The Medicare open enrollment period runs from October 15 to December 7. This is the annual window for people age 65 and older to enroll in Medicare or change their current coverage.
Who’s on Medicare
About 69 million people in the U.S. receive Medicare. Basic coverage consists of Part A (hospital) and Part B (medical). Roughly 81% of Medicare recipients are also enrolled in Part D prescription drug coverage.
What’s staying the same
CMS says much of Medicare will remain stable for 2026, but beneficiaries should review plans each year because costs, benefits, and networks can change.
Medicare Advantage (MA) updates
– CMS estimates about 5,600 Medicare Advantage plans nationwide in 2026, close to 2025’s offerings, though availability varies by state and some insurers may narrow service areas.
– Fewer plan choices can reduce flexibility and access to specific providers but may also consolidate higher-quality offerings.
– The in-network annual out-of-pocket limit for MA will fall slightly from $9,350 (2025) to $9,250 (2026).
– The average monthly premium for MA plans that include drug coverage is projected to drop from $16 to $14.
Part B and Part D changes
– The estimated average Part B premium will rise from $257 in 2025 to $288 in 2026.
– Stand-alone Part D plans nationwide are forecast to decrease from 464 to 360, while many will offer slightly lower premiums. Average stand-alone Part D premiums are projected to fall from $38 to $34; Part D premiums within MA plans from $13 to $11.
– The Part D annual out-of-pocket cap will increase from $2,000 to $2,100 in 2026.
– Maximum Part D deductibles that plans may charge could rise from $590 to $615.
– CMS will continue negotiating drug prices under the Medicare Drug Price Negotiation Program. Ten drugs selected for negotiated lower prices (effective January 1, 2026) include: Eliquis, Enbrel, Entresto, Farxiga, Fiasp, NovoLog, Imbruvica, Januvia, Jardiance, Stelara, and Xarelto. Savings are expected to total about $1.5 billion for enrollees in 2026.
– Automatic prescription payment plans that spread drug costs over the year will continue; current enrollees will be auto–re-enrolled unless they opt out.
Tools and policy changes
– CMS has added website features to simplify plan comparisons and an AI tool to compare prescription prices across pharmacies.
– New limits on the types of programs coverable by Medicare Advantage take effect.
– Six states (New Jersey, Ohio, Oklahoma, Texas, Arizona, Washington) will pilot an AI-assisted program to approve or deny coverage of services under Original Medicare in certain situations.
Federal budget and service uncertainties
– Although the recent wide-ranging spending bill did not directly change Medicare, the Congressional Budget Office warns it could add more than $3 trillion to the national debt by 2034. That increase could trigger automatic spending reductions under pay-as-you-go rules; the CBO estimates potential Medicare sequester cuts of about $45 billion in fiscal 2026 and a cumulative $536 billion by 2034 unless Congress acts.
– A continuing federal government shutdown could delay claim processing and payments to providers, lengthen response times for non-urgent inquiries, and affect telehealth programs. Some temporary telehealth flexibilities expired October 1 and were not renewed, possibly narrowing telehealth access again to rural or shortage areas.
What beneficiaries should do
– Read the annual notice from your insurer outlining coverage changes for 2026.
– Compare plan costs and provider networks during open enrollment. Beneficiaries whose MA plans are discontinued must select a new MA plan or return to Original Medicare (which may leave gaps unless they obtain Medicare Supplement and stand-alone Part D coverage).
– Consider the impact of premiums, deductibles, out-of-pocket limits, prescription coverage, and whether your providers remain in-network before making changes.
Open enrollment is the time to review, add, or remove benefits so your coverage aligns with your health needs and financial priorities for 2026.
