Attention Medicare patients! As you prepare to shop for prescription coverage this fall, here's a crucial update: your options are shrinking. But don't worry, we've got you covered with all the details you need to navigate this changing landscape.
The Shrinking Menu of Medicare Part D Plans
Fewer choices are becoming the norm, and this trend is set to continue into 2026. While most markets will still offer several options, some shoppers, especially those with low-income subsidies, may find their options particularly limited. And here's where it gets controversial: some insurers are no longer paying brokers for new business, making it harder for patients to get the help they need.
Who Needs a Medicare Part D Plan?
Regular Medicare, the program most people qualify for after turning 65, doesn't include prescription coverage, known as Part D. This means that people need to choose this coverage separately. According to KFF, a non-profit health care research organization, about 23 million people with regular Medicare have this standalone coverage. Additionally, around 34 million people have Medicare Advantage plans, which are privately run versions of Medicare often including prescription coverage.
The Changing Landscape of Medicare Part D Plans
Juliette Cubanski, a Medicare expert from KFF, predicts that a typical shopper will have eight to twelve standalone drug plan options for 2026. This is a decrease from the twelve to sixteen options available in 2025, and a significant drop from the nearly thirty choices available as recently as 2021, according to Gretchen Jacobson from the Commonwealth Fund.
Depending on the state, KFF reports that a range of one to four plans will be available at no premium to those qualifying for low-income subsidies. In 2021, eight such plans were available.
Some insurers are reducing their involvement in standalone Part D plans, and Elevance, a Blue Cross-Blue Shield carrier, is leaving the market entirely. Insurers and industry analysts attribute this to the Inflation Reduction Act, which will cap annual out-of-pocket drug costs at $2,100 in 2026, putting financial pressure on insurers. The same law also allows patients to spread prescription costs over the year.
Still Many Options, But...
While most markets will have several choices, experts note that Medicare Part D customers often resist shopping around, especially if their current plan covers their medications. Finding affordable coverage for multiple prescriptions can be a complex task.
"There's a lot of inertia," Cubanski explains, "and people may be concerned that switching could leave them worse off."
However, more people are being pushed to shop around. Research published in the Journal of the American Medical Association shows that nearly 11% of those with standalone prescription drug coverage lost their plan in 2024. Before 2023, this figure was often under 1%, according to Dr. Christopher Cai, one of the researchers involved in the study.
Changing Prices for Medicare Part D
The good news is that monthly premiums, or coverage prices, will fall nearly 10% on average to $34.50, according to the Centers for Medicare and Medicaid Services. Oliver Wyman, a consulting firm, reports that at least one option with a premium under $20 exists in almost every region of the country.
However, individual prices will vary widely, with premiums for the same plan differing by state, as noted by Cubanski. While plans may offer lower coverage prices, they could also increase deductibles or provide more limited lists of covered drugs, known as formularies. Shoppers should carefully check these details.
Insurers will be allowed to raise premiums by up to $50 a month for 2026, an increase from the $35 allowed this year. But Cubanski emphasizes that only some plans will reach this higher limit, and not necessarily in all states.
Where to Get Help
Shoppers can compare plan prices and coverage using a federal government website. States also have State Health Insurance Programs specifically designed to assist Medicare patients in finding coverage. Consumers can also help themselves by checking their coverage for changes and comparing it with other plans.
Jacobson, the vice president of Medicare at Commonwealth, advises shoppers to consider whether their pharmacy is in the network covered by any plan they are considering.
Some patients might also consider switching to Medicare Advantage plans with prescription coverage. However, these plans can have more limited networks of covered doctors, which could be a problem for people in rural areas with fewer care choices.
Why Procrastination Might Be Costly
The enrollment window spans several weeks, but brokers report that many people wait until the first week of December to make decisions, often after discussing with family during holiday dinners. This delay can create a deadline crunch, making it harder to find help in early December.
So, while the options may be shrinking, there's still time to make an informed decision. Stay tuned for more updates, and don't hesitate to share your thoughts and experiences in the comments below!
