Medicare Part D Options Shrink for 2026: Act Now to Secure Coverage

UPDATE: Medicare shoppers face shrinking prescription drug coverage options for 2026, with critical decisions looming just weeks away. The annual enrollment period runs from October 15 to December 7, and many beneficiaries must act quickly to secure their plans starting January 1.

For the upcoming year, the number of standalone drug plans available to Medicare recipients is set to decline, continuing a troubling trend observed over the past few years. Experts predict shoppers will have access to only 8 to 12 options, down from 12 to 16 in 2025. This reduction is particularly concerning for those eligible for low-income subsidies, where choices may be limited to as few as one to four plans.

The decline in options is compounded by a shift in the insurance market. Notably, the Blue Cross-Blue Shield carrier, Elevance, has announced its exit from the standalone Part D market entirely, leaving many beneficiaries in the lurch. According to the non-profit KFF, approximately 23 million Medicare participants rely on standalone coverage, while 34 million are enrolled in Medicare Advantage plans with built-in prescription benefits.

Experts are sounding alarms as nearly 11% of those with standalone drug coverage lost their plans in 2024, a sharp increase from less than 1% in previous years. Dr. Christopher Cai, a researcher involved in this alarming trend, states, “This shift indicates a significant upheaval in the market that could impact millions of seniors.”

The Inflation Reduction Act is also influencing these changes, capping annual out-of-pocket drug costs at $2,100 starting in 2026. While this provides some relief for beneficiaries, it places additional financial strain on insurers, potentially leading to fewer available options.

While many markets will still offer several choices, the inertia among Medicare Part D customers presents a challenge. Many beneficiaries are hesitant to switch plans, fearing they may end up worse off. KFF Medicare expert Juliette Cubanski warns, “There’s a lot of inertia, and frankly, people may be concerned that if they switch, they’re going to end up worse off.”

Shoppers should also be aware of fluctuating costs. Monthly premiums for Part D plans are expected to fall nearly 10% on average to $34.50, according to the Centers for Medicare and Medicaid Services. Yet, despite lower premiums, some plans may impose higher deductibles or limit coverage lists, known as formularies. It’s crucial for consumers to scrutinize these details carefully.

Insurers will be permitted to increase premiums by as much as $50 a month for 2026, up from a $35 increase this year. Cubanski notes, “Only some plans will hit that higher limit, and not necessarily in all states,” emphasizing the need for vigilant comparison shopping.

For assistance, beneficiaries can utilize the federal government’s website to compare plans or tap into their State Health Insurance Program, designed to help Medicare recipients navigate coverage options. It’s also advisable for shoppers to verify that their preferred pharmacies are within the network of any plan they consider.

Delaying decisions could be detrimental. With the enrollment window spanning several weeks, many shoppers procrastinate until the first week of December, often leading to a last-minute rush. This behavior can create a challenging deadline crunch, making it harder to secure adequate assistance in early December.

With significant changes on the horizon, Medicare beneficiaries are urged to act swiftly and ensure they have the best possible coverage for their prescription needs. The clock is ticking, and the landscape is shifting—don’t wait until it’s too late.