Medicare Open Enrollment is here – what has changed and how to avoid confusion

Each year, the details for Medicare shift, and trying to find the right coverage feels like wandering through a maze, whether you’ve been on it for years, you’re turning 65 and starting the journey for the first time, or you’re helping a loved one navigate the process.

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The 2026 Medicare Open Enrollment Period started on October 15 and closes on December 7. While seven weeks may seem like ample time to make a decision, the deluge of information is a lot to wade through.

Don’t worry. This article offers a clear, straightforward guide to the essential Medicare updates for next year. We’ll walk you through the key changes, explain the enrollment process, and answer the most frequently asked questions. Our goal? Making sure you have the information you need to confidently choose the best plan for your health and budget in 2026.

Changes to Medicare in 2026

The biggest changes to Medicare in 2026 will affect prescription drug costs and coverage, with minor tweaks for Parts A, B, and C. The most significant updates stem from the Inflation Reduction Act (IRA), which lowers costs for some medications. A caveat: Some Medicare recipients will face higher premiums and deductibles.

Here are the key changes and projections for 2026

	Out-of-pocket cap:	Standard premium:	Maximum deductible	Daily copayment	Donut Hole	Other
Medicare Part D (Prescription Drug Coverage)	Max for covered drugs will increase to $2,100	N/A	Increases to $616	N/A	Eliminated; $0 copays for recommended vaccines, and the $35 cap on monthly insulin copays will continue	N/A
Medicare Part B (Medical Insurance)	N/A	Projected to increase to $206.50/month	Projected to increase to $288	N/A	N/A	High-income surcharge (IRMAA): Projected to start at $109,000 for a single individual, with surcharges at each level also increasing.
Medicare Part A (Hospital Insurance)	N/A	N/A	Projected to increase to $1,716 per benefit period	Days 61-90 increasing to $429 per day Lifetime reserve days increasing to $858 per day Skilled nursing facility (SNF) copay: Days 21-100 copayment projected to increase to $241.50 per day	N/A	N/A
Medicare Advantage (Part C)	For in-network services, the amount is expected to decrease to $9,250	Medicare Advantage plans with prescription drug coverage (MA-PD) are expected to decrease to an average of $11.50 per month	N/A	N/A	N/A	N/A

Why you should review your Annual Notice of Change — without fail

Guillermo Triana, a benefits consultant and the founder, principal consultant, and CEO of PEO-Marketplace, said, “The greatest downside of skipping your plan review is that your coverage may become badly misaligned with your needs. Beneficiaries with chronic health conditions, multiple prescription drugs, or people on shaky incomes are most at risk. I’ve worked with people who ‘stayed in a plan because it was convenient’ who paid $1,200 more than they needed to, year over year.”

Medicare sends its Annual Notice of Change (ANOC) to every plan beneficiary. It’s the most important document that people ignore, but you shouldn’t because it details every change in a plan’s benefits, costs, or coverage for the coming year.

Use the Medicare Plan Finder Tool to make your comparisons. For example, check your plan’s 2026 formulary to confirm that your prescriptions are still in the same cost-sharing tier; small tier changes (like Tier 2 to Tier 3) can lead to hundreds of dollars in additional annual spending. If your drug’s tier changes unfavorably, ask your doctor for a formulary-approved alternative to keep prescription costs down.

Triana recommends comparing the ANOC line by line to your current plan, which can help avoid serious sticker shock like discovering your plan won’t cover a critical medication, provider, or benefit in January. The risk of not reviewing it? It’s like auto-insurance renewal without confirming that your annual premium didn’t double. For Medicare recipients, reviewing their ANOCs should become an annual rite.

Why do I need to choose a new plan each year?

While 51% of Medicare beneficiaries say they intend to review their coverage options during this current open enrollment period, there’s no official requirement to change plans from year to year. Even so, many Medicare Advantage and Part D plans are changing their cost and benefits for 2026, and some plans will disappear entirely, said Will Shanley, senior director of communications at eHealth.

If you read your ANOC letter and see that your plan isn’t available in 2026, you must take action. If you do nothing, you’ll lose your plan on January 1 and revert to the original Medicare Part A and B. If your 2025 plan had coverage for prescriptions, dental, vision, or hearing services, you may lose it.

What’s the difference between Original + Part D/Medigap and Medicare Advantage?

The biggest difference between Original + Part D/Medigap and Medicare Advantage is the control/bundling trade-off. Original + Medigap grants broader provider choice (you choose your doctor, fewer network constraints), whereas MA bundles benefits and may cap your out‑of‑pocket. If you have high care needs, this bundling security may make sense, but you sacrifice some freedom and flexibility in the process, said Triana.

What is the Medicare Prescription Payment Plan (MPPP)?

The Medicare Prescription Payment Plan (MPPP) for 2026 allows beneficiaries to pay their annual out-of-pocket prescription costs, including the new annual maximum, in monthly installments, thus lowering immediate expenses from large or unexpected charges.

The plan features automatic annual renewal, which streamlines the process and avoids missed-payment anxiety. Its most effective use is to synchronize the payment schedule with your pharmacy statements or plan notices to monitor drug price changes, which may signal a need to adjust or suspend your plan payments, said Triana.

How can I pick the best Medicare plan for me?

There’s no single Medicare plan that’s best for everyone, because everyone has different medical needs, priorities, and finances. You have several ways to access Medicare plan coverage, including Medicare Advantage, Medicare Supplement, and Part D plans. Shanley said, “Beneficiaries have an average of over 40 Medicare Advantage plans to choose from in their local areas. It’s not surprising that a recent eHealth survey found 75% of Medicare beneficiaries say shopping for coverage is confusing.”

Shanley says that Medicare plans boil down to three essentials:

• Doctor network: Confirm that your current doctors, specialists, and hospitals are in the plan’s network. If they’re out-of-network, your care will cost more or potentially not be covered at all.
• Drug coverage (formulary): Check the plan’s covered drug list (formulary) to confirm that it includes all your prescriptions and look at their estimated costs.
• Total cost: The monthly premium is just one part of your healthcare expense. Don’t forget to calculate your total out-of-pocket costs, including deductibles, copays, and coinsurance. Understanding these costs will help you determine the level of care you can afford in an emergency. Pro tip: A low premium isn’t worth it if the copays are too high when you actually need care.

What are the biggest mistakes people make with Medicare plan options?

Shanley says the biggest mistake people make is assuming all Medicare Advantage plans are the same. In reality, they vary significantly in terms of the prescription drugs they cover and the associated out-of-pocket costs. Included supplemental benefits (vision, dental, hearing, gym memberships, etc.) vary considerably, too. And yet, Shanley said a recent eHealth survey found that 39% of Medicare Advantage beneficiaries incorrectly believe that these plans are “generally all the same.” Shopping around will help save you money.

I’m in a higher-income bracket. Will I have to pay more?

The 2026 income-related monthly adjustment amount (IRMA) is set on a sliding scale. These brackets will be more heavily penalized in 2026. This annual surcharge, added to the standard Part B and Part D premiums for all high-earning Medicare beneficiaries, is based on your 2024 tax return’s taxable income.

It’s calculated on a sliding scale with five income tiers. The highest brackets start at $500,000 for individual filers and $750,000 for joint filers. Triana said, “If your income has recently dropped due to job loss, retirement, investment loss, or other factors, you may be eligible for an IRMAA recalculation. The key is collecting proof (via your 2024 tax return or other official documentation) and submitting it as soon as possible.”

What are chronic special needs plans (C-SNP), and do I need one?

C-SNPs are a type of Medicare Advantage plan for people with severe, chronic health conditions like diabetes, heart failure, or COPD. You might need one if you have one of the qualifying conditions it covers and want a plan with customized benefits, a focus on care coordination, and additional services tailored to manage your illness.

These plans can help lower prescription medication costs and offer additional benefits specifically designed for people with qualifying chronic conditions. For example, people with diabetes might be eligible for a diabetes-focused C-SNP. These plans can provide better coverage for blood glucose monitoring supplies or access to lifestyle programs focused on improving nutrition and exercise habits, said Shanley. “The additional coverage and support can translate into lower healthcare expenses and potentially improved well-being.”

What are enrollment red flags I should watch out for?

Unfortunately, there are several red flags you might see. Triana mentions agents who insist on “free gift” plan enrollments and aggressive cold calls promising “instant millionaire health benefits” or “one-time only free vision premiums.” Also, be cautious of plans that ask you to pay outside official channels (mail, money order, or pay at office visit).  

What’s the best way to find and enroll in a Medicare plan?

Your best bet is to stick to official and approved sources.

• Official Medicare Plan Finder website: Medicare.gov
• Call 1-800-MEDICARE (1-800-633-4227)
• Work with an approved Medicare agent or broker

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