The Medicare Open Enrollment 2026 period is now in focus as Americans aged 65+ and those with disability coverage evaluate their options. This annual window runs from October 15 to December 7, 2025, and any decisions you make during this time will take effect starting January 1, 2026. With confirmed cost changes, fewer plan options in some markets, and shifting benefit structures, it’s more important than ever to review your situation carefully.
Big Picture: Why This Year Matters More
Every year, the means to change or review your Medicare coverage rolls around. But for 2026, several features stand out:
- A notable increase in the standard monthly premium for Part B, meaning many beneficiaries will pay more just to maintain the same coverage.
- Deductibles and hospital/inpatient cost sharing are rising.
- The number of stand-alone prescription-drug plans (Part D) is shrinking in many areas, which may limit patient choice.
- Benefit structures such as out-of-pocket caps and payment plans for drugs are evolving.
- If you continue in your current plan without reviewing the changes, you may face surprise costs or network exclusions.
So while the enrollment window itself—October 15 to December 7—is familiar territory, the stakes this year are higher.
Key Dates to Remember
- October 1, 2025 (approx.) – New plan information becomes publicly available; use this time to compare.
- October 15, 2025 – Enrollment for 2026 coverage officially opens.
- December 7, 2025 – Deadline for making changes to the plan that takes effect January 1.
- January 1, 2026 – New coverage year begins for any new or switched plan.
- January 1 – March 31, 2026 – For those already on Medicare Advantage, an additional opportunity exists to change plans under certain conditions (separate process).
If you miss the December 7 deadline, generally you’ll remain in your current plan (assuming eligibility), or face penalties if you delayed necessary enrolment.
What’s Changing: Costs, Coverage & Options
Premiums and Deductibles on the Rise
- The standard monthly premium for Part B (which covers outpatient services, doctor visits, durable medical equipment) will be $202.90 in 2026, up from $185 in 2025.
- The annual deductible for Part B increases to $283.
- The inpatient hospital deductible under Part A is now $1,736 per benefit period, up from $1,676.
- For those who must buy Part A coverage (ineligible for premium-free Part A), monthly premiums will also rise (e.g., up to $565 in some cases).
- For stand-alone drug plans (Part D), premiums are expected to drop slightly in many regions (from roughly $38 to $34/month) but insurance carriers are still allowed to raise premiums by large amounts in some markets.
These changes mean your baseline cost for original Medicare (Parts A & B) is going up—and if you have supplemental, drug, or Advantage coverage, there may be secondary impacts.
Prescription Drug Coverage: Fewer Plans, Cap on Costs
- The annual out-of-pocket cap for covered drugs under Part D is set at $2,100 for 2026.
- In many regions, the number of stand-alone Part D plans is dropping—from over 460 nationwide in earlier years to possibly 360 plans in 2026.
- Although average premiums go down, fewer plan choices and changes to formularies (covered drugs list) and pharmacy networks mean you may still face higher costs or limited access.
Benefit Changes Beyond Premiums
- If you are enrolled in a Medicare Advantage (Part C) plan, ancillary benefits (such as over-the-counter allowances, extra dental/vision, meal benefits) may be modified or subject to tighter rules.
- The “automatic reenrolment” process for many current beneficiaries remains in place—if you take no action, you’ll generally stay in your current plan for 2026—but that does not guarantee that what you pay or what you get remains the same.
- If your health status changes (new diagnosis, new medications, different doctors) or you just moved, this is the time to review accordingly.
What You Can Do: A Step-by-Step Roadmap
Step 1: Review Your Mail and Plan Documents
Each fall your insurer should send an “Annual Notice of Change” (ANOC) and Evidence of Coverage (EOC). These detail changes to premiums, deductibles, coverage tiers, formularies and networks for the coming year. If you don’t receive one, contact your plan.
Step 2: Take Stock of Your Current Situation
- What doctors and hospitals do you use and are they still in-network for your plan next year?
- What medications do you take, are they still covered and at the same tier?
- Did your health needs change? New treatments, therapies or specialists?
- What is your expected out-of-pocket spending, including premiums, deductibles, coinsurance and maximums?
Step 3: Use the Plan Comparison Tools
Visit the official comparison resources (online or via phone) to see all available plans in your ZIP code for 2026. Filter by: monthly premium, annual deductible, out-of-pocket maximum, network, drug coverage. Don’t just compare “premium only”—total cost matters.
Step 4: Weigh Staying vs Switching
- Staying: If your current plan remains affordable, your doctors are in network, and meds covered, it may make sense.
- Switching: If costs are rising, your network changes, or you find a better fit (lower spending, more benefits), make the move in the window.
- Note: If you do nothing, you will likely be auto-reenrolled, but you’ll still carry whatever changes your plan made for 2026.
Step 5: Act by December 7
Once you decide a change is needed, submit your enrollment or switch request. Changes generally take effect January 1. After December 7, options are very limited unless you qualify for a special enrollment period.
Key Questions to Ask Right Now
- Are the doctors I use included under my current plan’s 2026 network?
- Are there any new or removed medications I take from the formulary?
- How does the annual cost in my current plan compare with other plans (premium + deductible + coinsurance) for 2026?
- Does the plan include extra benefits I might need (vision, hearing, fitness, OTC allowance)?
- If I switch, will I lose any special benefits I liked in my current plan?
- If I keep the plan, what changes are built into the new year that might surprise me?
Common Pitfalls and How to Avoid Them
- Assuming “it’s the same as last year.” Even minor changes in coverage or cost can affect your budget. Make a habit of reviewing annually.
- Focusing only on the premium. A “cheap” premium may mean higher deductible, fewer covered drugs, more coinsurance, or narrower network.
- Neglecting the pharmacy or drug list. A single medication moving to a higher cost tier or being excluded can add significant expense.
- Ignoring plan termination or withdrawal from market. Some carriers leave a geographic area and you may be forced to switch anyway—and later might be scrambling.
- Waiting until the last minute. December crowds and changes submitted near deadline invite processing errors or delays. Start early.
Why This Can Impact Your Wallet and Health
Because costs are rising and choices shifting, this enrollment window can literally determine how much you spend—and how easily you access care—the next 12 months. Imagine this scenario:
- Your Part B premium goes up $17.90/month, but your doctor leaves your network and now you must pay more or change physicians.
- Your current Advantage plan changes its drug list and one of your long-term meds moves from tier 2 to tier 4.
- The stand-alone drug plan you rely on isn’t available in your region next year—fewer plan options means you might be pushed into a higher-cost plan.
In essence: doing nothing is a decision—and it may cost you more. Conversely, taking time now to evaluate may save you hundreds or even thousands of dollars, and spare you headaches during the year.
Special Considerations for Certain Groups
- High-income beneficiaries: If your income exceeds a threshold (e.g., individual > $109,000, married > $218,000), you may owe an Income-Related Monthly Adjustment Amount (IRMAA), which raises your Part B premium further.
- New enrollees (turning 65 or newly eligible due to disability): Be aware that 2026 cost changes apply to you immediately after your eligibility date.
- Those in remote or underserved areas: Plan availability may be more limited. Fewer plan choices means greater need to compare carefully.
- People with frequent new prescriptions: These individuals especially should check the formulary and cost structure for 2026—they may benefit from switching plans.
- Dual-eligible (Medicare + Medicaid) individuals: While some costs may be covered, benefit changes and network shifts still matter for you and should be reviewed.
Bottom Line
This Medicare open enrollment season offers a vital opportunity. Every beneficiary should treat it not as a formality—but as a prompt to rethink whether their coverage still fits. With higher premiums, fewer plan choices in some areas, and shifting benefit rules, what worked last year may not work next year.
Start early, compare thoroughly, ask the right questions, and make a change if it aligns with your health and financial goals. Your future self will thank you.
What one thing will you check this fall in your review of your coverage for next year? Leave a comment or stay tuned for more updates.