During Medicare’s Open Enrollment period, October 15 to December 7, anyone with a Medicare drug plan, also known as “Part D,” can change their plan. That makes it a good time to double check your loved one’s coverage, even if they’ve been satisfied. Plans change every year. Medications may be dropped. Pharmacies shift in and out of networks. Out-of-pocket costs can go up or down.
For 2026, there are a few updates worthy of attention:
- The annual cap on out-of-pocket prescription costs is now indexed for inflation. In 2026, it goes up to $2,100.
- The Medicare Prescription Payment Plan spreads costs over the year. Those who enroll in 2026 will be automatically renewed in following years or must opt out.
- The monthly cost for insulin, in whatever form, is now capped at $35 (with no deductible).
- Medicare Part D enrollees are entitled to all vaccines on the federal approved list at no cost.
What to look for when comparing plans
- Medication coverage. Make sure every drug your loved one takes is still on the plan’s list (the “formulary”) and approved for their condition.
- Total costs. Look beyond the premium. Compare copays, deductibles, and pharmacy pricing. Also, depending on their income, they may qualify for the Extra Help program. Apply at ssa.gov/extrahelp.
- Preferred pharmacy. Using an “in-network” pharmacy can significantly reduce costs. Confirm this before enrolling.
- Restrictions. Some plans require preapproval or ask members to try lower cost drugs before covering others.
- Bundled plans. On a Medicare Advantage plan, drug coverage may be tied to specific doctor or hospital networks. Changes to drug plans could affect other care.
As a final step, check how the plan is rated. Medicare assigns each plan a star rating based on service and satisfaction. Carefully consider any plan with fewer than four stars. For more help, visit Medicare.gov, call 1-800-MEDICARE, or connect with a local, free SHIP (State Health Insurance Assistance Program) counselor at shiphelp.org.