Check Your 2026 Medicare Plans—You Have Until December 7 to Change
2026 Medicare plan changes to review during open enrollment
October 22, 2025 (Updated November 28, 2025)
- Summary: You have until December 7 to check and make changes in your Medicare Plans
- Reading time: 6–8 minutes.
Medicare Open Enrollment runs from October 15 to December 7. That is the time to review your Medicare choices for next year and decide if you want to make changes.
If you received the Medicare & You 2026 book by mail, it should contain your personal options based on your zip code.
You can also go to the Medicare Plan Finder (Medicare.gov/plan-compare) to check your current Medicare insurance and compare plans available in your area for 2026. Look for the Medicare Star Ratings shown for all plans when making comparisons among plans.
If you don’t make changes by December 7, your current plans will be in effect for 2026.
Types of Medicare
There are two types of Medicare to choose from, Original Medicare and Medicare Advantage.
- Original Medicare (Parts A & B): This covers hospitalization and doctor visits, typically at 80%; thus, you have a co-pay of 20%. To cover that co-pay, you can purchase extra insurance, called a Medicare Supplement, or Medigap for short. Medigap plans may only be available when you’re first eligible for Medicare, as some may exclude you for having a pre-existing condition once the 6-month period has passed (this can vary by state). Learn more about Medigap plans (Medicare.gov/medigap-supplemental-insurance-plans). Additionally, since Original Medicare does not cover medications, you’ll need a Part D drug plan as well. Check your Medicare.gov account for options based on your zip code.
- Medicare Advantage (Part C): Medicare Advantage covers hospitalization, doctor visits, and medications, and often has extra benefits such as dental, vision, and even transportation. Premiums tend to be much lower for Medicare Advantage plans than for other options. There are many different types of Medicare Advantage plans (HMO, MSA, PPO, PFFS, and SNP), some of which overlap with Medicaid. With so many variables, checking your own account at Medicare.gov is the best way to find out your options for next year. There are some downsides to Medicare Advantage plans in that you must use in-network providers, or pay much more for your care; these plans are more prone to using Prior Authorization and other tools that limit access; and some healthcare systems no longer accept Medicare Advantage patients.
While Medicare Open Enrollment is only from October 15 to December 7, if you’re in a Medicare Advantage Plan and not happy with it, you may be able to change plans or change back to Original Medicare from January 1 to March 31. However, you may have limitations or higher costs in accessing a Medicare Supplement or Part D plan.
You may want to review the slides at the bottom of this page to learn more about Medicare plans along with Medicaid (and dual eligibility), if you qualify for it.
Formulary Changes on Medicare Drug Plans
If you have an existing Part D or Medicare Advantage drug plan, it can be worth downloading or checking your Drug Guide (formulary) from your plan’s web site (if it was not mailed to you) to check for changes to the formulary regarding your current medications.
Another option is to enter your medications and quantities, and your pharmacy, in Medicare’s Plan Finder (https://www.medicare.gov/plan-compare/). There, you can get cost comparisons of your current plan to other medication plans based on what is covered and what is not by the plans available in your area. Also, look for the Medicare Star ratings on the various plans for comparison purposes.
If your plan drops your medications from the formulary, it could be costly to you. That can happen when brand drugs go off patent and generics are available, or when drugs are very expensive. When that happens, you may have to pay 100% or be forced to switch medications (called “non-medical switching”).
Non-medical switching means your insurance plan forced you to change medications against the wishes of you and your doctor. If you’re stable on your medications and they work well for you, having to switch could harm your health. Insurance companies should not play doctor, changing your doctor’s decisions.
On some plans, expensive drugs may require extra steps, such as:
- Prior Authorization (PA), where your doctor has to provide documentation as to why the drug is medically necessary for you.
- Step Therapy, where you are required to try a lower cost drug first, and fail it, before you are allowed to have the medication that your doctor prescribed for you.
If any of your medications have been dropped, the Plan Finder can help you find plans that cover them. If you need to change plans, the Plan Finder makes learning about your options easy and even helps you change to a new plan.
You have until December 7 to make changes. You may want to make a note to recheck the formulary of your chosen plan a few days before open enrollment ends to ensure nothing has changed (and while you still have time to make last minute adjustments).
2026 Medicare Drug Plan Changes
A lot is changing in 2026, so you can expect the following changes in Medicare Drug Plans:
- The standard annual drug deductible will increase.
- Out-of-pocket cap on drugs will increase from $2,000 to $2,100. This applies to Part D drug plans and Medicare Advantage drug plans. This cap applies only to Covered Medications. If your medication is not on your plan’s formulary, the cap does not apply, and you could end up paying significantly more for your medications in that case. Some costly medications may end up being removed from the formulary for this reason. If this happens to you, your doctor can submit a Prior Authorization request. If it is turned down and you choose to pay for the medication yourself, it is not considered a covered medication and the $2,100 cap does not apply to it.
- Medicare Prescription Payment Plan (MPPP, often called “smoothing”) will continue and allows spreading your medication costs across the entire year. In 2026, you should be able to sign up for this at your pharmacy. If you signed up in 2025 and stay with the same drug plan, it should continue into 2026 for you automatically. See Medicare Prescription Payment Plan for more information.
- In 2026, negotiated prices will go into effect for the ten medications that Medicare negotiated with the manufacturers, including Eliquis and Xarelto. Medicare refers to them as Maximum Fair Prices (MFPs), but they are often referred to as “government-set” prices (if the price Medicare decided to pay was not agreed to, the manufacturer’s drugs would be removed from Medicare, which is not a negotiation.) While Medicare will pay less for them, patients may pay more since middlemen, called Pharmacy Benefit Managers (PBMs), are charging more for all medications to make up for their loss of margins on these 10 drugs and due to the caps. In the first quarter of 2025, medication prices increased 32%, largely due to the PBMs. We don’t have data yet for the rest of the year, but further increases were expected. Once you reach the $2,100 cap in 2026, you will not pay anything additional for covered medications. Only about 5% of Medicare beneficiaries are expected to reach this cap. My concerns about the impact of these changes on patients prompted me to write an op-ed, Government Just Set Prices on 10 Medicare Drugs: That Doesn’t Mean Patients Will Win.
You may want to review the slides at the bottom of this page to learn more about Medicare drug plans.
Medication Affordability Options
If you cannot afford your medications, there are many options for getting help, such as Medicare Savings Programs, Extra Help with drug costs for those with lower incomes, Medicaid, and state programs. Check Medicare.gov to learn more about these options, or check with your state for any state programs.
There are also other affordability options, such as low and no-cost drug programs. You may want to review the slides below for information about some of these low and no-cost options for medications.
Medicare Stars Program
The Medicare Stars Program is a useful tool for deciding which Medicare plans to consider, and yet, the program is not well-known among cardiovascular patients.
Charles River Associates, with support from Pfizer, undertook research to understand how much cardiovascular patients are aware of the program, whether they use it to select their health plans, and whether those who use it find it valuable.
Their research used a three-step approach:
- Conducted a literature review to understand recent trends in Star rating measures and which were most relevant for cardiovascular patients.
- Worked with patient advocacy groups StopAfib.org and Partnership to Advance Cardiovascular Health to develop and field a survey of Medicare beneficiaries living with cardiovascular disease (some of you may have participated in this survey).
- Carried out a formulary analysis across a sample of plans to evaluate access to commonly prescribed cardiovascular medications.
What they learned was that most people responding to the survey were unfamiliar with the Stars program; in fact, only one in three were aware of it.
Among those who knew about the program and used it, the Star ratings were almost as important in selecting a plan as monthly premiums and out-of-pocket drug costs, and as important as whether the drugs being taken were on formulary.
The Medicare Stars Program has a lot of potential, but is not well-known or used by afib and other cardiovascular patients. Since we are in the midst of Medicare Open Enrollment (October 15-December 7), we want you to be aware of it as it may provide value for you in evaluating your current plan as it compares to other plans.
To understand more about the Medicare Stars program to find the best plan for you, check out the following resources:
Slides
Medicare, Medicaid, and Affordability Options: Learn more about navigating Medicare and Medicaid and medication affordability options.
Medicare, Medicaid, and Affordability