As the Medicare Open Enrollment Period approaches (Oct. 15 to Dec. 7, 2025), it's time to review your health and prescription drug plans to ensure they meet your needs for 2026. This year brings significant changes that could save you money and improve your care.
1. Save on prescription drugs with a $2,100 cap
Thanks to the Inflation Reduction Act, Medicare Part D plans (prescription drug coverage) capped your out-of-pocket costs at $2,000 per year starting January 1, 2025. However, for 2026, this cap is adjusted for inflation and increases to $2,100 per year. Once a Medicare Part D enrollee reaches this $2,100 out-of-pocket limit in 2026, they will pay $0 for covered Part D prescriptions for the remainder of the year. This cap applies to deductibles, copayments, and coinsurance for covered drugs under Part D plans, but it does not apply to drugs covered under Medicare Part B or non-covered medications.
Once you hit this limit, you'll pay nothing for covered Part D medications for the rest of the year — no copays or coinsurance. The 'donut hole' coverage gap is also gone, meaning no surprise costs for expensive drugs. Plus, a new Medicare Prescription Payment Plan lets you spread your drug costs into monthly payments, making budgeting easier. Contact your Part D plan to opt in if this helps you manage costs.
Check your plan's drug list (formulary) during open enrollment, as fewer Part D plans are available in 2026, and some may cover different medications or have higher premiums.
2. More flexibility for low-Income seniors
If you're enrolled in both Medicare and full Medicaid or qualify for the Part D Extra Help program, you'll have new options in 2026. Starting January 1, you can change your Medicare Advantage or Part D plan monthly, not just quarterly, to better match your health needs or coordinate benefits.
Call 1-800-MEDICARE to see if you qualify for Extra Help, which can lower drug costs to $4.90 for generics and $12.15 for brand-name drugs.
3. Fewer Medicare Advantage plans
In 2026, there will be fewer Medicare Advantage plans to choose from, and some may change their provider networks or benefits. Review your Annual Notice of Change (ANOC) letter, sent by September 30, 2025, to confirm your doctors and services are still covered.
Use Medicare's Plan Finder tool at Medicare.gov/plan-compare to compare plans by your ZIP code, medications, and preferred pharmacies.
