- The Medicare open enrollment period begins on October 15 for older adults who wish to enroll in or change their current health insurance plans.
- There’s expected to be slightly fewer Medicare Advantage plans offered nationwide, although the average premium is forecasted to decrease.
- The annual cap on out-of-pocket prescription drug costs will rise slightly, but Medicare officials will continue to negotiate price reductions with pharmaceutical companies.
This eligibility window is for people ages 65 years and older who wish to sign up for the federally funded health program or change their current plans.
Medicare officials say much of this government healthcare system will remain the same in 2026 as it was in 2025.
However, Medicare recipients should note a number of changes. The most important involves prescription drug coverage and increases in some premiums.
“Open enrollment is the opportunity to look at your current plan and add or remove benefits,” said Kanwar Kelley, MD, a specialist in otolaryngology head and neck surgery, obesity medicine, and lifestyle medicine, and the co-founder and chief executive officer of Side Health in Orinda, CA.
“Because plans can change annually, it is a good idea to review your plan to ensure it is working well for you. If not, make adjustments to ensure you are satisfied with your coverage,” Kelley told Healthline.
Whitney Stidom, the vice president of consumer enablement at eHealth, agreed.
“Medicare beneficiaries should take a proactive approach during this year’s annual enrollment period, as major changes to plan costs and benefits are expected for 2026,” she told Healthline. “Comparing Medicare Advantage plans can help people find coverage that better aligns with their healthcare needs and financial priorities, potentially saving them over $1,800 annually in out-of-pocket costs while maintaining access to quality care.”
In addition, there may also be some uncertainties if the federal government shutdown lasts for an extended period of time. The processing of claims by recipients and payments to medical providers could potentially be delayed.
“If the shutdown drags on long enough, it could eventually result in longer-than-expected processing times for non-urgent questions,” Stidom said. “Beneficiaries enrolled in Medicare Advantage, Medicare Supplement and Medicare Part D plans will be unaffected by a government shutdown, as long as they access support through insurance agents or private insurance companies that offer these plans.”
Telehealth services could also be impacted by the shutdown. Some telehealth programs that were offered over the past several years expired on October 1, and Congress didn’t take action to renew them. That means telehealth coverage could once again be limited to people in rural areas and places with healthcare professional shortages.
“Patients will continue to lose access to telemedicine until a new bill is passed. They can also expect administrative delays while staff is furloughed,” Kelley said.
Here is some vital information and important changes to know about Medicare in 2026.
About 69 million people in the United States get health coverage under the Medicare system.
About 90% of those covered are 65 years or older. Most of those under 65 are people with certain disabilities.
Basic Medicare coverage includes what’s known as Part A and Part B.
Part B covers necessary medical services, such as ambulances, as well as preventive services such as screenings. Premiums are usually deducted from a person’s monthly Social Security check.
It’s also estimated that about 81% of Medicare recipients are also enrolled in Part D, which covers prescription drug expenses.
The Centers for Medicare & Medicaid Services (CMS) estimates there will be about 5,600 Medicare Advantage Plans available nationwide in 2026.
That’s close to the same number as 2025, when the number of options decreased from the previous year.
The number of plans available to an individual Medicare recipient varies from state to state.
In addition, some Medicare Advantage providers have said they may scale back their service areas and coverage options.
Experts say fewer programs or choices could have some impact on consumers.
“Fewer Medicare Advantage plans will result in less overall choice,” said Kelley. “Fewer choices could lead to high costs due to a lack of other coverages… Fewer plans likely result in less flexibility and reduced access to your physicians and practitioners.”
“However, fewer plans mean that some consolidate and offer higher-quality plans overall. The additional quality may make these plans more effective in the long run,” he added.
The annual out-of-pocket limit for in-network services for Medicare Advantage recipients will decrease slightly from $9,350 in 2025 to $9,250 in 2026.
The average monthly premium for Medicare Advantage plans with prescription drug coverage is projected to decrease from $16 in 2025 to $14 in 2026.
However, the average Part B premium is estimated to rise from $257 in 2025 to $288 in 2026.
The number of stand-alone Part D plans nationwide is forecasted to decrease from 464 in 2025 to 360 in 2026. However, many of these plans are expected to have slightly lower premiums.
The CMS estimates that monthly premiums for stand-alone Part D plans will drop from $38 in 2025 to $34 in 2026. Premiums for Part D that are part of Medicare Advantage plans will dip slightly from $13 to $11 per month.
The annual cap on out-of-pocket expenses for Part D drugs will increase slightly from $2,000 in 2025 to $2,100 in 2026.
“The out-of-pocket cap for prescriptions is beneficial for those who take expensive medications,” said Kelley. “Once that mark is reached, there are no more out-of-pocket costs for those medications, providing significant relief for seniors and those suffering from chronic diseases.”
However, earlier this year, the Trump administration decided against Medicare covering the cost of GLP-1 weight-loss drugs like Ozempic.
In addition, Medicare officials will continue to negotiate prices for drugs covered under Part D, which experts say could lower some the cost of some medications.
People with Part D plans will also continue to be able to utilize an automatic prescription payment plan that spreads out drug costs over the year. People who currently have this plan will be automatically re-enrolled for 2026 unless they opt out.
“The ability to spread payments over the year also makes the pricing more manageable,” said Kelley. “It will hopefully curb the number of individuals who have to ration funds to afford their medication. This change will save individuals a lot of costs of acquiring their drugs and prevent worsening of their conditions due to a lack of prescription access.”
CMS officials say they’ve introduced new features on their website that make it easier for recipients to compare Medicare plans.
In addition, there is an artificial intelligence tool that will help recipients compare prescription drug prices across pharmacies.
CMS officials have also established new limits on the types of programs that can be covered by Medicare Advantage programs.
In addition, six states — New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington — will begin using an AI-assisted program to approve or deny coverage of medical services provided to people who have Medicare plans that don’t include a Medicare Advantage supplement.
Stidom said that most people with current plans should have received an annual notice from their insurance provider detailing any changes in their coverage. She noted it’s important for consumers to read this notification.
“Medicare Advantage and Part D plan enrollees should know how their current coverage may be changing before reviewing their plan options for 2026,” Stidom said. “This fall, millions of Medicare beneficiaries will be facing significant changes to their benefits, increases to their costs, and adjustments to their plan’s care provider network.”
She added that people whose lose insurance coverage have an important decision to make.
“Beneficiaries whose Medicare Advantage plans are being discontinued in 2026 will face special challenges,” Stidom said. “They will be required to find a new Medicare Advantage plan or else return to Original Medicare, which could leave them with significant coverage gaps and no prescription drug benefit, unless they turn to Medicare Supplement and stand-alone Part D coverage, which can be costly.”
