As Medicare beneficiaries begin to explore their prescription coverage options this fall, they’re finding that choices may be shrinking once again.
In recent years, the number of standalone drug plans has been on the decline, a trend set to continue in 2026. While there are still options available in many areas, some specific choices, especially for low-income individuals, are becoming harder to come by. Additionally, finding assistance might pose challenges, as some insurers have stopped paying brokerage fees for new enrollments.
The window for shoppers to secure new coverage runs from October 15th to December 7th, with coverage beginning in January.
Understanding Medicare Part D
Regular Medicare, which most individuals qualify for when they turn 65, doesn’t typically cover prescription drugs—this is known as Part D, and people need to select it separately.
Currently, around 23 million people enrolled in regular Medicare have opted for this coverage, according to KFF, a medical research nonprofit.
Additionally, about 34 million others are enrolled in Medicare Advantage plans, a private alternative to Medicare that often includes prescription coverage.
Changes Coming to Medicare Part D Plans
By 2026, the average individual is projected to have eight to twelve options for standalone drug plans, according to Medicare expert Juliet Cubansky from KFF. This is a reduction from 12 to 16 choices in 2025.
Before 2021, shoppers had nearly 30 options available, as noted by Gretchen Jacobson from the Commonwealth Fund.
For those eligible for low-income subsidies, plans one through four are offered for free, as per KFF. Currently, only eight are available this year.
Some insurers, like Blue Cross Blue Shield’s Elevance, are stepping back from standalone Part D options entirely. Analysts say that with the inflation control law set for 2026, which caps annual out-of-pocket expenses for drugs at $2,100, financial pressure on insurers is expected to escalate.
Options Still Exist for Medicare Part D
While most areas still offer several choices, experts suggest that many Medicare Part D customers are hesitant to explore alternatives, particularly if they’re satisfied with their current plans. The challenge of finding affordable coverage for multiple prescriptions can be daunting.
“There’s definitely a bit of inertia. People might fear that switching could put them in a worse situation,” Cubansky commented.
For an increasing number of people, the need to shop around is becoming pressing. Nearly 11% of individuals with standalone prescription drug insurance lost their plans in 2024, according to a study published in the Journal of the American Medical Association.
This is a notable change from the pre-2023 statistic, where that figure was typically under 1%, highlighted Dr. Christopher Cai, a researcher involved in the study.
What to Expect in Medicare Part D Pricing
Monthly premiums for plans are expected to drop nearly 10%, bringing the average down to about $34.50, according to the Centers for Medicare and Medicaid Services.
Oliver Wyman, a consulting firm, reports that nearly every region will have at least one plan option available for under $20.
However, prices can vary significantly, and premiums for the same plan might differ state by state, as Cubansky pointed out.
While some plans may present lower premiums, they could also come with higher deductibles or a more limited list of covered medications, which is something shoppers should verify.
In 2026, insurers may raise premiums by up to $50 a month, compared to this year’s cap of a $35 increase. Cubansky mentioned that only certain plans will likely reach this upper limit, and not uniformly across states.
Finding Help with Medicare Part D Plans
Those looking for assistance can visit the federal government’s website to compare plan prices and coverage options.
Each state provides a specific health insurance program to assist Medicare enrollees in navigating their coverage choices.
Consumers can further support themselves by reviewing coverage changes and comparing alternative plans.
It’s also beneficial to check if their preferred pharmacy is included in the plan’s network, advised Jacobson from the Commonwealth Fund.
Some individuals might think about switching to a Medicare Advantage plan that includes prescription coverage, but such options can limit access to doctors, especially in rural regions with fewer resources.
Why Timeliness Matters
The enrollment period lasts several weeks, but many people tend to postpone their decisions until the first week of December, often after discussing with family during holiday gatherings.
This tendency can complicate finding last-minute assistance, particularly with approaching deadlines.
