This fall, as Medicare patients explore options for prescription coverage, they might find fewer choices available again.
Standalone drug plans have been on the decline in recent years, and this trend is expected to persist into 2026. While certain markets still offer options, it’s becoming increasingly challenging for low-income and subsidized shoppers to find suitable plans. Furthermore, the lack of brokerage fees for new transactions from some insurance companies could mean less guidance for shoppers.
The window to select new coverage extends from October 15 to December 7, with coverage starting in January.
Points to keep in mind:
Need a Medicare Part D plan?
Regular Medicare, which most individuals qualify for after age 65, does not automatically include prescription coverage—known as Part D. Instead, it’s an optional choice.
According to KFF, around 23 million people currently enrolled in basic Medicare have chosen this particular insurance.
Additionally, about 34 million others are signed up for Medicare Advantage plans, which typically include prescription coverage.
What changes can we expect in Medicare Part D plans?
By 2026, an average shopper may have only eight to twelve options for a single drug plan, as indicated by KFF expert Juliet Cubansky. This is a decrease from the 12 to 16 options available in 2025.
Back in 2021, shoppers enjoyed nearly 30 choices, as noted by Gretchen Jacobson from the Commonwealth Fund.
Low-income subsidy-eligible individuals can access plans 1 through 4 for free, with eight options available in 2021.
Some insurers are pulling back from standalone Part D plans altogether; for instance, Blue Cross Blue Shield’s parent company, Elevance, is exiting this market. Analysts believe that the Inflation Control Act, which sets a cap on annual out-of-pocket drug costs at $2,100 in 2026, will heighten financial strain on these insurers. Patients can now also spread their prescription costs throughout the year under this legislation.
Are there still options for Medicare Part D?
Many markets do offer several choices. However, experts note that Medicare Part D customers often hesitate to shop around—especially if they already have a plan that covers their prescriptions. Finding affordable options for multiple medications can prove quite difficult.
“There’s a noticeable inertia,” Cubansky said. “People could worry that switching plans might lead to worse outcomes.”
More individuals are finding themselves needing to shop as well. Nearly 11% of those with standalone drug insurance lost their coverage last year, according to a recent study published in the Journal of the American Medical Association.
Before 2023, this figure was usually under 1%, as noted by Dr. Christopher Cai, a researcher involved in the study.
How will Medicare Part D prices change?
The average monthly premiums are set to decrease by nearly 10%, bringing them down to about $34.50, according to the Centers for Medicare and Medicaid Services, which was announced last month.
Consulting firm Oliver Wyman reports that there’s typically at least one option available in almost every region of the country costing less than $20.
However, premiums can differ significantly, and the same plan may have varying prices from state to state, Cubansky remarked.
It’s important to note that while some plans may have lower premiums, they might also come with higher deductibles or a more limited drug coverage list. Shoppers should verify these details before deciding.
Insurers can increase premiums by up to $50 a month in 2026, up from this year’s allowed increase of $35. Cubansky mentioned that only certain plans might reach this maximum, and it may not be uniform across all states.
Where can I find help with purchasing a Medicare Part D plan?
Shoppers can visit the federal government website to compare plan prices and coverage options.
Each state has its own health insurance program designed to assist Medicare enrollees in finding coverage.
Consumers can also play an active role in reviewing their coverage changes and comparing them with alternative plans.
It’s wise for shoppers to check if their pharmacy participates in the network of the plan they’re considering, Jacobson recommends.
Some individuals may think about switching to a Medicare Advantage plan that includes prescription coverage. However, it’s worth noting that these plans might limit the network of doctors, which can especially affect those in rural areas.
Why you shouldn’t delay
The enrollment period lasts several weeks, yet brokers frequently find that many people wait until early December to make their choices—often after discussing it with family during holiday gatherings.
This delay can complicate finding assistance in early December due to looming deadlines.
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