Evaluate When Comparing Plans
- Formulary coverage: Are your meds covered? On what tier? Do prior authorization, step therapy, or quantity limits apply?
- Pharmacy networks: Is your preferred pharmacy included? Some plans restrict you to specific chains or mail-order.
- Total costs: Add up premiums, deductibles, copays/coinsurance. Keep in mind that formularies aren’t static—plans can adjust tiers or add new restrictions during the year, although you’ll receive advance notice. If this happens, you may be able to request an exception to maintain access at the same cost.
- Provider networks: Make sure your doctors and specialists are in-network, especially if frequent medication changes are expected.
How the RxLess® Assurance Plan Fits Into Open Enrollment
- Before enrollment: Use the Real-Time Price Finder to estimate what your annual drug costs might look like under different plans. Compare plan copays vs. discount coupon prices.
- After enrollment: At each refill, quickly check whether your plan copay or RxLess® Assurance Plan coupon gives you the lowest price. Just show the digital coupon from the app at the pharmacy counter—no membership fees required.
Extra Tips to Maximize Savings
- Know which drugs are not covered under Medicare Part D or ACA plans (e.g., weight-loss medications like Wegovy, cosmetic meds, some vitamins/minerals). These can often be purchased at a much lower cash price by using the RxLess® app.
- If a medication isn’t covered or requires prior authorization, ask about formulary exceptions or appeals.
- For specialty or expensive drugs (e.g., biologics for rheumatoid arthritis like Humira or Enbrel), explore patient assistance programs (PAPs) or manufacturer coupons.
