What to know about Medicare changes before you shop for a 2026 plan
Annual enrollment period opens Oct. 15; medicareresources.org urges careful plan comparisons
Minneapolis, MN, Sept. 18, 2025 (GLOBE NEWSWIRE) -- Millions of Americans will soon have the chance to make critical decisions about their health coverage during the upcoming annual Medicare open enrollment period. Health policy analysts at medicareresources.org say that changes to plan offerings and to Medicare rules and costs make it essential for beneficiaries to review their coverage and compare options for 2026.
Medicare’s annual enrollment period runs Oct. 15-Dec. 7, 2025.
“Medicare beneficiaries have more to consider this fall than just their monthly premiums,” said Louise Norris, a health policy analyst at medicareresources.org, an online consumer guide since 2011. “From higher out-of-pocket costs to changes in plan offerings, it’s important to look closely at all of your options before making a decision.”
Norris is the author of medicareresources.org’s “Medicare Open Enrollment 2026 Guide.”
4 key factors for Medicare beneficiaries to consider during open enrollment
Medicare’s rules and costs shift every year, and even small adjustments can have a big impact on household budgets. For 2026 coverage, consumers should be aware of:
1. Part D out-of-pocket cap increases
The annual cap on a beneficiary’s prescription drug out-of-pocket costs will increase from $2,000 in 2025 to $2,100 in 2026, indexed for inflation.
“While most beneficiaries typically don’t reach the cap,” said medicareresources.org health policy analyst Jenny Chumbley Hogue, “more Medicare Advantage members will see plans with drug deductibles, at least on certain tiers.”
“In the past, many Medicare Advantage plans didn’t require a drug deductible,” Chumbley Hogue said. “Starting in 2026, most of them will have a deductible for drugs in Tiers 3, 4 and 5.”
Other cost changes for 2026 include:
- The maximum Part D deductible rises to $615 (up from $590), though some plans offer lower or no deductibles.
- The $35 insulin cap on out-of-pocket costs and no-cost coverage of recommended vaccines continue.
“In addition to the monthly premium, beneficiaries should pay close attention to how each plan covers their medications,” Chumbley Hogue said.
2. Some insurers discontinue Medicare Advantage or prescription drug plans
In addition to rising drug costs, some beneficiaries may find fewer Medicare Advantage (MA) or prescription drug plan (PDP) options for 2026. Several insurers, including Elevance, Aetna, and UnitedHealthcare, are scaling back their MA or PDP offerings or exiting certain markets altogether. If an MA or PDP plan is discontinued, beneficiaries can select new coverage during Medicare open enrollment.
Those whose MA plans are eliminated may also qualify for a special enrollment period (SEP), providing guaranteed-issue rights to enroll in most available Medigap plans, if they want to switch to Original Medicare.
3. Negotiated drug prices start in 2026
- The Inflation Reduction Act allows the Centers for Medicare & Medicaid Services to negotiate with drug manufacturers on the prices of certain high-cost prescription drugs. The first round of negotiated prices will take effect in January 2026.
- While negotiated prices may help consumers long-term, premiums may still rise. That’s because insurers will receive less federal assistance through the Part D premium stabilization program — dropping from $15 to $10 per enrollee per month — and participating insurers will be allowed to raise premiums by up to $50 per month (up from $35 per month this year).
“While negotiated prices should help in the long term, beneficiaries may still see premium increases,” Norris said. “That makes comparing plans during the annual enrollment period more important than ever.”
4. What to know about changing broker commissions
Consumers should be aware that broker commissions vary widely, with some insurers paying commissions for the sale of certain plans while others do not, Chumbley Hogue said. More insurers tend to pay commissions for selling Medicare Advantage plans than for stand-alone Part D plans.
“This doesn’t mean brokers aren’t a valuable resource—they absolutely are,” Chumbley Hogue said. “But consumers should confirm they’re being shown all available plans.”
Beneficiaries can double-check by reviewing plan options directly at Medicare.gov. They also can find more guidance, plan comparisons and enrollment tips at medicareresources.org.
Medicareresources.org has been an online source of in-depth information about Medicare for consumers since 2011. The site, owned by HealthInsurance.org, LLC, provides an overview of the basics of Medicare coverage options, enrollment and eligibility; coverage FAQs; state-specific Medicare information; and a glossary of Medicare terms. Medicareresources.org is not connected with or endorsed by the U.S. government or the federal Medicare program.
medicareresources.org mromedia@afmcommunications.com
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