Medicare Open Enrollment 2026: Major Changes, Costs, Drug Coverage Updates & Expert Advice

Medicare Open Enrollment 2026: Key Changes, Benefits, and What Seniors Must Know

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The Medicare Open Enrollment period for 2026 runs from October 15 to December 7, giving older adults the opportunity to join, switch, or update their Medicare plans. More than 69 million Americans depend on Medicare, and understanding the upcoming changes for 2026 is essential for making informed healthcare decisions.

Overview of Medicare Coverage

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Basic Medicare includes two main parts:

• Part A: Covers inpatient hospital care, skilled nursing facilities, hospice, and some home health services.
• Part B: Covers medically necessary services, preventive screenings, and ambulance services. Premiums are usually deducted from Social Security payments.

Many beneficiaries also enroll in:

• Medicare Advantage (Part C)
• Prescription Drug Plans (Part D)

What’s New for Medicare in 2026?

Medicare officials confirm most features will remain the same as 2025, but several important updates affect costs, premiums, and prescription drug benefits.

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🔹 1. Fewer Plans, but Lower Costs for Medicare Advantage

CMS projects around 5,600 Medicare Advantage plans in 2026, slightly fewer than in 2025.

However, fewer plans may lead to:

• Reduced flexibility
• Limited provider networks
• Higher costs for some recipients

Yet, consolidation may improve overall plan quality.

Key Cost Changes

• Annual Out-of-Pocket Maximum:
  From $9,350 (2025) → $9,250 (2026)
• Average Monthly Premiums for Medicare Advantage (with drug coverage):
  From $16 → $14

Part B Premium Increase

• Monthly Part B premium is expected to rise from $257 → $288 in 2026.

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🔹 2. Prescription Drug Costs Will Decrease in 2026

Standalone Part D plans will drop from 464 in 2025 to 360 in 2026, with lower premiums.

Key Part D Changes

• Average Premium:
  From $38 → $34 for standalone Part D
  From $13 → $11 for Advantage-inclusive Part D
• Annual Out-of-Pocket Cap:
  From $2,000 → $2,100
• Insulin Cost:
  Remains capped at $35/month
• Vaccines:
  Most remain fully covered.

Drug Price Negotiations

Medicare will continue negotiating drug prices under the Medicare Drug Price Negotiation Program.

10 major medications will drop in price starting January 1, 2026, saving beneficiaries $1.5 billion collectively.
These include:
Eliquis, Enbrel, Entresto, Farxiga, Imbruvica, Jardiance, Januvia, Fiasp, NovoLog, Stelara, Xarelto.

Payment Plans

Beneficiaries can continue using the automatic monthly payment plan to spread costs throughout the year.

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🔹 3. New Tools & Features on Medicare Website

CMS has introduced:

• Simplified plan comparison tools
• AI-powered drug price comparison
• Limits on what supplemental programs Medicare Advantage can cover

Six states — New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington — will also start using AI-assisted approval for certain claims.

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🔹 4. Possible Medicare Spending Cuts Due to Rising National Debt

Although Medicare wasn’t directly impacted by July’s “One Big Beautiful Bill Act,” the Congressional Budget Office warns that increasing national debt could trigger automatic Medicare spending cuts.

This could lead to:

• $45 billion in cuts by FY 2026
• More than $536 billion in cuts by 2034

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🔹 5. Government Shutdown May Delay Some Medicare Services

If the government shutdown continues:

• Claims processing could slow
• Provider payments may be delayed
• Telehealth services could be limited again, especially outside rural areas

Some pandemic-era telehealth expansions expired on October 1 and may not be renewed.

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🔹 6. What Medicare Recipients Should Do During Enrollment

Experts strongly recommend reviewing the Annual Notice of Change (ANOC) sent by your insurer.

Key steps:

1. Check changes to premiums, benefits, and provider networks.
2. Compare Medicare Advantage and Part D plans to avoid gaps in coverage.
3. Switch plans if yours is being discontinued.

Failing to choose a new plan could push beneficiaries back into Original Medicare, which does not include prescription drug coverage and may lead to higher costs.

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Final Takeaway

Medicare Open Enrollment 2026 brings a mix of lower prescription costs, slightly reduced out-of-pocket limits, higher Part B premiums, and fewer plan options.

Seniors should carefully compare plans to ensure they maintain adequate coverage and avoid unexpected costs.