Open enrollment for Medicare runs from October 15 through December 7, 2026. This annual window lets people 65 and older enroll in Medicare or change their current coverage, including Medicare Advantage (MA) and stand-alone prescription drug plans (Part D).
Who is on Medicare
About 69 million Americans are covered by Medicare. Basic Original Medicare includes Part A (hospital coverage) and Part B (medical coverage). Roughly 81% of beneficiaries have Part D prescription drug coverage in some form.
Overall outlook
CMS says most Medicare rules and options will remain stable in 2026, but plan details—costs, covered benefits, and provider networks—can change yearly. It’s important to review options each open enrollment period.
Medicare Advantage (MA) changes
– CMS estimates about 5,600 MA plans nationwide in 2026, a level similar to 2025. Availability varies by state and some insurers may narrow service areas.
– Fewer plan options in some markets can limit flexibility and access to particular providers, though it may also concentrate higher-quality plans.
– The MA in-network annual out-of-pocket limit will drop slightly from $9,350 in 2025 to $9,250 in 2026.
– The average monthly premium for MA plans that include drug coverage is projected to fall from $16 to $14.
Part B and Part D updates
– The estimated average Part B premium is projected to rise from $257 in 2025 to $288 in 2026.
– The number of stand-alone Part D plans is forecast to decline from 464 to 360 nationwide, and many remaining plans are expected to have slightly lower premiums. Average stand-alone Part D premiums are projected to fall from $38 to $34; Part D premiums embedded in MA plans are expected to drop from $13 to $11.
– The Part D annual out-of-pocket cap will increase from $2,000 to $2,100 in 2026.
– The maximum deductible that Part D plans may charge could rise from $590 to $615.
– CMS will continue negotiating prices under the Medicare Drug Price Negotiation Program. Ten medicines selected for negotiated lower prices effective January 1, 2026 include: Eliquis, Enbrel, Entresto, Farxiga, Fiasp, NovoLog, Imbruvica, Januvia, Jardiance, Stelara, and Xarelto. These negotiations are expected to save enrollees about $1.5 billion in 2026.
– Automatic prescription payment plans that let enrollees spread drug costs over the year will remain available; current participants will be re-enrolled automatically unless they opt out.
Tools and policy shifts
– CMS has added website features to make plan comparisons easier and introduced an AI tool to compare prescription costs across pharmacies.
– New limits are taking effect on the types of programs Medicare Advantage may cover.
– Six states (New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington) will pilot an AI-assisted program to help approve or deny certain services under Original Medicare in specific situations.
Federal budget and service risks
– The recent broad spending bill did not directly change Medicare policy, but the Congressional Budget Office warns the legislation 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, increase response times for non-urgent inquiries, and affect telehealth programs. Some temporary telehealth flexibilities expired on October 1 and were not renewed, which could narrow telehealth access outside rural or shortage areas.
What beneficiaries should do
– Read your insurer’s annual notice of changes to understand how coverage, costs, and networks will change in 2026.
– Compare plan costs, provider networks, prescription coverage, and out-of-pocket limits during open enrollment.
– If your MA plan is discontinued, you must pick a new MA plan or return to Original Medicare; returning to Original Medicare without supplemental coverage can leave coverage gaps unless you also enroll in a Medicare Supplement policy and a stand-alone Part D plan.
– Consider premiums, deductibles, annual out-of-pocket limits, drug formularies, and whether your regular providers will remain in-network before making changes.
Open enrollment is the time to review, add, or drop benefits so your coverage matches your health needs and financial priorities for 2026.
