Medicare Open Enrollment 2025 (Fresno): What to Do Between Oct 15 – Dec 7
From Oct 15 to Dec 7, you can review and change your Medicare Advantage or Part D plan for 2026. Check your doctors, drugs, and costs, and let us help you confirm your choice.
The Modern Medicine Group — 7053 N. Cedar Ave, Fresno, CA 93720
Medicare Open Enrollment with Dr. Virk
Why this year matters
01
$2,000 annual cap for Part D drugs is now in effect for 2025; after you hit it, you owe $0 for covered Part D drugs for the rest of the year.
02
New “Medicare Prescription Payment Plan (MPPP)” lets you spread Part D out‑of‑pocket costs in monthly bills instead of paying at the pharmacy (optional; doesn’t lower total costs).
03
Star Ratings for 2026 plan shopping become available each fall before enrollment (for 2025 they posted Oct 10). Use stars as one input—check networks and drugs first
04
Many people skip shopping: Nearly 7 in 10 Medicare beneficiaries did not compare plans during a recent enrollment period—leaving savings on the table. We’ll help you not miss out.
05
Scams spike now: Medicare won’t call you out of the blue. Hang up on unsolicited calls asking for your Medicare or SSN and contact SMP to report fraud.
How we help (at no cost to your insurance choice)
We don’t sell insurance. As your doctors, we help you:
-
Verify your doctors and hospitals are in‑network for your 2026 plan.
-
Review your medication list against plan formularies and the new $2,000 cap/MPPP implications.
-
Spot red flags (prior auth, tier changes, pharmacy changes).
-
Coordinate with local, unbiased counselors (HICAP/SHIP) if you want plan‑agnostic advice.
Fast path: Call 559‑369‑7787 or use our Contact page to tell us your plan name and member ID. We’ll confirm network status and book your Annual Wellness Visit and med review.
The 10‑minute “Fresno Fit Check” before you switch
Doctors & hospitals
Are your clinicians and facilities in‑network? (Don’t rely on marketing.)
Drugs
Plug your exact meds and pharmacy into the Medicare Plan Finder to see 2026 costs.
ANOC letter
Read the Annual Notice of Change you got in September for your current plan’s 2026 changes. If you didn’t get it, call your plan.
Total cost
Look at premiums plus deductibles, copays, max out‑of‑pocket (not just “$0 premium”)
Star Ratings
Check plan quality, but still verify doctors/drugs.
$2,000 cap
If you have expensive Part D drugs, the new cap may change your math.
MPPP
If early‑year drug costs are heavy, consider monthly billing to smooth cash flow.
Extra Help
If your income is limited, you may qualify for full Extra Help (since 2024) to cut Part D costs.
Local help
Book a free, unbiased counseling session with Fresno/Madera HICAP (phones get busy fast).
Security
Ignore surprise calls offering “upgrades.” Report suspected fraud to Senior Medicare Patrol.
Fresno‑local help & events
-
HICAP (Fresno‑Madera) — Free, unbiased Medicare counseling. Phone: 559‑224‑9117. (Valley Caregiver Resource Center, 5363 N. Fresno St.)
-
Monthly Medi‑Cal Application Assistance Day with HICAP (Fresno County DSS & VCRC). Dates run monthly, including Oct 8 & Nov 12, 2025.
-
California HICAP program overview (State Dept. of Aging) and the SHIP national locator.
Short videos (trusted sources)
If you prefer a live walkthrough, HICAP regularly hosts “Welcome to Medicare” sessions (some offer on‑demand modules).
Key dates you should know
-
Annual Open Enrollment (AEP): Oct 15 – Dec 7 — Switch your Medicare Advantage or Part D plan for Jan 1 start.
-
MA Open Enrollment (MA‑OEP): Jan 1 – Mar 31 — If you’re already in an MA plan, you can make one change or go back to Original Medicare (with/without a stand‑alone Part D).
-
ANOC arrives in September — Review your plan’s “Annual Notice of Change.”
What most seniors are thinking about (and searching for)
01
Are my doctors in‑network?
Can I get appointments quickly? (Patient experience and access drive satisfaction.)
02
Will my prescriptions be covered (and at what tier)?
especially with the $2,000 cap and monthly billing option.
03
Is my current plan still a good deal?
Most beneficiaries don’t compare options; it’s worth doing.
04
Is this call a scam?
Unsolicited calls pretending to be Medicare surge in the fall—don’t share your ID.
Step‑by‑step: Compare plans the right way
-
Gather your list — Medications (name, dose), preferred pharmacies, and your doctors/specialists.
-
Use the official Medicare Plan Finder — Enter ZIP (93720), meds, and pharmacies; save/print the comparison.
-
Check Star Ratings as a tie‑breaker; confirm in‑network with the plan and your clinic before you enroll.
-
Ask us to sanity‑check your shortlist, then enroll via Medicare.gov, your plan, or with help from HICAP.
Doctor Virk was the first doctor to really listen to all of my issues stemming from my traumatic injury in 2022. First time I did not feel rushed to get through a visit. He listened and told me that he would help me without assuming that he knew what I was going through. Looking forward to having him as my new primary doctor. One hundred percent recommend him.
Richard Smith
Fresno, CA
Dr. Virk is the best primary care physician I have ever had. It's been a long time trying to find the right doctor. He's extremely knowledgeable and attacks the root of the problem, testing efficiently to get a clear picture of what's going on. He's 1 of 2 doctors in my life-time that has taken the time to listen and understand my issues fully, before judging or rushing to a solution. Easy to talk to. I highly recommend trying him as a primary.
Randy V
Fresno, CA
What Our Patients Say
Extra Help (LIS) — apply via Social Security; all who qualify receive full Extra Help (since 2024).
Older adults & online health info — ~36% of adults 75+ looked up health info online (CDC). This is why plain‑English guides matter.
Medicare & You 2025 handbook (drug‑cost cap & payment plan overview)
2025 Star Ratings (what they mean; how CMS builds them).
MPPP (monthly billing) program page + FAQ.
Resources we trust (official)
Medicare FAQ
Get answer to the most frequently asked questions.
Oct 15 – Dec 7. Switch Advantage or Part D for Jan 1.
$2,000 drug cap + optional MPPP monthly billing.
Use the plan’s provider directory and call us with your plan name + member ID so we can confirm our network status from the clinic side before you switch. (Clinic phone: 559‑369‑7787.)
Plans send ANOC each September. Call your plan if you didn’t receive it—don’t assume nothing changed.
MPPP can smooth cash flow (monthly bills) but doesn’t lower total costs. Use Medicare’s tool to see if it helps your situation, and we’ll review it with your med list.
If you’re in a Medicare Advantage plan, Jan 1 – Mar 31 you can make one change (switch MA plans or go back to Original Medicare; you can add Part D if you return to Original).
Yes—HICAP (Fresno/Madera) provides free, unbiased counseling. 559‑224‑9117. Appointments fill fast.
They’re a quality signal (1–5 stars). Use them as a tie‑breaker after you confirm your doctors, drugs, and total costs.
Likely not. Medicare doesn’t make unsolicited calls. Hang up and report suspected fraud to Senior Medicare Patrol.
Check Extra Help (LIS)—apply any time via Social Security; since 2024, all who qualify get the full subsidy. We’ll help you assemble documents.
Our Blogs
