With Medicare’s open enrollment period running through December 7, millions of American beneficiaries face the same autumn task: deciding whether to keep or change their prescription drug plans. But in 2026, that choice has become especially critical.
Significant changes in costs, new spending limits, and the removal of government subsidies could drastically alter how much retirees and seniors will pay for their medications next year. For many, reviewing their plans now could mean the difference between financial stability and an unmanageable medical bill.
Enrollment Season Brings Surprises and Unexpected Costs
Holly Kluck, a 66-year-old retired teacher from New Jersey, learned that the hard way. Last year, she paid just $18 per month for her Part D plan, which covers prescription drugs. This year, that same plan will cost more than $70 per month.
“It’s so complicated, isn’t it?” she said, frustrated after realizing her husband Jeff’s plan costs would also rise at a similar pace. Together, the couple estimates their annual Medicare premiums could increase by around $2,000 in 2026.
The Klucks’ situation is increasingly common. While some plans are lowering premiums, others are raising them sharply, a direct result of new coverage rules and cost redistribution between the government and insurers.
Understanding What Changes in Medicare Part D in 2026
Medicare Part D covers prescription drugs and is one of the most sensitive parts of the U.S. healthcare system. In 2026, it will undergo one of the biggest overhauls since its creation, driven by the Inflation Reduction Act (IRA) of 2022.
For the first time, that law capped the maximum amount beneficiaries can pay out of pocket for covered drugs, known as the “annual out-of-pocket maximum.” In 2026, that limit will be set at an amount to be determined.
The measure brings relief to those relying on high-cost drugs, such as those used to treat cancer, multiple sclerosis, and heart disease. But it also puts pressure on insurers, who will now bear a larger share of financial risk.
Concerned about sharp increases, the federal government created a premium stabilization program in 2025, limiting monthly hikes to $35. The program continues in 2026, though with reduced subsidies, already triggering price increases in several states.
The Most Affected Plans and Where Prices Are Falling
According to an analysis by the Kaiser Family Foundation (KFF), premium changes vary widely:
- Wellcare Value Script, the nation’s most popular drug plan, will see monthly increases in 30+ states and in the District of Columbia.
- SilverScript Choice, another widely used plan, will rise about $50 per month in 30 states, but drop in 20 others.
- Some Humana plans will actually see price reductions in up to 30 states, defying the overall trend.
| Plan | Price Trend (2026) | Coverage | Notes |
| Wellcare Value Script | +$50/month | 32 states + D.C. | Nation’s most popular plan; sharp increase. |
| SilverScript Choice | +$50/month / -$20 in 20 states | 50 states | Uneven adjustments depending on region. |
| Humana Basic Rx | -$30/month | 30 states | One of the few plans with significant decrease. |
| Cigna Secure Rx | Stable | 20 states | Adjustment within stabilization limit. |
Zero-Premium Plans: Attractive but Risky
Depending on the state, there are six plans with $0 monthly premiums. That might sound tempting, especially for those who only use low-cost generic medications.
But experts warn: these plans often come with high deductibles, up to $615 in 2026 (compared to $590 this year). That means even if you pay nothing monthly, your total costs could be higher if you need brand-name drugs.
“You might end up paying much more overall if your drug coverage is limited,” explains Juliette Cubanski, Director of Medicare Policy at KFF.
Additionally, some insurers may sharply raise premiums in subsequent years after attracting consumers with low initial prices.
“It’s a strategy to capture healthier enrollees and reduce the plan’s average risk,” says Kylie Stengel of Avalere Health.
What to Watch When Reviewing Your Plan
Don’t look only at the premium
According to Cubanski, many consumers make the mistake of choosing solely based on the monthly price. It’s crucial to check the formulary, make sure your medications are still covered, and verify if any have changed tiers — drugs moving from tier 1 (generic) to 2 or 3 can become much more expensive.
Review the Annual Notice
Each fall, beneficiaries receive the Annual Notice of Change (ANOC), which details premiums, deductibles, and coverage changes. Ignoring that document can be costly.
Use the Medicare Plan Finder tool
The official Medicare website lets you compare plans, estimate annual costs, and verify drug coverage, one of the most reliable ways to identify savings opportunities.
Check provider networks
If you have a Medicare Advantage plan, confirm whether your preferred doctors and hospitals will remain in-network in 2026. Contract changes between plans and providers are common and can bring unpleasant surprises.
Medicare Advantage: When the “All-in-One” Plan Can Cost More
Medicare Advantage, the private alternative to traditional Medicare, continues to grow, but also requires extra caution. During open enrollment, beneficiaries can switch providers or return to the traditional system.
However, there’s an important caveat: anyone trying to buy a Medigap supplemental plan after their initial enrollment period (six months after joining Part B) may be denied coverage for preexisting conditions.
“When switching plans, confirm whether you’ll still be eligible for Medigap,” advises Philip Moeller, author and Medicare expert. He also recommends that beneficiaries call their doctors directly to ask which plans they’ll accept next year, since online lists may contain errors.
Step-by-Step: How to Choose Your Coverage
- Read the Annual Notice carefully, it outlines all changes for the next year.
- Use online comparison tools, the Medicare Plan Finder provides real costs and usage simulations.
- Check your drug tiers, changes can significantly increase prices.
- Review the star ratings, they reflect plan quality but vary by region.
- Seek professional help, the State Health Insurance Assistance Program (SHIP) offers free, unbiased counseling in every state.
- Be wary of easy promises, independent brokers may not represent all plans and often prioritize those with higher commissions.
Conclusion: The Cost of Inertia
Most beneficiaries keep the same plan year after year, often unaware of significant coverage changes. That inertia can cost hundreds, or even thousands, of dollars.
In 2026, with fluctuating premiums and higher deductibles, reviewing your drug plan isn’t just good practice, it’s a financial necessity.
As Cubanski explains, “Consumers tend to focus on the premium and think they’re saving money. But in the end, what really matters is the total cost of care.”
Medicare is evolving, and beneficiaries need to evolve with it. Understanding your plan, comparing options, and acting now may be the smartest investment you’ll make in 2026, for your health and your wallet.
