Medicare Open Enrollment: What You Need to Know for 2026

Medicare beneficiaries have until December 7 to make crucial changes during the annual open enrollment period. This is an ideal time for retirees who depend on prescription medications to assess their drug costs for the upcoming year.

Understanding Medicare Enrollment Options

During this annual open enrollment, beneficiaries can switch their private Medicare Advantage plans, which may include drug coverage, or alter their Medicare Part D prescription plans if they have Original Medicare (Parts A and B). Additionally, beneficiaries have the option to transition from Original Medicare to Medicare Advantage or the reverse.

Maximizing Flexibility in Coverage Choices

While there are specific times throughout the year when beneficiaries can change their coverage, this open enrollment period provides the most flexibility, according to Ryan Ramsey, associate director at the National Council on Aging. It’s crucial for beneficiaries to take advantage of this window to reassess their healthcare needs.

Medicare Advantage Open Enrollment Period

A different open enrollment for Medicare Advantage runs from January 1 to March 31, during which beneficiaries can switch plans. However, those with Original Medicare who have Part D plans cannot alter their drug coverage during this time. With around 55 million people enrolled in these plans, selecting the right coverage is vital as prescription costs can be a significant burden.

Changes to Premium Costs in 2026

In 2026, average premiums for prescription drug plans and Medicare Advantage plans are expected to decrease. This is a positive development, as noted by experts. “Part D premiums have not only remained stable, but may even be lower in certain areas,” stated Alex Cottrill, a senior policy analyst at KFF.

New Out-of-Pocket Caps and Drug Cost Limits

Starting in 2026, the out-of-pocket limit for prescription drug spending will rise to $2,100 from $2,000 in 2025. Beneficiaries will be responsible for 25% of the costs until reaching this cap, after which Medicare will cover all prescription costs for the remainder of the year. However, this limit applies only to drugs covered under the plan.

Helpful Tips for Choosing Your Medicare Coverage

Beneficiaries should have received an annual notice of change document in September, outlining modifications to their plans. To find the best coverage, retirees are encouraged to use Medicare’s online plan finder, which helps identify medications and pharmacies that offer the best cost options. Moreover, organizations like the State Health Insurance Assistance Program (SHIP) provide free counseling to compare plans effectively.

Explore Financial Assistance Programs

For those facing financial challenges, exploring the government’s Extra Help program for prescription costs or Medicare savings programs can be beneficial. It’s essential for retirees to understand their options and choose plans that best suit their healthcare needs while keeping costs manageable.