This fall, Medicare patients may face limited choices when it comes to shopping for prescription drug coverage. The trend of decreasing available standalone drug plans is expected to continue into 2026, with most markets still offering several options, although options are becoming particularly limited for shoppers utilizing low-income subsidies. Compounding the problem, some insurers have ceased paying broker commissions on new business, making it more challenging for beneficiaries to find adequate assistance.
Medicare patients have from October 15 to December 7 to select new coverage that will take effect in January. Unlike the standard Medicare program, which most individuals qualify for upon reaching 65 years of age, there is no built-in prescription coverage, known as Part D. As of now, approximately 23 million people with standard Medicare rely on standalone drug coverage, as reported by the non-profit KFF, which specializes in healthcare research. Additionally, about 34 million beneficiaries are enrolled in Medicare Advantage plans, which are privately managed alternatives to original Medicare that typically include prescription coverage.
Looking ahead to 2026, shoppers can expect to choose from approximately eight to twelve standalone drug plans, a decrease from the twelve to sixteen options available in 2025, according to KFF Medicare expert Juliette Cubanski. Just five years ago, shoppers had nearly 30 choices. In terms of low-income subsidy recipients, only one to four plans will likely be available at no premium in various states, down from eight options in 2021.
Several insurers have reduced their participation in standalone Part D plans, with Elevance, a Blue Cross-Blue Shield carrier, exiting the market entirely. Experts note that the financial pressure on insurers has been exacerbated by the Inflation Reduction Act, which will cap annual out-of-pocket drug costs at $2,100 starting in 2026, and allows patients to spread their prescription costs evenly over the year.
While many markets will still provide multiple choices, experts acknowledge that Medicare Part D customers tend to be hesitant to switch plans, especially if they are currently satisfied with their medication coverage. The inertia to shop is apparent, as many beneficiaries worry that switching plans could result in diminishing their coverage. This is critical given that nearly 11% of individuals with standalone prescription coverage lost their plans in 2024, a sharp rise from less than 1% prior to 2023, according to a study recently published in the Journal of the American Medical Association.
In terms of pricing, the average monthly premium for Medicare Part D plans is projected to decline by almost 10% to $34.50, as announced by the Centers for Medicare and Medicaid Services. Options with premiums below $20 will be available in nearly every region, according to consulting firm Oliver Wyman. However, the premiums for the same plan may vary significantly by state. Though coverage prices may be decreasing, plans may respond by raising deductibles or restricting drug formularies, so shoppers are advised to scrutinize these details closely.
Insurers are permitted to increase premiums by up to $50 per month for 2026, a jump from this year’s cap of $35. However, Cubanski indicated that not all plans are expected to reach this higher premium limit, nor will this solely apply across all states.
For those seeking guidance on selecting Medicare Part D plans, the federal government offers a website to help compare plan options and prices. Additionally, state health insurance programs exist specifically to aid Medicare beneficiaries in navigating coverage selections. Consumers can take the initiative by reviewing their current coverage for any changes and comparing it against other available plans. Considering whether their preferred pharmacy is included in a plan's network is also a key factor to bear in mind.
Shoppers might also explore switching to Medicare Advantage plans, which include prescription coverage; however, these plans can feature narrower networks of doctors, which could be particularly problematic for patients in rural areas with limited healthcare access.
While the enrollment window spans several weeks, many individuals tend to delay making decisions until early December, often consulting family during holiday gatherings. This procrastination can lead to increased difficulty in obtaining help as the deadline approaches.
