As Americans prepare for the 2026 Medicare season, many face the prospect of higher premiums and potential reductions in benefits. A recent NerdWallet survey found that 64% of Americans believe their Medicare benefits could shrink under the current administration. For some seniors, these changes may arrive as early as next year, accompanied by steeper costs.
Medicare Part B premiums are projected to increase by $21.50, reaching $206.50 in 2026—a substantial hike by historical standards. Medicare Part D prescription drug plans could see premiums rise up to $50, up from last year’s $35 cap. Meanwhile, some major private insurers are reducing their Medicare offerings or leaving the market altogether, citing profitability concerns.
Open Enrollment: Your Key Defense Against Rising Costs
The Medicare fall open enrollment period, running from October 15 to December 7, remains the primary opportunity for beneficiaries to manage costs and ensure coverage. During this time, seniors can add, drop, or switch Medicare plans to align with their needs.
“This is the most important open enrollment period in Medicare’s 60-year history,” says Melinda Caughill, co-founder of 65 Incorporated, a Medicare guidance organization. “Everyone should be reviewing their plan carefully.”
Step 1: Review Your Annual Notice of Change (ANOC)
Each September, Medicare enrollees receive an Annual Notice of Change detailing modifications to their plans for the upcoming year. Key elements to review include:
- Premiums and deductibles
- Copays, coinsurance, and maximum out-of-pocket limits
- Provider networks and service areas
- Prescription drug coverage and pharmacy networks
- Medical and additional benefits
Step 2: Check Prescription Drug Coverage and Costs
Carolyn McClanahan, a physician and certified financial planner, emphasizes that seniors often overlook prescription drug coverage. “Too many people just let it coast, and their drugs may not be on the formulary or costs may have increased significantly,” she warns.
Even with Medicare’s $2,100 out-of-pocket cap on covered drugs in 2026, uncovered medications could create substantial expenses. Beneficiaries should verify that their prescriptions remain on the formulary and check for changes in cost-sharing tiers, which can dramatically increase costs.
Step 3: Confirm Provider Networks on Medicare Advantage Plans
Medicare Advantage plan networks can shift, affecting which doctors and hospitals are covered. Caughill cautions that network changes may require finding new providers or facing higher out-of-network charges. Some insurers are shutting down PPO plans that previously allowed more flexibility. Beneficiaries should confirm that their primary care doctors, specialists, and hospitals remain in-network for 2026.
Step 4: Prioritize Long-Term Coverage Over Perks
While some Medicare Advantage plans promote low premiums and additional perks like gym memberships, McClanahan advises focusing on comprehensive care coverage. “The extras are like sprinkles,” she says. “The priority is protecting against major health events—cancer, heart attacks, chronic conditions—not the small perks.”
Step 5: Consider Switching to Original Medicare and Medigap
If your Medicare Advantage plan is discontinued or exits your area, switching to Original Medicare with a Medigap plan may be prudent. Medigap policies cover out-of-pocket costs that can be unlimited on Original Medicare, reducing financial risk. Certain plan changes also trigger “guaranteed issue rights,” allowing beneficiaries to obtain Medigap coverage regardless of health status.
After reviewing plan changes, seniors can use the Medicare Plan Finder tool on Medicare.gov to compare options and enroll in a new plan by the December 7 deadline.
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