Open Enrollment and What is Changing in 2026

Medicare’s annual open enrollment for 2026 runs from October 15 to December 7, with several notable changes to costs, coverage, and plan options that beneficiaries should carefully review.  The current government shutdown does NOT affect Medicare nor the open enrollment period.

The 2026 Medicare open enrollment period allows eligible individuals to make changes to their coverage, including switching between Original Medicare and Medicare Advantage (MA), changing Advantage plans, or modifying Part D prescription drug coverage. Any changes made during this window will take effect on January 1, 2026.

Beneficiaries are encouraged to review their Annual Notice of Change letters, which outline updates to their current plans, and compare alternatives to ensure their coverage aligns with evolving health needs and financial priorities.

Many areas of the country will have fewer MA and stand-alone Part D plan options than in 2025.  In Ohio for example, 212 MA plans will be offered in 2026, down from 217 in 2025.  Ten stand-alone Part D plans, down from 16 in 2025.

Part B premiums are expected to increase about 11.6%, with the standard premium rising from $185/month to $206.50/month.  However, the average monthly premium for Medicare Advantage (MA) plans is projected to decrease by $2.40 to $14.00, while standalone Medicare Part D prescription drug plans will drop by $3.81 to an average of $34.50.

Additionally, drug savings from the Inflation Reduction Act of 2022 (IRA) continue, as out-of-pocket costs for prescription drugs will be capped at $2,100 annually (inflation-adjusted, the cap was $2,000 in 2025), offering more predictable spending for those with high medication needs. This was the dreaded “donut hole” or Part D coverage gap.  However, some MA plans may offer fewer benefits or have higher premiums, making it essential to compare options thoroughly.

The Drug Price Negotiation Program takes effect in 2026.  Also initiated under the IRA, the Centers for Medicare and Medicaid Services will annually choose certain expensive, brand-name drugs without competition and negotiate prices with drug companies.  10 drugs were selected last year, with lower prices in effect for 2026.  15 drugs were selected for the second cycle, taking effect in 2027.

Unlike MA plans, Original Medicare doesn’t typically require pre-authorization for care.  But starting Jan. 1, 2026, 6 states will be included in a pilot program requiring prior authorization for Original Medicare beneficiaries.  Ohio is one of them, along with NJ, OK, TX, AZ and WA.

The Medicare Advantage plan finder tool has also been updated to improve transparency, and beneficiaries misled by plan information may have an opportunity to switch plans mid-year.

With fewer MA plans available nationwide, beneficiaries should act promptly during open enrollment to secure the most suitable coverage for 2026.