Guide to Medicare’s 2025 Annual Enrollment for 2026 Coverage

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The Medicare Annual Enrollment Period is the single most important time of year for millions of Americans who rely on Medicare for health coverage. Running from October 15, 2025, through December 7, 2025, this window offers the opportunity to review, compare, and make vital changes to health and prescription drug plans for the upcoming year.

Any new selections made during this period will take effect on January 1, 2026.

This period isn’t for initial sign-ups but for those already enrolled in Medicare to ensure their coverage continues to meet their evolving health needs and financial circumstances. The healthcare landscape isn’t static. Every year, private insurance companies that offer Medicare Advantage and Part D plans can alter their costs, benefits, provider networks, and lists of covered drugs, known as formularies.

While it may be tempting to let your current plan auto-renew, this act of inertia has become more financially perilous than ever. Research shows that a significant majority of beneficiaries—nearly seven out of ten—don’t compare their plan options annually.

In previous years, this might have been a missed opportunity for modest savings. For 2026, however, it could be a costly mistake.

Major changes to Medicare Part D stemming from the Inflation Reduction Act are placing new financial pressures on insurance companies. In response, many insurers are reducing popular supplemental benefits, increasing out-of-pocket costs, and shrinking their provider networks to maintain profitability.

The plan you were satisfied with in 2025 is almost certain to be different in 2026, and likely less generous. The gap between your passively renewed plan and the best available option in the market has widened, potentially translating into thousands of dollars in unexpected expenses or gaps in care.

This transforms the annual plan review from a recommended best practice into a critical financial necessity for protecting both your health and your wallet.

Understanding Enrollment Periods

Navigating Medicare requires understanding its specific timelines. While the Annual Enrollment Period is the most widely known, it’s just one of several distinct windows during which you can enroll in or change your coverage.

Confusing these periods can lead to missed opportunities or unexpected penalties.

Annual Enrollment Period (October 15 – December 7)

This is the primary period for making changes and is open to anyone already enrolled in Medicare. It’s also referred to as the Annual Election Period or Medicare Open Enrollment.

During these 54 days, you can make a wide range of changes, including:

• Switching from Original Medicare to a Medicare Advantage plan
• Switching from a Medicare Advantage plan back to Original Medicare
• Changing from one Medicare Advantage plan to another (with or without drug coverage)
• Enrolling in a Medicare Part D prescription drug plan
• Switching from one Part D plan to another
• Dropping your Part D coverage entirely

You can make as many changes as you wish during AEP. The last selection you make before the December 7 deadline will be the one that takes effect on January 1.

Medicare Advantage Open Enrollment Period (January 1 – March 31)

This period serves as a “do-over” window, but it’s exclusively for individuals who are already enrolled in a Medicare Advantage plan as of January 1.

If you’re unhappy with the MA plan you chose during AEP, the MA-OEP allows you to make a single, one-time change. You can:

• Switch to a different Medicare Advantage plan
• Drop your Medicare Advantage plan and return to Original Medicare. If you do this, you’ll also be able to join a standalone Part D prescription drug plan.

If you’re enrolled in Original Medicare, you can’t use this period to make any changes.

These two enrollment periods can be used strategically. A beneficiary on Original Medicare who is curious about the extra benefits of a Medicare Advantage plan but wary of its network restrictions can use the AEP to enroll in an MA plan for the upcoming year.

They can then use the first few months of the year to “test drive” the plan—scheduling appointments with their doctors, checking access to specialists, and filling prescriptions. If the plan proves to be a poor fit, the MA-OEP provides a guaranteed escape hatch back to Original Medicare.

This strategy lowers the perceived risk of trying Medicare Advantage, but it comes with a critical warning: returning to Original Medicare may make it difficult or impossible to purchase a comprehensive Medigap policy.

Other key enrollment periods

Initial Enrollment Period: This is the seven-month window for first-time Medicare enrollment. It begins three months before the month you turn 65, includes your birth month, and extends for three months after. Missing this window can result in lifelong late enrollment penalties.

General Enrollment Period (January 1 – March 31): If you missed your IEP and don’t qualify for a Special Enrollment Period, you can sign up for Medicare Part A and/or Part B during the GEP. Your coverage will begin the first day of the month after you sign up. Late enrollment penalties may apply.

Special Enrollment Periods: These are chances to change your coverage outside of the standard periods, triggered by specific life events. Qualifying events include moving to a new address outside your current plan’s service area, losing other health coverage (like from an employer), or your current plan terminating its contract with Medicare.

Notably for 2026, a new SEP will be granted to individuals who were given incorrect provider or pharmacy network information by the official Medicare Plan Finder tool.

Original Medicare vs. Medicare Advantage

At the heart of the Annual Enrollment Period is a fundamental choice between two distinct ways to receive your Medicare benefits: Original Medicare and Medicare Advantage.

Understanding the profound differences in their structure, costs, and flexibility is essential to making a decision that aligns with your health needs, lifestyle, and financial situation.

Original Medicare

Original Medicare is the traditional, fee-for-service health program administered directly by the federal government. It’s composed of two parts:

Part A (Hospital Insurance): Helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care.

Part B (Medical Insurance): Helps cover services from doctors and other health care providers, outpatient care, durable medical equipment, and preventive services.

This structure, however, has significant gaps. Original Medicare doesn’t cover most prescription drugs, nor does it cover routine dental, vision, or hearing care.

To fill these gaps, beneficiaries typically assemble a complete coverage package by adding:

A standalone Medicare Part D Plan: Purchased from a private insurer to cover prescription drugs.

A Medicare Supplement Insurance (Medigap) policy: Also purchased from a private insurer, Medigap plans help pay for the out-of-pocket costs that Original Medicare doesn’t cover, such as deductibles and the 20% coinsurance for Part B services.

Medicare Advantage

Medicare Advantage, also known as Part C, is an alternative to Original Medicare offered by private insurance companies that are approved by Medicare.

These plans are required by law to cover everything that Original Medicare (Parts A and B) covers. They bundle these benefits into a single plan and, in most cases, also include Part D prescription drug coverage.

A key appeal of Medicare Advantage is that many plans also offer extra benefits not covered by Original Medicare, such as routine dental, vision, and hearing services, as well as fitness program memberships.

Key differences

The choice between these two paths involves significant trade-offs.

Provider choice and flexibility

This is perhaps the most critical distinction. With Original Medicare, you have the freedom to see any doctor or hospital in the United States that accepts Medicare, without needing a referral to see a specialist. This nationwide access is invaluable for those who travel or want the widest possible choice of providers.

Medicare Advantage plans typically operate with local provider networks, such as Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs). Seeing a provider outside the plan’s network will likely result in higher costs or no coverage at all, except in emergencies.

Out-of-pocket costs

Original Medicare has no annual limit on your out-of-pocket expenses. A serious illness could expose you to unlimited 20% coinsurance costs, which is why a Medigap policy is considered essential by many.

Medicare Advantage plans, by law, must have an annual maximum out-of-pocket (MOOP) limit for medical services. Once you reach this limit, you pay nothing for covered services for the rest of the year, providing a crucial financial safety net.

The Medigap “one-way door”

This is a critical factor that can make the decision to leave Original Medicare a permanent one.

When you first enroll in Medicare Part B at age 65, you have a one-time, six-month Medigap Open Enrollment Period. During this window, you have a guaranteed issue right to buy any Medigap policy sold in your state, regardless of your health history.

Insurers can’t deny you coverage or charge you more for pre-existing conditions.

If you choose a Medicare Advantage plan and later decide to switch back to Original Medicare, in most states, you lose this guaranteed issue right. An insurance company can then use medical underwriting to review your health history and can legally deny you a Medigap policy or charge significantly higher premiums if you’ve developed health conditions.

This makes leaving Original Medicare a high-stakes decision, particularly for those who may need comprehensive coverage in the future.

What’s New for 2026

Each fall, the Centers for Medicare & Medicaid Services announces the official costs for the following year. While final numbers for 2026 will be released in late 2025, projections based on trustee reports and recent trends indicate notable increases in costs for Original Medicare beneficiaries.

Original Medicare costs

For context, the key costs for Original Medicare in 2025 were:

• Part B Standard Monthly Premium: $185.00
• Part B Annual Deductible: $257
• Part A Inpatient Hospital Deductible: $1,676 per benefit period

For 2026, beneficiaries should brace for significant increases. Projections indicate the standard Part B monthly premium could jump by as much as 12% to approximately $206.50. The Part A deductible and daily coinsurance amounts are also projected to rise.

Income-Related Monthly Adjustment Amount (IRMAA)

A crucial factor in Medicare costs is IRMAA. This is a surcharge that higher-income beneficiaries must pay in addition to their standard Part B and Part D premiums.

The Social Security Administration determines who pays IRMAA based on the modified adjusted gross income (MAGI) reported on your IRS tax return from two years prior. Therefore, your 2026 IRMAA will be based on your 2024 tax return.

The income thresholds that trigger these surcharges are adjusted annually for inflation. For 2025, the thresholds started at a MAGI of $106,000 for an individual and $212,000 for a couple filing jointly. Projections for 2026 suggest these thresholds will rise slightly, starting at an income of around $109,000 for an individual.

The table below shows the official 2025 Part B IRMAA surcharges, which serve as a close estimate for the adjustments in 2026.

Source: Data compiled from the Centers for Medicare & Medicaid Services and the Railroad Retirement Board.

Medicare Advantage Changes

While official government reports from CMS project that the average monthly premium for a Medicare Advantage plan will decrease slightly in 2026 to around $14.00, this headline figure masks a more complex and concerning reality for beneficiaries.

The Medicare Advantage market is currently experiencing a form of “shrinkflation.” Insurers are holding the line on the highly marketable low or $0 premium, but they’re simultaneously reducing the underlying value of the plans through significant cuts to benefits and increases in patient cost-sharing.

This trend is largely a response to new financial pressures and regulatory changes, including adjustments to how Medicare pays plans and the increased drug costs plans will bear under the Inflation Reduction Act.

For beneficiaries, this means looking past the monthly premium is more important than ever.

Reduction of supplemental benefits

The most substantial changes for 2026 are happening in the supplemental benefits that have made MA plans so popular. These “extras” are often the first to be trimmed when insurers face financial headwinds.

Flex cards and OTC allowances: These benefits, which provide beneficiaries with a pre-loaded debit card or an allowance for health-related items, have seen the deepest cuts. Analysis of 2025 plan data showed that over half of all members enrolled in plans with these benefits would face a reduction in the allowance, a complete removal of the benefit, or a plan closure.

Dental coverage: While still widely offered, the generosity of dental benefits is also being curtailed. The same analysis found that roughly 37% of members with a dental allowance would experience a decrease in the allowance amount or see it eliminated entirely.

Vision and hearing benefits: The prevalence of coverage for vision and hearing hardware (eyeglasses and hearing aids) has also seen slight decreases, as plans tighten their budgets.

Higher costs and network changes

Beyond benefit cuts, insurers are shifting more costs to beneficiaries and altering their networks.

Higher cost-sharing: While copays for primary care visits have remained largely stable, a significant number of beneficiaries will see increases in their specialist copays for 2026.

A more notable trend is the widespread introduction of a prescription drug deductible in MA plans that previously had none, a direct response to insurers managing increased liability under the IRA.

Plan and network disruptions: The market is also seeing disruption. Some major insurers are eliminating specific plans, particularly PPO plans that offer more provider flexibility but are more expensive to operate.

This forces millions of beneficiaries to shop for entirely new coverage. Furthermore, even if a plan continues, its network of doctors and hospitals can change from year to year. It’s essential to verify that your preferred providers will still be in-network for 2026.

Part D Changes for 2026

The Medicare Part D prescription drug program is undergoing its most significant transformation since its creation, thanks to landmark provisions in the Inflation Reduction Act.

These changes bring unprecedented new protections for beneficiaries but are also causing major shifts in the insurance market that will affect plan choice and monthly costs.

New protections

$2,100 annual out-of-pocket cap: This is the most impactful change. Beginning in 2026, your out-of-pocket spending on covered Part D prescription drugs will be capped at $2,100 for the year. This cap is a slight increase from the $2,000 cap that was in place for 2025.

After you’ve spent $2,100 out-of-pocket, you’ll pay $0 for your covered drugs for the remainder of the year. This effectively eliminates the “catastrophic coverage” phase where beneficiaries previously had to pay 5% of their drug costs.

Medicare Prescription Payment Plan: To help beneficiaries manage high upfront drug costs, a new voluntary program called the Medicare Prescription Payment Plan will be available in 2026.

If you opt in, you can spread your out-of-pocket costs into predictable monthly payments over the course of the year instead of paying large sums at the pharmacy counter.

Negotiated drug prices: For the first time, Medicare has negotiated lower prices for 10 high-cost drugs. These new, lower “maximum fair prices” will take effect on January 1, 2026, and will apply to drugs including the blood thinners Eliquis and Xarelto, and diabetes medications Jardiance, Januvia, and Farxiga. Beneficiaries taking these specific medications could see substantial savings.

The Part D squeeze

While the new $2,100 cap provides a powerful financial backstop, the path to reaching that cap may become more challenging for many. The IRA’s provisions increase the financial liability for insurance plans, leading them to make several strategic adjustments to control their costs.

This creates a “squeeze play” on beneficiaries.

The benefit: The annual cap offers unprecedented protection against catastrophic drug costs.

The insurer reaction: To offset their increased financial risk, insurers are consolidating their plan offerings, leading to fewer choices for consumers. Some national carriers are even exiting the standalone Part D market entirely.

The squeeze: A major trend is the shift away from predictable, flat-dollar copayments toward percentage-based coinsurance, especially for brand-name and specialty drugs. Instead of a stable $45 copay, you might now owe 25% or 30% of a drug’s total cost, which can fluctuate from month to month and pharmacy to pharmacy.

This makes monthly budgeting far more difficult.

The implication: This shift to coinsurance makes the new Medicare Prescription Payment Plan more than just a convenience. It’s a necessary tool designed to help beneficiaries manage the cash-flow problems and budget volatility created by the market’s reaction to the IRA.

The cap and the payment plan are two sides of the same coin, designed to work together to make the new Part D benefit manageable.

Formulary changes

To further control costs, plans are actively managing their formularies. Expect to see more plans favoring lower-cost generics and biosimilars over their brand-name counterparts.

This is particularly true in therapeutic classes with multiple treatment options, such as multiple sclerosis, pulmonary arterial hypertension, and diabetes (insulins). For example, some plans are removing brand-name insulins like Fiasp and Toujeo while expanding coverage for authorized generics.

Other plans are removing drugs like Ozempic and Rybelsus from their formularies entirely, requiring patients with type 2 diabetes to try alternatives like Mounjaro or Trulicity first.

It’s absolutely essential to use the plan comparison tools to ensure all of your specific medications are covered by the plan you choose for 2026.

How to Choose Your Plan

The sheer volume of information and the high stakes can make the Annual Enrollment Period feel overwhelming. However, by following a structured process, you can break down the task into manageable parts and make an informed decision with confidence.

Gather your information

Before you begin comparing plans, collect all the necessary documents and information. This preparation will make the process significantly smoother and more accurate.

You’ll need:

• Your red, white, and blue Medicare card, which has your Medicare number and your Part A and Part B effective dates
• A complete list of all your prescription medications. Include the exact name, dosage, and how often you take it (e.g., Lisinopril, 20 mg, once daily)
• The names and addresses of the pharmacies you prefer to use
• The names of all your doctors, specialists, and preferred hospitals

Review your Annual Notice of Change

If you’re currently enrolled in a Medicare Advantage or Medicare Part D plan, your plan provider is required to mail you an Annual Notice of Change (ANOC) by the end of September.

This is the single most important document you’ll receive. It’s not junk mail. The ANOC provides a concise, side-by-side summary of how your plan’s costs and coverage will change from the current year to the next.

Carefully review the ANOC for changes to your:

• Monthly premium
• Annual deductible
• Maximum out-of-pocket limit
• Copayments and coinsurance for medical services and drugs
• Provider network
• Drug formulary (which drugs are covered and at what cost tier)

This document is your personalized roadmap, highlighting exactly why you can’t assume your current plan will serve you equally well next year.

Use the Medicare Plan Finder

The official Medicare Plan Finder tool is the most powerful and comprehensive resource for comparing all the Medicare Advantage and Part D plans available in your area.

Go to Medicare.gov: Click on “Find health & drug plans” to start.

Create or log in to your account: While you can do a general search, it’s highly recommended that you log in to your secure Medicare account (or create one if you haven’t already). This allows the tool to automatically access your information, save your drug list for future use, and provide a more accurate, personalized comparison.

Enter your information: The tool will prompt you to enter or confirm your zip code, the prescription drugs you take (using the list you gathered), and your preferred pharmacies. You can select up to two pharmacies to compare costs.

Filter and compare: The Plan Finder will generate a list of available plans, sorted by the lowest estimated total annual cost—this includes your premiums plus all your estimated out-of-pocket costs for drugs and services.

You can then filter the results based on insurance carrier, star ratings, and plan benefits. Select up to three plans to view a detailed, side-by-side comparison.

Examine the details: For each plan, drill down into the details. Check the “Drug Costs & Coverage” tab to see if any of your medications have restrictions like “Prior Authorization” or “Step Therapy.”

For MA plans, check the “Health Plan Benefits” tab and look for the provider directory link to confirm your doctors are in-network.

Verify and enroll

Once you’ve narrowed your choices down to one or two plans, verify the information directly with the plan. Call the insurance company’s member services number (listed in the Plan Finder) to confirm that your key doctors are indeed in the 2026 network and that your most important drugs are on the 2026 formulary.

When you’re ready to enroll, you can do so directly through the Medicare Plan Finder, by calling 1-800-MEDICARE, or by contacting the plan itself.

Enrolling through the official Medicare platforms provides an extra layer of protection. If you receive incorrect information from Medicare sources that leads to a poor enrollment choice, you may be granted a Special Enrollment Period to fix it.

Common Mistakes to Avoid

Navigating the Annual Enrollment Period successfully often means knowing what not to do. Many beneficiaries fall into common traps that can lead to higher costs, coverage gaps, or restricted access to care.

Passive auto-renewal

The most common and, for 2026, most dangerous mistake is simply letting your current plan roll over without a review. Plans change significantly every year.

Your doctor could leave the network, your prescriptions could move to a more expensive tier, or your deductible could double without you realizing it until you need care in January. Your Annual Notice of Change is your guide to these changes and your signal to start comparing options.

Shopping by premium alone

It’s easy to be drawn to a Medicare Advantage plan with a $0 monthly premium, but this single data point can be misleading. A plan with no premium might have a high deductible, expensive copayments for specialist visits, or poor coverage for your specific drugs.

The true cost of a plan is its total estimated annual cost, which includes the premium plus all the out-of-pocket expenses you’re likely to incur. The Medicare Plan Finder is designed to calculate this total cost for you.

Sometimes, a plan with a modest monthly premium can save you thousands of dollars over the year in overall costs.

Ignoring the drug formulary

Prescription drug coverage is a critical and complex part of Medicare. A plan’s formulary can change dramatically from one year to the next.

A drug that was on a low-cost tier last year might move to a high-cost specialty tier, or it might be removed from the formulary altogether. Furthermore, the plan might add new restrictions, such as requiring prior authorization from your doctor before they’ll cover the medication.

Failing to enter your specific drug list into the Plan Finder can lead to costly surprises at the pharmacy.

Misunderstanding network restrictions

If you’re considering a Medicare Advantage plan, you must verify that your essential healthcare providers—your primary care physician, key specialists, and preferred hospital—are in the plan’s network for 2026.

Don’t assume that because a provider accepted your plan this year, they’ll accept it next year. Provider networks change frequently. Enrolling in a plan without this confirmation could force you to either pay much higher out-of-network rates or find new doctors.

Waiting until the last minute

The AEP lasts 54 days for a reason. It takes time to gather your information, review your ANOC, use the Plan Finder, and verify details with potential plans.

Many people wait until the final week before the December 7 deadline, creating a scramble that leads to rushed decisions and overlooked details. Start the process in October to give yourself ample time to make a careful, unhurried choice.

Getting Help

You don’t have to navigate the complexities of Medicare alone. There are robust federal and state programs designed to provide financial assistance to those with limited incomes, as well as free, expert counseling to help anyone make sense of their options.

Financial assistance programs

If you’re struggling with the costs of Medicare, you may qualify for programs that can significantly reduce or even eliminate your premiums, deductibles, and copayments.

Medicare Savings Programs: These are state-administered programs that help pay for Medicare costs. Eligibility is based on your monthly income and financial resources, but you should apply even if you think you might not qualify, as some states have more generous limits.

There are four main types of MSPs:

Source: Data compiled from the Centers for Medicare & Medicaid Services. Note: Income limits are slightly higher in Alaska and Hawaii. State-specific limits may vary.

Part D “Extra Help” / Low-Income Subsidy: This is a federal program administered by the Social Security Administration that helps people with limited income and resources pay for their Medicare Part D prescription drug costs.

If you qualify for any of the MSPs listed above, you automatically qualify for Extra Help. The program can cover your Part D premium and deductible and lower your drug copayments to a few dollars per prescription.

Source: Data compiled from Illinois Department on Aging and Medicare.gov.

Where to get unbiased advice

When you’re inundated with marketing materials from insurance companies, it can be difficult to find objective guidance. The following resources provide free, expert help and aren’t affiliated with any insurance company.

State Health Insurance Assistance Programs (SHIPs): This is the most valuable resource available to Medicare beneficiaries. SHIPs are federally funded, state-based programs that provide free, in-depth, and unbiased one-on-one counseling from certified counselors.

A SHIP counselor can help you understand your options, use the Plan Finder tool, screen you for financial assistance programs, and answer your specific questions. They don’t sell or endorse any insurance products.

You can find your local SHIP by visiting shiphelp.org or calling their national hotline.

Official Medicare resources: The official sources of information are the Medicare.gov website and the 24/7 helpline at 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.

Non-profit advocacy groups: Organizations like the Medicare Rights Center offer expert helplines and comprehensive online resources to help beneficiaries navigate their coverage options and resolve problems. Their helpline is 800-333-4114.

Our articles make government information more accessible. Please consult a qualified professional for financial, legal, or health advice specific to your circumstances.