What to Do About These Three Medicare Changes During Open Enrollment

When the Medicare open-enrollment season for 2026 starts on October 15, brace yourself for some big, and potentially costly, changes.

Premium hikes for both medical and drug coverage, shrinking benefits on some private insurers' Medicare Advantage plans and a few rule changes mean it will be especially wise to research your choices to protect your health and save money.

Yet, nearly seven out of 10 Medicare beneficiaries don’t compare plan options, according to a study last year by health policy and research firm KFF. That can be an expensive error — even if you’re satisfied with your current coverage.

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“Medicare Advantage and Part D plans often change from one year to the next, so people may see changes to their premiums, cost-sharing, coverage of their medications, and their health provider or pharmacy networks,” says Alex Cotrill, a senior policy analyst at KFF.

As always, during open enrollment this year you’ll be able to sign up for either government-run original Medicare or a Medicare Advantage (Part C) plan from a private insurer; switch from original Medicare to Medicare Advantage or vice versa; replace your Medicare Advantage plan with a different one; and choose or change a Part D prescription-drug plan.

Here’s a rundown of the key changes and tips to pick the best coverage for your needs.

New restrictions on Medicare coverage

Experts expect many Medicare Advantage plans to trim benefits, hike costs or both for 2026, due to the financial squeeze insurers are facing. In addition, some insurers — including UnitedHealthcare, the largest provider — will not offer all the plans they did in 2025.

“These companies are trying to find their way to profitability,” says David Lipschutz, co-director of the Center for Medicare Advocacy.

The biggest news for original Medicare is that some beneficiaries will now need to get prior authorization to receive certain treatments. This rule applies to residents in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington and is limited to 17 medical needs, including pain management and help for urinary incontinence.

The basic choice between the two types of coverage, though, remains the same. Although original Medicare is usually more expensive than Advantage (due to the need to supplement coverage with a Part D prescription-drug plan and a medigap policy), it lets you go to any doctor or hospital that takes Medicare.

By contrast, Medicare Advantage plans typically have restrictive physician and hospital networks and require prior authorization to see a specialist. Many, however, offer benefits original Medicare doesn’t (such as dental, vision and hearing coverage) and typically include Part D coverage.

What to do: “In general, people may prefer original Medicare if they want the broadest access to doctors and hospitals,” says Cotrill. “They may prefer Medicare Advantage if they want extra benefits, reduced cost-sharing or the simplicity of one-stop shopping.”

If you opted for Medicare Advantage in 2025 and plan to renew, check the Annual Notice of Change sent out by your insurer to see whether your plan will be back and whether benefits and networks will stay the same.

Just because the plan was right for you in 2025 doesn’t mean it will be your best choice next year. Also keep in mind that if you switch from Medicare Advantage to original Medicare, you can be rejected when applying for a medigap plan in most states.

Higher Medicare premiums

“It’s possible premiums could go up pretty significantly,” says Stephanie Fajuri, health insurance counseling and advocacy program manager at the Center for Health Care Rights in Los Angeles.

The Part B monthly premium, $185 in 2025, is expected to jump by 12%, to $206.50, adding nearly $2,500 to your annual costs in 2026. Monthly premiums for Part D will be allowed to rise by up to $50 a month, compared with a limit on increases of $35 a month last year.

For higher-income beneficiaries, the Medicare Part B and D premium surcharge known as IRMAA (income-related monthly adjustment amount) will also rise next year. In 2026, the surcharge applies to anyone whose 2024 income was greater than about $107,000 ($214,000 for joint filers) and could add as much as $448 a month to Part B premiums and $91 monthly to Part D.

What to do: You can compare prices and coverage for Medicare Advantage and Part D plans in your area via Medicare.gov’s Plan Finder. If you get a notice saying you’ll owe the IRMAA next year, you can appeal it if you’ve had a life-changing event that has caused your income to drop since 2024, such as retirement.

Higher and lower drug costs

In 2025, Medicare instituted a $2,000 out-of-pocket annual cap, which will rise to $2,100 in 2026, on Part D prescription costs. But because the cap will limit insurers’ income, some plans are expected to charge more for certain prescriptions or cover fewer medications next year.

On the plus side, look for discounts of at least 38% to 79% off list prices on 10 popular prescriptions, in-cluding blood thinners Eliquis and Xarelto and diabetes medications Januvia, Jardiance and Farxiga, as the long-awaited Medicare Part D price-negotiation program begins next year. “Part D plans have the ability to negotiate for even lower prices,” says Leigh Purvis, AARP prescription-drug policy principal.

What to do: The Part D changes in price and coverage make it even more imperative to compare plans. In addition to Medicare’s Plan Finder tool, consider using HeyMOE (heymoe.com; $30 a year), a Part D review service from Medicare advisory firm 65 Incorporated.

For more general advice about the process, AARP has a free, interactive open-enrollment guide. Your State Health Insurance Assistance Program, or SHIP can also provide free, expert Medicare tips. Says Purvis, “SHIPs are the best way to get advice from an objective source.”

Note: This item first appeared in Kiplinger Personal Finance Magazine, a monthly, trustworthy source of advice and guidance. Subscribe to help you make more money and keep more of the money you make here.

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