The Medicare open enrollment period begins October 15 and runs through December 7, 2025, giving older adults the opportunity to enroll in or change their Medicare health insurance plans.
While the number of Medicare Advantage plans available nationwide may slightly decrease, the average monthly premium is expected to drop. Some coverage rules and costs, especially for prescription drugs, will shift in 2026.
Overview of 2026 Medicare Changes
Medicare officials report that most program features will remain the same as in 2025, but beneficiaries should pay attention to changes in prescription coverage, premiums, and plan availability.
Open enrollment allows enrollees to review their current plans, add or remove benefits, or switch to another provider. Because plans adjust yearly, experts recommend reviewing coverage carefully to ensure it still meets your medical and financial needs.
Whitney Stidom, vice president of consumer enablement at eHealth, advises Medicare recipients to be proactive: “Comparing plans can help people find coverage that better aligns with their healthcare needs and potentially save them over $1,800 annually in out-of-pocket costs.”
A potential federal government shutdown could delay processing of claims or payments, though Medicare Advantage, Supplement, and Part D beneficiaries would generally remain unaffected if they access support through private insurers.
Telehealth coverage, however, could be affected. Some pandemic-era telemedicine programs expired on October 1, and without renewal, virtual visits may again be limited to rural or underserved areas.
Medicare BasicsRoughly 69 million Americans receive Medicare coverage. About 90% are 65 or older, with the rest qualifying due to disability.
- Part A covers inpatient hospital care, skilled nursing, hospice, and limited home health services. About 99% of recipients pay no monthly premium.
- Part B covers outpatient services, medical supplies, and preventive care. Premiums are generally deducted from Social Security checks.
- About 51% of enrollees have a Medicare Advantage plan (Part C), and around 81% are also enrolled in Part D for prescription coverage.
Medicare Advantage Plans in 2026
The Centers for Medicare & Medicaid Services (CMS) projects around 5,600 Medicare Advantage plans nationwide for 2026—about the same as 2025. Availability varies by state, and some insurers may reduce service areas or merge options.
Fewer plans could mean less choice but potentially higher quality offerings as companies consolidate.
Key financial changes include:
- Out-of-pocket maximum for in-network services will slightly decrease from $9,350 (2025) to $9,250 (2026).
- Average monthly premium for Medicare Advantage plans with prescription coverage will drop from $16 to $14.
- Part B premium is projected to increase from $257 to $288.
Prescription Drug Coverage (Part D)
Stand-alone Part D plans will decline from 464 in 2025 to 360 in 2026, though premiums will generally be lower.
- Average Part D premium (stand-alone): $38 → $34/month
- Average Part D premium (within Medicare Advantage): $13 → $11/month
- Annual out-of-pocket cap: $2,000 → $2,100
- Annual deductible (maximum): $590 → $615
Insulin will remain capped at $35/month, and most vaccines will continue to be fully covered. However, Medicare will not cover GLP-1 weight-loss medications such as Ozempic.
Medicare will continue negotiating drug prices with pharmaceutical companies to reduce costs. Enrollees can also opt for monthly payment plans to spread drug expenses evenly over the year—an automatic re-enrollment feature unless they choose to opt out.
Digital Tools and Technology
CMS has introduced:
- Enhanced online comparison tools for Medicare Advantage and Part D plans.
- An AI-driven system to compare prescription drug prices at pharmacies.
- Pilot AI-assisted claims review programs in six states (New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington) to streamline service approval decisions.
What Medicare Recipients Should Do
By this time of year, beneficiaries should have received an Annual Notice of Change detailing updates to their current plan’s costs and benefits.
Those whose plans will be discontinued in 2026 must select a new Medicare Advantage plan or revert to Original Medicare. Returning to Original Medicare alone could leave significant coverage gaps, especially for prescription drugs, unless they purchase additional Supplement and Part D plans.
Experts recommend comparing plans early, verifying provider networks, and factoring in drug and service costs before the enrollment deadline.
Quick Summary of Key 2026 Medicare Updates
| Category | 2025 | 2026 | Change |
|---|---|---|---|
| Medicare Advantage Plans Nationwide | 5,600 | ~5,600 | Similar |
| Average MA Premium | $16 | $14 | ↓ |
| Part B Premium | $257 | $288 | ↑ |
| MA Out-of-Pocket Cap | $9,350 | $9,250 | ↓ |
| Stand-Alone Part D Plans | 464 | 360 | ↓ |
| Average Stand-Alone Part D Premium | $38 | $34 | ↓ |
| Out-of-Pocket Drug Cap | $2,000 | $2,100 | ↑ |
| Max Part D Deductible | $590 | $615 | ↑ |
| Insulin Cost Cap | $35/month | $35/month | Unchanged |
Bottom Line
While the number of Medicare Advantage and Part D plans will slightly shrink in 2026, most enrollees will benefit from lower premiums and continued improvements in drug cost protection.
Beneficiaries should review their current coverage, consider their medication needs, and use the updated CMS comparison tools to ensure they’re getting the best value and access for 2026.
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