Medicare open enrollment: must-know changes that could raise your costs

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• Key dates, who should act and why it matters
• How many people rely on Medicare and what each part covers
• Medicare Advantage in 2026: fewer options but slightly lower average premiums
• Prescription drug coverage: Part D changes and what they mean
  • Coverage decisions still under policy debate
• New tools, AI pilots and other CMS policy updates
• How a federal shutdown and telehealth rules could affect access
• Practical steps beneficiaries should take now

Medicare’s annual enrollment window opens on October 15, and millions of older Americans must decide whether to keep their current coverage or switch plans. This year brings subtle shifts in plan availability, premium changes and prescription drug rules that could affect costs and access in 2026.

Key dates, who should act and why it matters

Open enrollment runs from October 15 through December 7. During this period, people eligible for Medicare can enroll, change Medicare Advantage plans, switch Part D drug plans, or return to Original Medicare.

• Who should review plans: anyone turning 65, those with changing health needs, and beneficiaries whose insurers send notice of plan changes.
• Action to take: compare network providers, drug formularies and total yearly costs—not just monthly premiums.
• Watch for notices: insurers must send annual change notices. Read them to spot shifts in coverage or costs.

How many people rely on Medicare and what each part covers

Roughly 69 million Americans receive Medicare benefits. Most are 65 or older; a smaller share qualifies because of disabilities.

• Part A: hospital stays, skilled nursing care, hospice and limited home health services. Most people pay no premium.
• Part B: outpatient care, preventive services and medical supplies. Premiums are typically taken from Social Security checks.
• Part D: optional prescription drug coverage. About four in five beneficiaries enroll.
• Medicare Advantage (Part C): bundled alternatives to Original Medicare. Roughly half of beneficiaries use some form of supplemental plan.

Medicare Advantage in 2026: fewer options but slightly lower average premiums

CMS projects about 5,600 Medicare Advantage plans nationwide for 2026.

That number is close to last year, but several insurers are trimming service areas or consolidating products.

• Choice impact: fewer plan options may reduce flexibility and could limit access to preferred doctors.
• Possible upside: consolidation can produce stronger, higher-quality plans for some beneficiaries.
• Out-of-pocket limit: the in-network annual cap falls slightly to $9,250 from $9,350.
• Average monthly premium: Medicare Advantage plans with drug coverage are expected to average $14 per month, down from $16.
• Part B premium: projected to rise to about $288 in 2026, up from $257.

Prescription drug coverage: Part D changes and what they mean

Part D landscape will shift noticeably in 2026. Stand-alone drug plans are expected to fall in number, but many will cost a bit less.

• Plan count: stand-alone Part D plans forecast to decrease from 464 to about 360.
• Premiums: average monthly standalone Part D premiums may drop from $38 to $34. Part D within Medicare Advantage could fall from $13 to $11.
• Out-of-pocket cap: annual limit on drug spending rises to $2,100 from $2,000.
• Insulin and vaccines: insulin remains capped at $35 per month; most vaccines continue to be covered under Part D.
• Deductibles: the maximum Part D deductible any plan may charge could increase to $615 from $590.
• Payment smoothing: automatic payment plans that spread drug costs across the year will continue, with current enrollees auto‑re‑enrolled unless they opt out.

Medicare will keep negotiating drug prices for medications covered under Part D, which could lower costs for some treatments over time.

Coverage decisions still under policy debate

Notable policy choices will influence which drugs Medicare covers. For instance, GLP‑1 weight-loss agents like Ozempic are not covered under Medicare this year, which affects affordability for those medications.

New tools, AI pilots and other CMS policy updates

CMS has rolled out new consumer tools to make plan comparison easier. An AI tool is being used to compare drug prices across pharmacies, helping people find cheaper options.

• Website upgrades: improved plan comparison features to help beneficiaries weigh cost and network trade-offs.
• AI-assisted decisions: six states will use AI in programs that approve or deny certain services for people not in Medicare Advantage plans.
• Limits on supplemental programs: CMS clarified what supplemental benefits Medicare Advantage plans can offer.

How a federal shutdown and telehealth rules could affect access

A prolonged federal government shutdown could slow some Medicare processing. Claim payments and responses to non-urgent inquiries may take longer.

Telehealth rules also changed: certain flexibilities expired on October 1 and have not been renewed by Congress.

• Telehealth access may return to pre‑pandemic limits, favoring rural areas and provider shortage zones.
• Beneficiaries who rely on telemedicine could see reduced options while lawmaking is pending.

Practical steps beneficiaries should take now

Experts urge a proactive review of coverage each year. Plan changes, provider networks and drug lists can shift annually.

• Read the annual notice from your insurer carefully.
• Compare total yearly costs, not only monthly premiums.
• Check whether your doctors and pharmacies are in-network.
• Verify drug formularies and prior authorization rules before switching plans.
• If your plan is discontinued, explore new Medicare Advantage options or Original Medicare with a supplement and Part D.

Acting early in open enrollment can prevent coverage gaps and unexpected out-of-pocket costs.