Introduction: Open Enrollment Season Begins
Every year between October 15 and December 7, millions of Americans 65 and older enter the annual Medicare Open Enrollment Period — a chance to review coverage, compare plans, and make changes for the coming year.
For 2026, Medicare officials promise stability and predictability, but also some important updates you’ll want to know before you lock in your coverage.
If you’ve noticed higher pharmacy bills, changing doctor networks, or confusing mailers, you’re not alone. Let’s simplify what’s new for 2026 and how to make smart choices before enrollment closes.
The Basics: What Open Enrollment Means
During this period, you can:
- Switch from Original Medicare (Parts A & B) to a Medicare Advantage (Part C) plan.
- Switch back from Medicare Advantage to Original Medicare.
- Join, drop, or change a Part D prescription drug plan.
- Compare plans to make sure your doctors, prescriptions, and costs are still the best fit.
Any change you make takes effect January 1, 2026.
What’s Actually New for 2026
1. A Cap on Out-of-Pocket Drug Costs
For the first time, Part D out-of-pocket costs will be capped at $2,100 per year.
This change is part of the Inflation Reduction Act, aimed at lowering prescription costs for seniors.
What it means:
- Once you’ve spent $2,100 out of pocket on covered drugs in 2026, you won’t owe more for the rest of the year.
- No more “donut hole” surprises.
- Plan premiums may vary slightly, but this cap provides certainty and peace of mind.
2. New $35 Monthly Cap on Insulin Continues
The $35 insulin cap that began in 2023 remains in effect for 2026. If your plan charges more than $35 per month for insulin, contact your provider — you’re entitled to the lower price, even if you haven’t met your deductible.
This rule applies to both standalone Part D and Medicare Advantage plans that include drug coverage.
3. More Transparency on Doctor Networks
Starting this year, Medicare Advantage providers must clearly display which doctors and specialists are “in-network” and accepting new patients — not just listed.
The change was driven by complaints from seniors who enrolled in plans only to learn their doctors weren’t taking new Medicare patients.
When reviewing plans online at Medicare.gov/plan-compare, look for:
- ✅ “Accepting new Medicare patients” badge
- 🏥 Facility participation status (hospital, lab, etc.)
- 📞 Contact details verified by CMS
4. Simpler Language on Plan Summaries
The government is cracking down on “marketing confusion.”
All plan documents — including comparison charts, letters, and call scripts — must use plain language that’s easier to read.
Expect fewer acronyms and clearer explanations like:
“You pay $0 for preventive services,” instead of “Cost-sharing may not apply under qualifying conditions.”
5. Expansion of Behavioral and Home Health Services
Medicare Advantage plans can now cover more mental health, grief counseling, and in-home support services, especially for isolated seniors.
This includes coverage for peer support specialists, social workers, and at-home fall prevention programs.
These benefits vary by plan, but seniors are encouraged to look beyond just premiums and drug lists when comparing — mental wellness counts too.
How to Review Your Plan Step by Step
Step 1: Gather Your Current Plan Information
Locate your Annual Notice of Change (ANOC) letter, which your plan sent by late September.
It lists what’s changing in your premiums, copays, and drug coverage for 2026.
Step 2: Make a List of Your Doctors & Medications
Write down:
- Every doctor you see (include specialists)
- Your prescription drugs and dosages
- Pharmacies you prefer
This will help when using the Medicare Plan Finder at Medicare.gov.
Step 3: Compare Plans
On the official site, enter your ZIP code and prescriptions. You’ll see:
- Estimated yearly drug costs
- Premiums and copays
- In-network providers
- Star ratings (1–5 scale for quality and satisfaction)
Tip: Focus on total annual cost, not just the monthly premium.
Step 4: Check for Extra Help Eligibility
If your income is limited, you might qualify for Extra Help (Low-Income Subsidy).
This program can lower or eliminate your drug premiums and copays.
Apply at ssa.gov/extrahelp.
Step 5: Ask for Free Counseling
Certified advisors through SHIP (State Health Insurance Assistance Program) can review your plan options for free.
Find your state’s SHIP office: shiphelp.org.
What Stays the Same for 2026
- Medicare Part A (hospital) and Part B (medical) benefits remain the same core structure.
- Preventive care services — such as flu shots, annual wellness visits, and screenings — remain $0 copay.
- Premium-free Part A continues for most retirees with 40 quarters (10 years) of work history.
- Medicare Advantage Star Ratings remain available for comparing plan quality.
Key Dates to Remember
| Date | Action |
| Oct 15, 2025 | Open Enrollment starts |
| Dec 7, 2025 | Last day to make plan changes |
| Jan 1, 2026 | New coverage begins |
| Mar 31, 2026 | Last day of Medicare Advantage open-switch window |
Common Mistakes to Avoid
🚫 Ignoring your ANOC letter.
Even small premium or copay changes can add up over a year.
🚫 Assuming your plan automatically covers your medications.
Drug lists change annually — double-check before January.
🚫 Falling for TV or phone marketing pitches.
Only use Medicare.gov, your insurer’s official site, or a SHIP counselor.
🚫 Forgetting about dental or vision benefits.
Many Medicare Advantage plans now include these — verify coverage limits.
Tips to Save Money in 2026
💡 Use preferred in-network pharmacies.
They often save you up to 30% on drug copays.
💡 Consider mail-order prescriptions for 90-day refills.
Lower per-pill cost and fewer trips.
💡 Bundle care under one provider network if you use specialists.
It reduces overlap and improves coordination.
💡 Review your plan every year — don’t “set it and forget it.”
Your health and the plans change yearly.
Scam Warning: Stay Alert During Open Enrollment
Fraudsters use Medicare season to steal personal data.
Watch for:
- Calls claiming “your new Medicare card needs reactivation”
- Emails offering “free medical equipment”
- Fake plan comparison websites
👉 Never give your Medicare number, SSN, or bank details to unsolicited callers.
If in doubt, call 1-800-MEDICARE (1-800-633-4227).
Key Takeaways
- Open Enrollment runs Oct 15–Dec 7, 2025 — changes take effect Jan 1, 2026.
- $2,100 out-of-pocket cap is the biggest update for 2026.
- Check drug coverage, doctor networks, and premiums carefully.
- Use trusted sources — Medicare.gov and SHIP counselors — to avoid scams.
- Your plan’s total annual cost is more important than the monthly premium.