There may once again be fewer choices on the menu as Medicare patients shop for covered prescription drugs this fall.
The number of available stand-alone drug plans has declined for several years, and this trend will continue into 2026. Most markets will still have several options to choose from, but some options are becoming especially rare for low-income buyers. And help may be harder to come by because some insurers no longer pay brokers commissions on new business.
Buyers have from October 15 to December 7 to find new coverage, which will begin in January.
Some things to consider:
Regular Medicare, which most people are eligible for after age 65, does not include prescription coverage known as Part D. People must choose this separately.
About 23 million people with regular Medicare have this separate insurance, according to health care research nonprofit KFF.
About 34 million more people have Medicare Advantage plans, which are private versions of Medicare that often include prescription coverage.
The typical consumer will be able to select a stand-alone drug plan from eight to 12 options by 2026, according to KFF Medicare expert Juliet Kubanski. In 2025, this number will decrease from 12 to 16 options.
Back in 2021, shoppers had about 30 options to choose from, according to Gretchen Jacobson of the Commonwealth Fund.
Depending on the state, one to four plans will be available without a premium to people eligible for low-income subsidies, according to KFF. Eight were available in 2021.
Some insurers are reducing their presence in select Part D plans, while carrier Elevance Blue Cross-Blue Shield is exiting the market entirely. Insurers and analysts who follow the industry note that Inflation Reduction Actwhich would cap annual drug costs at $2,100 in 2026, puts more financial pressure on insurers. The same law now allows patients to spread the cost of prescriptions throughout the year.
In most markets there will be several options to choose from. But experts say Medicare Part D customers don't like to shop around, especially if they already have a plan that covers their drugs. Finding affordable coverage for multiple recipes can be challenging.
“I think there's a lot of inertia and, frankly, people might be concerned that if they switch, they'll be worse off,” Kubanski said.
More and more people are forced to go to stores. According to research published recently in the Journal of the American Medical Association.
Before 2023, that figure was often less than 1%, said Dr. Christopher Kaye, one of the researchers involved in the study.
Monthly premiums, or prices for coverage, will drop nearly 10% on average to $34.50, the Centers for Medicare and Medicaid Services said. announced last month.
At least one option with a premium of less than $20 exists in nearly every region of the country, according to consulting firm Oliver Wyman.
Individual prices will vary widely, with premiums for the same plan varying by state, Kubanski noted.
But while plans may offer lower prices for coverage, they may also raise deductibles or offer more limited lists of covered drugs, called formularies. Buyers should check these details.
Insurers will be allowed to raise premiums by as much as $50 a month in 2026, up from a $35 increase allowed this year. But Kubanski said only some plans would reach that higher limit, and not necessarily in all states.
Buyers can use federal government website to compare prices of plans and coverages.
States also have a State Health Insurance Program designed specifically to help people on Medicare find coverage.
Consumers can help themselves by checking their insurance coverage for changes and comparing it with other plans.
Shoppers should also consider whether their pharmacy is in-network covered by any plan they're considering, said Jacobson, vice president of Medicare for the Commonwealth.
Some may also consider switching to Medicare Advantage plans with prescription coverage. But these plans may have a more limited network of covered doctors, which could pose a problem for people with fewer health care choices in rural areas.
The registration window lasts several weeks, but brokers say many people are waiting until the first week of December to make a decision, often after talking to family during holiday dinners.
This can result in a tighter timeline, making it more difficult to find help in early December.
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