Medicare’s annual open enrollment period runs from October 15 through December 7, and experts are warning recipients that 2026 will bring higher premiums, shifting drug plan options, and lingering effects from the government shutdown that could delay claims processing. With roughly 69 million people enrolled in the federal health program, the decisions made this fall will affect costs for doctor visits, hospital stays, and prescription drugs.
Whitney Stidom, vice president of consumer enablement at eHealth, said millions of beneficiaries face higher out-of-pocket costs and reduced benefits in 2026. “Comparing Medicare coverage options is especially important this year,” they told a health news outlet. Beneficiaries should shop around during the enrollment window, they added, because plans from different insurers can save them money.
Part B premiums jump 12% — and that’s before the Social Security bump
The average monthly Part B premium is set to rise from $185 in 2025 to $206 in 2026. That 12% increase is double the hike from last year. For retirees on Social Security, it more than offsets the projected 2.7% cost-of-living adjustment in monthly benefits.
The Centers for Medicare & Medicaid Services (CMS) cites higher utilization of Part B services, rising enrollment, and increased costs for hospitalization and outpatient care. The annual deductible for Part B coverage will also climb 12%, from $257 in 2025 to $288 in 2026.
Medicare Advantage plans: fewer options, lower premiums — but also narrower networks
About 51% of Medicare recipients carry a Medicare Advantage plan. CMS estimates around 5,600 such plans will be available nationwide in 2026, roughly the same as 2025, when the number of options actually dropped from the previous year. Some large insurers, including UnitedHealthcare, have said they plan to scale back service areas or coverage options.
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On the plus side, the average monthly premium for Medicare Advantage plans with prescription drug coverage is projected to fall from $16 to $14. The annual out-of-pocket limit for in-network services edges down slightly, from $9,350 to $9,250.
Still, experts caution that narrower networks and reduced service areas could make it harder for people to keep their current doctors. Beneficiaries need to check whether their preferred providers will remain in-network next year.
Part D drug plans: premiums down, deductibles up
Standalone Part D prescription drug plans will see average monthly premiums drop from $38 to $34, while Part D plans packaged with Medicare Advantage dip from $13 to $11. However, insurers will be allowed to raise the monthly premium for Part D by as much as $50 — up from the current $35 cap. That cap increase gives insurers more flexibility but also means some beneficiaries could see steep hikes.
The annual deductible for Part D plans can vary, but the maximum allowed will rise from $590 to $615. The cap on out-of-pocket drug expenses will tick up from $2,000 to $2,100. Insulin co-pays remain capped at $35 per month, and most vaccines stay covered under Part D.
The number of standalone Part D plans is shrinking sharply — from 464 nationwide in 2025 to 360 in 2026. That means fewer choices for the roughly 81% of Medicare recipients who enroll in Part D. At the same time, Medicare officials are expected to continue negotiating prices on 10 widely used drugs, including blood thinners Eliquis and Xarelto, and diabetes drugs Januvia, Jardiance, and Farxiga. Those negotiations could knock 38% to 79% off list prices, but the timing of savings remains uncertain.
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Telehealth squeeze and government shutdown spillover
Adding uncertainty to open enrollment is the unresolved government shutdown. If it drags on, processing of Medicare claims and payments to providers could slow. Telehealth services, which expanded during the pandemic, have already taken a hit. Several temporary telehealth flexibilities expired on October 1, and Congress didn’t renew them.
Dr. Kanwar Kelley, a California otolaryngologist and co-founder of Side Health, said the restrictions will create gaps for patients with disabilities and those in rural areas. “Converting patients accustomed to telehealth back to in-person visits will incur costs for transportation, lost work, and time,” they said. “Delayed or avoided care can increase downstream costs and worse outcomes.”
GLP-1 drugs: no Medicare coverage for weight loss
Earlier this year, the Trump administration decided not to cover GLP-1 weight-loss drugs like Ozempic under Medicare. That means beneficiaries who want those medications for weight loss will have to pay out of pocket — or find a Part D plan that covers them for diabetes if that’s their diagnosis.
What to watch in the fine print
Deductibles, co-pays, and coinsurance changes can hit fixed-income households hard. “It is important that beneficiaries are confident they can afford the medical care they will need in case of an unforeseen illness or injury,” Stidom said. People already on a Medicare prescription payment plan that spreads drug costs over the year will be automatically re-enrolled for 2026 unless they opt out.
For most enrollees, the smartest move is to compare plans side-by-side during open enrollment — what worked this year may not be the best deal for next year. Explore our content hubs for more health coverage information.
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