Medicare Open Enrollment 2026: What You Need to Know
Medicare, Medicare Open Enrollment, MedicareOpenenrollment206, Annual Enrollment Period
Medicare Open Enrollment 2026: What You Need to Know Before Choosing a Plan
If you have Medicare, the Annual Enrollment Period is an important time to review your coverage for the coming year. For 2026 coverage, the Annual Enrollment Period ran from October 15 through December 7, 2025. During this period, Medicare beneficiaries could review their current coverage, compare Medicare Advantage and Part D prescription drug plans, and make changes for coverage beginning January 1, 2026. Understanding your plan’s costs, prescriptions, provider network, and benefits can help you make a more informed coverage decision.
1. Key Dates: What the Annual Enrollment Period Means for 2026
The Medicare Open Enrollment Period, also called the Annual Enrollment Period (AEP) or Annual Election Period, runs from October 15 through December 7, 2025, for coverage that begins on January 1, 2026. During this window, Medicare beneficiaries can:
Switch from Original Medicare to a Medicare Advantage plan (Part C), or move back to Original Medicare from Medicare Advantage.
Join, change, or drop a Medicare Advantage plan that includes drug coverage (MA-PD).
Enroll in, switch, or drop a standalone Medicare Part D prescription drug plan.
If your plan receives your enrollment request by December 7, coverage changes made during the Annual Enrollment Period generally take effect January 1, 2026. If you miss the Annual Enrollment Period, other opportunities to make changes may be available depending on your circumstances, including certain Special Enrollment Periods and, for eligible Medicare Advantage members, the Medicare Advantage Open Enrollment Period.
📌 Key Takeaway: The Annual Enrollment Period from October 15 through December 7 is an important opportunity to review your Medicare coverage for the upcoming year. Even if you are satisfied with your current plan, costs, benefits, provider networks, and prescription drug coverage can change from year to year.
2. Start by Reviewing Your Current Coverage for 2026
Before you look at new plans, carefully review what you already have. Each fall, your current plan must send you an Annual Notice of Change (ANOC) and Evidence of Coverage (EOC). These documents explain how your premiums, deductibles, copays, covered services, and provider networks will change for 2026.
Highlight any changes in monthly premiums, deductibles, and maximum out-of-pocket limits.
Note any services that will have higher copays or coinsurance in 2026, such as hospital stays, specialist visits, or diagnostic tests.
Confirm whether your preferred doctors, hospitals, and pharmacies will remain in the plan’s network.
💡 Pro Tip: Don’t assume your current plan will work exactly the same way in 2026. Review your Annual Notice of Change carefully, especially for changes to prescription drug coverage, provider networks, copays, deductibles, and other out-of-pocket costs.
3. Understanding Medicare Advantage Options for 2026
For 2026, Medicare beneficiaries may continue to have a variety of Medicare Advantage options available depending on where they live. Medicare Advantage plans are offered by Medicare-approved private insurance companies and provide Medicare Part A and Part B coverage. Most Medicare Advantage plans also include prescription drug coverage (Part D). Plan availability, costs, provider networks, benefits, and coverage rules can vary by plan and location.
Common plan types include:
HMO (Health Maintenance Organization): Usually requires you to use in-network providers and select a primary care doctor. Referrals are often needed for specialists, but HMOs may offer lower premiums and copays.
PPO (Preferred Provider Organization): Offers more flexibility to see out-of-network providers, typically at higher costs, and usually does not require referrals.
PFFS (Private Fee-for-Service): Allows you to see any provider who agrees to the plan’s terms. Some PFFS plans do not include drug coverage, so you may need a separate Part D plan.
MSA (Medical Savings Account): Combines a high-deductible health plan with a medical savings account that Medicare funds. Drug coverage must be purchased separately through Part D.
SNP (Special Needs Plans): Tailored for people with certain chronic conditions, dual eligibility for Medicare and Medicaid, or those in institutions. These plans always include drug coverage.
In 2026, the average monthly Medicare Advantage plan premium is projected to be about $14 per month, according to CMS. Actual premiums, benefits, deductibles, copays, provider networks, and out-of-pocket costs vary by plan and location. Keep in mind that a low monthly premium does not necessarily mean lower overall health care costs, so it is important to compare the full costs and benefits of each plan.
Comparing Medicare Advantage and Part D options side by side can reveal major cost and coverage differences.
4. Part D Coverage in 2026: What’s Changing for Prescription Drugs
Prescription drug coverage can be an important factor when reviewing your Medicare options. For 2026, there are several Part D changes and benefit amounts Medicare beneficiaries should know:
Annual out-of-pocket threshold: For 2026, the Part D annual out-of-pocket threshold is $2,100. After reaching this threshold for covered Part D drugs, beneficiaries enter the catastrophic phase and pay no cost sharing for covered Part D drugs for the remainder of the year.
Coverage gap: The former Part D coverage gap, often called the “donut hole,” was eliminated beginning in 2025. The redesigned Part D benefit now consists of the deductible phase, initial coverage phase, and catastrophic phase.
Deductible: The standard Part D deductible for 2026 is $615. Individual plans may have a lower deductible or different cost-sharing structures. Under the defined standard benefit, beneficiaries generally pay 25% coinsurance during the initial coverage phase after the deductible.
Medicare also provides special cost protections for certain prescription drugs and vaccines. In 2026, cost sharing for a one-month supply of each covered insulin product is limited to the lesser of $35, 25% of the Medicare-negotiated maximum fair price when applicable, or 25% of the plan's negotiated price. The Part D deductible does not apply to covered insulin products. In addition, ACIP-recommended adult vaccines covered under Part D are available with no deductible or cost sharing. Negotiated prices for the first group of drugs selected under the Medicare Drug Price Negotiation Program also take effect in 2026.
When comparing Part D coverage—whether as a standalone plan or bundled in a Medicare Advantage plan—use the Medicare Plan Finder tool on Medicare.gov to enter your prescriptions, dosages, and preferred pharmacies. This helps you estimate annual drug costs under each plan, including premiums, deductibles, and copays.
5. Confirming Your Doctors, Hospitals, and Pharmacies
Before choosing or switching Medicare Advantage plans, it is important to review the plan’s provider network and pharmacy information. Confirm that:
Your primary care physician and key specialists participate in the plan’s network.
Your preferred hospitals and health care facilities participate in the plan’s network, particularly if you have upcoming procedures or treatments.
Your regular pharmacies participate in the plan’s pharmacy network and whether they are considered preferred pharmacies, which may affect what you pay for prescriptions.
Provider and pharmacy networks can change from year to year. Do not assume that because a doctor, hospital, or pharmacy participated in your plan’s network in 2025, it will continue to participate in 2026. Check the plan’s current provider or pharmacy directory and, when appropriate, contact the provider or pharmacy directly to confirm participation.
6. Balancing Costs and Benefits: Looking Beyond the Premium
When comparing Medicare coverage options, it can be tempting to focus primarily on the monthly premium. However, the monthly premium is only one part of the overall cost of coverage. It is important to also consider potential out-of-pocket costs, provider access, prescription drug coverage, and the value of any additional benefits.
• Estimate how often you typically use medical services, including visits with doctors and specialists. Consider applicable copays, coinsurance, deductibles, and premium costs.
• Review the plan’s maximum out-of-pocket limit for covered Part A and Part B services. Medicare Advantage plans have an annual limit on the amount you pay out of pocket for covered Medicare Part A and Part B services.
• Consider supplemental benefits a plan may offer, such as dental, vision, hearing, transportation, or fitness benefits. Benefits, eligibility requirements, limitations, and availability vary by plan and location. Consider these benefits along with your medical, prescription drug, provider, and overall cost needs.
7. Other Important Enrollment Periods to Keep in Mind
While the Annual Enrollment Period is an important time to review Medicare Advantage and Part D coverage, other enrollment periods may also provide opportunities to make changes, depending on your circumstances:
Medicare Advantage Open Enrollment Period: From January 1 through March 31 each year, people who are already enrolled in a Medicare Advantage plan can make one change. You may switch to another Medicare Advantage plan or return to Original Medicare. If you return to Original Medicare, you may also be able to join a separate Medicare Part D drug plan. Changes generally take effect the first day of the month after the plan receives your request.
General Enrollment Period for Medicare Part A and/or Part B: From January 1 through March 31 each year, certain people who did not enroll when first eligible may be able to sign up for Medicare Part A and/or Part B. Coverage generally begins the first day of the month after enrollment. Late-enrollment penalties may apply in some circumstances.
5-Star Special Enrollment Period: If a Medicare Advantage plan, Medicare drug plan, or Medicare Cost Plan with a 5-star quality rating is available in your area, you may have an opportunity to switch to a 5-star plan once between December 8 and November 30 of the following year.
8. A Step-by-Step Checklist Before You Decide
List your current health care needs. Consider the doctors and specialists you see, expected medical services or treatments, and the prescription drugs you take, including dosages.
Review your current plan’s 2026 Annual Notice of Change (ANOC). Look for changes to premiums, deductibles, copays, coinsurance, prescription drug coverage, provider networks, and other benefits that may affect you.
Compare your Medicare coverage options. Use the Medicare Plan Finder and other available plan information to compare Medicare Advantage and Part D options available in your area. Consider your prescriptions, preferred doctors and pharmacies, benefits, and estimated costs.
Review plan quality ratings. Medicare Star Ratings can provide useful information about plan quality and performance, but ratings should be considered along with your individual health care needs, prescription coverage, provider access, and costs.
Ask for help if you need it. Medicare beneficiaries can get information from 1-800-MEDICARE, their local State Health Insurance Assistance Program (SHIP), or a licensed insurance agent who can help explain available coverage options.
Making the Most of Medicare Open Enrollment 2026
Medicare’s Annual Enrollment Period, from October 15 through December 7, gives beneficiaries an opportunity to review their current coverage and consider changes for the upcoming year. Even if you are satisfied with your current plan, premiums, costs, provider networks, prescription drug coverage, and benefits can change from year to year.
Before making a decision, take time to review your plan’s Annual Notice of Change (ANOC), confirm that your doctors and prescriptions are covered, and compare the costs and benefits of available Medicare options. The plan with the lowest premium may not always be the best fit for your individual needs.
If you have questions about your Medicare coverage options, a licensed insurance agent can help you understand and compare plans available in your area.
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Disclaimer: Haddy Health Insurance is not connected with or endorsed by the U.S. government or the federal Medicare program. This content is for educational purposes only and is not intended to provide a complete description of all Medicare options. Plan availability, benefits, costs, and coverage may vary by plan and location.
Sources: 1. Medicare.gov, “Medicare & You 2026.” 2. CMS.gov, “Medicare Open Enrollment Partner Resources.” 3. KFF.org, “Medicare Advantage 2026 Spotlight.” 4. Medicare.gov, “Your Medicare Coverage Choices.” 5. CMS.gov, “Medicare Advantage and Part D Programs Expected to Remain Stable in 2026.” 6. CMS.gov, “Final CY 2026 Part D Redesign Program Instructions.” 7. CMS.gov, “2026 Medicare Advantage and Part D Rate Announcement.” 8. Medicare.gov, “How Medicare Drug Plans Work.” 9. Medicare.gov, “Medicare Costs at a Glance.”
Haddy Health Insurance is not connected with or endorsed by the U.S. government or the federal Medicare program.
