Medicare Patients Face Fewer Prescription Coverage Options This Fall
This fall, Medicare patients looking for prescription coverage may find their choices shrinking once again. The trend of decreasing standalone drug plans has been ongoing, and it appears set to continue into 2026. While many markets still provide a few options, those beneficial for low-income and subsidized shoppers are becoming increasingly scarce. Additionally, assistance might be harder to come by since some insurance companies have stopped paying brokerage fees for new transactions.
New coverage options will be available starting in January, with the enrollment period running from October 15 to December 7.
Understanding Medicare Part D Coverage
Most people can qualify for regular Medicare once they turn 65, but this does not cover prescriptions, often referred to as Part D— which must be selected separately. Currently, about 23 million individuals enrolled in regular Medicare have this standalone drug insurance, according to KFF, a nonprofit focused on medical research.
In addition, approximately 34 million people are on Medicare Advantage plans, which is a private version of Medicare that typically includes prescription coverage.
What to Expect with Medicare Part D Plans
According to KFF Medicare specialist Juliet Cubansky, the average shopper might only have eight to twelve choices for a single drug plan by 2026, down from 12 to 16 options in 2025. Until 2021, shoppers had nearly 30 options available, as noted by Gretchen Jacobson of the Commonwealth Fund.
Eligibility for free plans varies by state for those receiving low-income subsidies. In 2021, eight units were provided. Insurance providers, like Blue Cross Blue Shield’s Elevance, have been pulling back from offering standalone Part D plans. Insurers have had to adapt to the new inflation control law which caps annual out-of-pocket drug expenses at $2,100 starting in 2026. This has put additional financial pressure on insurers.
Options Still Exist in Medicare Part D
Although most markets continue to have a range of options, experts highlight that Medicare Part D customers often hesitate to shop around, especially if they currently have a plan that meets their needs. Finding affordable coverage for multiple medications can be quite challenging.
“I think there’s a lot of inertia. People might worry that switching could leave them worse off,” Cubansky shared.
A growing number are compelled to shop for new options, as nearly 11% of those with standalone drug insurance lost their plans in 2024— a significant increase compared to before 2023 when it was often below 1%, according to researcher Dr. Christopher Cai.
Changes in Medicare Part D Pricing
Average monthly premiums are projected to drop by nearly 10%, settling around $34.50, according to the Centers for Medicare and Medicaid Services. There’s even at least one option in most areas of the country that costs under $20.
Nevertheless, pricing can vary considerably; premiums for identical plans may differ from state to state. Lower coverage prices might come with higher deductibles or limited drug lists (formularies), so shoppers should pay close attention to the specifics.
For 2026, insurers can raise premiums by as much as $50 per month— a jump from the $35 limit imposed this year. However, it’s worth noting that only certain plans might hit that cap, and this won’t necessarily apply across all states.
Finding Help for Medicare Part D Plans
Consumers can visit the federal government website to compare plan prices and coverage. Each state has its own health insurance program designed to aid Medicare beneficiaries in finding suitable coverage.
It’s a good idea for consumers to review coverage changes and compare their current plans with alternatives. The network of pharmacies covered by the plan should also be considered, as highlighted by Jacobson, who is vice president at Commonwealth.
Some might even contemplate transitioning to a Medicare Advantage plan that includes prescription coverage, though these options frequently have a restricted network of doctors, particularly problematic for those residing in rural locations with limited access to care.
The Risks of Delaying Decisions
Although the registration window spans several weeks, brokers note that many people often procrastinate until the first week of December, usually after discussing their options during holiday gatherings. This lag can complicate efforts to find assistance due to looming deadlines.
