Medicare open enrollment for 2026 starts soon, and beneficiaries of Part D prescription drug plans are in for some unpleasant changes.
“These plans will cost more next year with higher premiums and higher out-of-pocket deductibles, and some plans may stop covering certain drugs, or your pharmacy will no longer have the lowest costs,” Philip Moeller, a Medicare and Social Security expert, who writes the Aging in America newsletter, told Yahoo Finance.
In other words, added Moeller, “everybody with a Part D plan has got to be vigilant.”
But before the bad news details, a quick refresher.
Medicare has three parts. Part A covers inpatient hospitalizations, skilled nursing facility services, and home health and hospice care. Part B covers preventive services, outpatient hospital and physician services, and drugs administered by doctors.
Part D covers prescription drugs that you take on your own.
This year, the open enrollment period starts Oct. 15 and runs through Dec. 7. During this time, those who are enrolled can make modifications to their coverage, which goes into effect on Jan. 1. You can switch between Original Medicare and Medicare Advantage, change Medicare Advantage plans, and add or switch your Part D prescription drug plan or Medigap policy.
This year, 54.8 million of the 68.8 million Medicare beneficiaries in total are enrolled in Medicare Part D prescription drug plans operated by private insurers, and that’s where some of the biggest changes for 2026 are likely to be found.
Last month, you received your Annual Notice of Change (ANOC) letter spelling out changes in Medicare Part D prescription drug coverage and costs that will be effective next year. If it’s buried under a pile of unopened mail, now’s the time to unearth it.
You’ll thank me.
In 2026, seniors enrolled in Part D prescription drug plans will have their annual out-of-pocket drug costs capped at $2,100 for co-pays or coinsurance for the prescription drugs their plan covers — a provision in the 2022 Inflation Reduction Act.
Sounds swell, but “that cap only applies to drugs that are actually covered by a plan,” Juliette Cubanski, deputy director of the program on Medicare policy at KFF, told Yahoo Finance. That means if you’re taking a medication that’s not covered in your plan, you pay in full.
A man enters a CVS Pharmacy location in Watertown, Mass., on Jan. 12. (Suzanne Kreiter/The Boston Globe via Getty Images) ·Boston Globe via Getty Images
Also, most plans will have a deductible in 2026, according to Moeller. In 2025, 85% of standalone Part D plans had deductibles, according to KFF. (Part D enrollees will shell out a maximum annual deductible for their covered prescription drugs of $615, up from $590 this year).
Some Part D plans will charge higher monthly premiums next year too. Last year, the average monthly Part D premium was $39 for a standalone plan. Many Medicare Advantage Part D plans have $0 premiums.
The average standalone Part D plan total premium is projected to decrease from $38.31 in 2025 to $34.50 in 2026, according to the Centers for Medicare & Medicaid Services (CMS). But the math changes depending on where you look. The national average premium will be $38.99 in 2026, limited by law to a 6% increase over the 2025 amount, per KFF.
Actual premiums vary depending on your location and plan. Monthly premiums paid by Part D enrollees in standalone plans in 2026 will range from $0 to $100 or more in most regions, according to KFF research.
In addition to the monthly premium, Part D enrollees with higher incomes ($106,000/individual; $212,000/couple) pay an income-related premium surcharge. This year, that ranged from $13.70 to $85.80 per month, depending on income.
A Biden administration rule limited monthly premium increases to $35, but the Trump administration is raising that to $50.
As insurers shift offerings, making it imperative to be eagle-eyed when scrutinizing your 2026 Part D Plan, there is a spark of good news for 2026.
If you take any of the 10 prescription medications like Eliquis and Stelara in the new Medicare drug-price negotiation program, the lower prices will take effect in 2026.
Part D plans are also required to cover all drugs that have been selected for Medicare drug price negotiation, which include popular blood thinners and diabetes medications of all dosage forms and strengths.
“The market is going through a lot of changes, and people need to use this enrollment time to compare their current coverage to other coverage available in their area and see if they might be able to save money by switching plans or get better coverage for the drugs that they’re taking,” Cubanski said.
How do you find out if there are bombshells in your drug plan coverage for next year? Say, for instance, your medications are jettisoned from your plan or tossed into a higher cost offering? Or what if you find yourself with a deductible for the first time?
Start by scrutinizing your current plan’s options for the coming year and confirm your medications will be covered next year, plus find out your premiums and co-pays, and compare them to other plans in your area.
If your drugs have been pushed out of your current plan, or into a pricer tier offering, search for an alternative one that will cover them, and ideally at a lower cost.
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Senior Leon Washington is helped by volunteer Rebecca Cox as he signs up for the new Medicare drug prescription program during a Medicare enrollment event on Dec. 19, 2005, in Pleasanton, Calif. (Justin Sullivan/Getty Images) ·Justin Sullivan via Getty Images
The Medicare Rights Center offers a free consumer helpline: 800-333-4114. You can also contact Medicare directly at 800-633-4227 to find Medicare Advantage and Part D Plans in your area and to enroll directly.
Medicare’s online searchable Plan Finder on the Medicare.gov site allows you to review Medicare plan options. Every fall before open enrollment, Medicare loads all of the private plan data into this tool, including Part D drug plans, private Medicare Advantage plans, and even the Medigap plans, which are run by the states.
The National Council on Aging has a free helpline (1-800-794-6559) to assist you in navigating Medicare.
The Medicare advisory firm 65 Incorporated provides a $30-a-year service that reviews Part D plans and recommends the best ones for you when your medications are no longer available in your current one or costs have jumped.
If you have a limited income, you might be eligible for Medicare’s Extra Help, which covers Part D premiums and deductibles and caps drug costs
Finally, there could be less costly options for the drugs you’re taking, so it’s always smart to have a talk with your physician to see if there are alternative ones covered by your plan.
