Important Information on Medicare Part D Plans for 2026
Medicare Open Enrollment Begins Amid Government Shutdown
Open Enrollment season for Medicare begins this week amid a government shutdown and continuing changes to Medicare Part D (prescription drug) plans. The shutdown may delay or limit updates to information on the Medicare.gov website, but “benefits and coverage will continue as before”, according to the website.
If you are a Medicare enrollee, then you should have received your Annual Notice of Change (ANOC) by now and, if you are like most Medicare beneficiaries, the odds are unfortunately that you’ll toss it or ignore it. The ANOC details how your costs and coverage will be different next year. We highly recommend that you review your 2026 plan details because it’s unlikely to be identical to your 2025 plan.
Fewer Plan Options and Rising Costs
The first warning sign that things are changing is the continued decrease in the number of Part D prescription drug plans (PDPs) available. The number of plans is decreasing by -22% from 2025 and, for 2026, will have dropped in half from 2024. Among the plans being discontinued are SilverScript Smart Saver and Plus plans, AARP Medicare Rx Walgreens and all Mutual of Omaha and Elevance Part D drug plans.
The reduction in the number of available plans and several other less obvious changes to your Part D benefit are occurring as a result of the Inflation Reduction Act of 2022, including an annual cap on out-of-pocket spending, which will be set at $2,100 in 2026 (up from $2,000 in 2025) and an increase in the share of costs now paid for by Part D plans and drug manufacturers.
It would be naïve to assume that the out-of-pocket cap will mean that you’ll pay less and that the Part D plan sponsors and drug manufacturers will simply eat the higher costs that they are now responsible for under the provisions of the Inflation Reduction Act.
You should expect that your monthly premiums will go up and we are already seeing this in the ANOCs our clients have shared with us. Plans will be able to increase premiums by up to $50 per month in 2026.
Higher Out-of-Pocket Costs and Coverage Changes
Separately, you may see higher co-payments (from $0 to $3, for example, or from $5 to $10). Or you may see a co-payment change to coinsurance. For example, the $606 retail price for the popular blood-thinner Eliquis may have had a $47 co-pay and this could change to coinsurance of 25% instead, which would increase the refill cost to $151.50 from $47. Patients with coinsurance spend about six time more than those with just co-pays.
Or you may see your medication dropped from your plan entirely. Part D plans generally must cover at least two medications in each drug category, but they have leeway to pick and choose which ones they’ll cover. For example, while drug plans are required to include insulins, they may not cover the one that you use. The $2,100 out-of-pocket cap for 2026 only applies to medications covered your Part D drug plan and not to “Part B” drugs administered at a doctor’s office or a hospital’s outpatient department. It’s important to note that you will pay the full retail price for medications that are not covered by your Part D plan.
Why Reviewing Your Plan Matters More Than Ever
If some or all of this sounds scary, then it’s not because Halloween is fast approaching. It’s because open enrollment season is here and the data tells us that only about ½ of Medicare beneficiaries open their ANOC each year and around 70% of Medicare beneficiaries do not shop their Part D prescription plan each year.
For those with original Medicare and a comprehensive Medicare Supplement (Medigap) plan, shopping your Part D prescription plan has been the only “moving part” that you’ve had to consider. We have recommended for years that you shop your Part D prescription drug plan (and your Medicare Advantage plan if you have one) during Open Enrollment each year and this has only become more important as a result of the Inflation Reduction Act. The best plan isn’t necessarily the one with the lowest monthly premium, but rather the one with the lowest overall cost.
Tools and Support for Reviewing Your Plan
You can continue to shop for the lowest cost plan using the Plan Finder tool available when you log into the Medicare.gov website.
We’re also happy to announce that ACM Wealth has partnered with a third-party to offer a new service at no additional cost to help our clients shop for their Part D prescription drug plan as well as other Medicare plans (Medicare Supplement or Medicare Advantage) and health insurance plans for those younger than 65 years old. If you are interested, then contact your ACM Wealth Advisor for more information.
Lastly, if you haven’t received the “Medicare & You 2026” handbook in the mail, then you can find it online here. This 100-plus-page resource shares important updates for 2026 plans, as well as detailed information about various types of plans and individuals’ rights and protections within the program.
As always, we’ll follow-up with any additional changes as they occur and please let us know if you have any questions.
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