Medicare Open Enrollment started October 15, and this year’s different. You’re facing fewer Medicare Part D prescription drug plan choices, changing costs, and new coverage rules. About one in five plans disappeared from the marketplace, and your current plan might not be your best option anymore. Here’s what you need to know before Medicare Open Enrollment ends on December 7.
Fewer Part D Plans, Fewer Choices
The Medicare Part D marketplace has experienced substantial consolidation over the past year. You’ll find approximately 8 to 12 standalone prescription drug plans available in your state for 2026, compared to the broader selection you had previously. The number of insurance companies offering these plans has dropped from 19 sponsors in 2025 to 17 sponsors this year, representing a 22% decrease in total plan availability.
This consolidation stems directly from the Inflation Reduction Act’s implementation. While the law created important consumer protections, including a $2,100 out-of-pocket spending cap for 2026, it also shifted more financial risk to insurance companies. Plans now bear greater liability for high-cost medications, particularly once you reach the catastrophic coverage threshold. Many insurers have determined that standalone Part D plans aren’t profitable enough to continue offering them, especially when they can focus resources on Medicare Advantage plans instead.
What this means for you is simple but significant. If your current plan is discontinuing or your insurer is exiting certain markets, you’ll need to select a new plan during this enrollment period. Even if your plan continues, you should still review it carefully because formularies, premiums, and cost-sharing structures have changed substantially.
Premium Changes Aren’t What You’d Expect
You might’ve heard that Part D premiums are skyrocketing, and while that’s true for some plans, the complete picture is more nuanced. The Part D Premium Stabilization Demonstration has been extended for 2026, though it’s been scaled back. Insurance companies can now increase monthly premiums by up to $50 compared to their 2025 rates, and some plans have done exactly that.
However, the Centers for Medicare and Medicaid Services projects that the average standalone Part D premium will actually decrease slightly to around $34.50 per month for 2026. This seemingly contradictory information reflects a key reality: Medicare Advantage plans with prescription drug coverage typically charge zero or very low premiums, and these plans heavily weight the overall average downward. If you’re enrolled in a standalone Part D plan, you’re more likely to see a premium increase than the average suggests.
Your premium depends entirely on which specific plan you choose. Some areas offer plans with zero monthly premiums, while others range up to $100 or more per month. Plans that were previously free or low-cost have often increased by $5 to $40 monthly. What was considered an affordable plan last year might now cost significantly more, and what you pay doesn’t count toward your $2,100 out-of-pocket maximum.
Deductibles and Cost-Sharing Are Rising
The maximum Part D deductible has increased to $615 for 2026, up $25 from last year’s $590. Most plans now carry this maximum deductible, though a few offer lower deductibles paired with substantially higher monthly premiums. You’ll need to pay this full deductible amount before your plan begins covering medication costs, except for certain Tier 1 generic drugs that some plans cover before you meet the deductible.
Beyond the deductible, cost-sharing structures have shifted noticeably. Many 2026 plans are moving away from fixed copayments toward percentage-based coinsurance, especially for higher-tier medications. This change creates more variability in what you’ll actually pay at the pharmacy. Under a copay structure, you might’ve paid $47 for a medication regardless of its total cost. With coinsurance, you’ll pay a percentage of the drug’s negotiated price, which can fluctuate based on your plan’s negotiations with manufacturers and pharmacies.
Formulary restrictions have tightened across many plans as well. Lower-premium plans typically offer narrower formularies, meaning they cover fewer medications within each drug class. If your medication isn’t on your plan’s formulary, you’ll pay 100% of its cost unless you successfully appeal for a formulary exception. Your Annual Notice of Change letter should detail whether your medications have moved to different tiers or if cost-sharing requirements have changed for drugs you currently take.
Your Action Steps Before December 7
Don’t assume your current plan remains your best option, even if it’s continuing into 2026. Create a complete list of every medication you take, including the exact name, dosage, and how frequently you refill it. Include any medications your doctor has mentioned you might need to start soon. You’ll need this information to accurately compare plans.
Check whether your prescriptions remain on your current plan’s formulary and at the same tier levels. Verify that your preferred pharmacy stays in-network, as out-of-network pharmacies typically result in substantially higher costs. If you use mail-order pharmacy services, confirm they’re still available and determine whether they offer cost advantages for your maintenance medications.
Review any coverage gap or manufacturer discount programs you’ve been using. While the $2,100 out-of-pocket cap provides important protection against catastrophic drug costs, you need a plan that minimizes your spending before reaching that threshold. Programs like GoodRx might offer cheaper prices than your insurance for certain medications but remember that money spent using discount cards doesn’t count toward your deductible or out-of-pocket maximum, and these programs don’t qualify as creditable coverage.
It’s advised to contact a licensed agent who can help you evaluate every available plan in your area based on your specific drug list. Be sure to compare total estimated annual costs, not just monthly premiums. A plan with a $0 premium might actually cost you more over the year than a plan with a $40 monthly premium if its formulary forces you into higher tiers for your medications or requires you to use more expensive pharmacies. Call 866-633-4427 to get a personalized plan comparison that works with your budget.
Conclusion
The Part D marketplace consolidation represents a significant shift in how prescription drug coverage works for people with traditional Medicare. While you’re facing fewer choices and potentially higher costs, the new $2,100 out-of-pocket cap provides crucial protection against the devastating expenses that high-cost medications previously created. The key is selecting a plan that minimizes your total spending while ensuring your medications remain accessible and affordable throughout the year.
You can’t afford to skip the annual review process this year. The combination of reduced plan availability, changing formularies, modified cost-sharing structures, and premium increases means your 2025 plan likely won’t serve you as well in 2026. Take the time to compare your options thoroughly, ask questions when you’re uncertain, and make your selection before the December 7 deadline. For more information about Medicare Part D plans, please call 866-633-4427 to speak with a Senior Healthcare Solutions Medicare expert.
