Attention, Medicare shoppers! A pressing issue is on the horizon as we navigate the world of prescription drug coverage. The options are shrinking, and it's time to address this head-on.
The Shrinking Landscape of Prescription Coverage
As we approach the fall season, Medicare patients are faced with a challenging reality: fewer choices for prescription coverage. This trend has been ongoing for a few years, and experts predict it will continue into 2026. While most markets will still offer several options, the landscape is particularly sparse for those relying on low-income subsidies. And here's where it gets tricky - finding help might be even harder due to insurers' reduced commissions for brokers.
Navigating the Medicare Part D Maze
For those unfamiliar, regular Medicare, the program most people qualify for after turning 65, does not include prescription coverage, known as Part D. This means an additional step for millions of individuals - choosing a standalone Part D plan. According to KFF, a non-profit healthcare research organization, approximately 23 million people with regular Medicare have this separate coverage. Additionally, around 34 million people opt for Medicare Advantage plans, which are privately run versions of Medicare often including prescription coverage.
The Changing Face of Part D Plans
Juliette Cubanski, a Medicare expert at KFF, predicts that shoppers will have fewer options for standalone drug plans in 2026, with a range of eight to twelve choices, down from twelve to sixteen in 2025. Gretchen Jacobson from the Commonwealth Fund notes that as recently as 2021, shoppers had nearly thirty options. For those qualifying for low-income subsidies, the situation is even more dire, with a range of one to four plans available at no premium, compared to eight in 2021.
Some insurers are reducing their involvement in standalone Part D plans, while others, like Elevance, a Blue Cross-Blue Shield carrier, are exiting the market entirely. Industry analysts attribute this to the Inflation Reduction Act, which caps annual out-of-pocket drug costs at $2,100 in 2026, putting financial pressure on insurers. Additionally, the same law now allows patients to spread prescription costs over the year.
The Challenge of Finding Affordable Coverage
Despite the shrinking options, most markets still offer several choices. However, experts like Cubanski highlight the inertia among Medicare Part D customers, especially those with plans that cover their medications. Finding affordable coverage for multiple prescriptions can be a daunting task, and many are hesitant to switch plans for fear of ending up worse off.
The Push to Shop
The situation is becoming more urgent, with nearly 11% of those with standalone prescription drug coverage losing their plans in 2024, according to research published in the Journal of the American Medical Association. Before 2023, this figure was often under 1%, highlighting a significant shift.
The Changing Prices of Medicare Part D
There's some good news on the price front. The Centers for Medicare and Medicaid Services announced a nearly 10% drop in average monthly premiums, or coverage prices, to $34.50. Additionally, the consulting firm Oliver Wyman reports that at least one option with a premium under $20 exists in almost every region of the country. However, individual prices will vary widely, with premiums for the same plan differing by state, as noted by Cubanski.
While plans may offer lower coverage prices, they could also increase deductibles or provide more limited lists of covered drugs, known as formularies. Shoppers should carefully review these details to ensure they get the best coverage for their needs.
Insurers will be allowed to raise premiums by up to $50 a month for 2026, an increase from the $35 allowed this year. However, Cubanski emphasizes that only some plans will reach this higher limit, and not necessarily in all states.
Getting Help with Your Medicare Part D Shopping
Shoppers can utilize the federal government website to compare plan prices and coverage. Additionally, states have State Health Insurance Programs specifically designed to assist Medicare beneficiaries in finding coverage. Consumers are encouraged to check their coverage for changes and compare it with other plans. It's also essential to consider whether your preferred pharmacy is in the network covered by any plan you're considering, as advised by Jacobson, Commonwealth's vice president of Medicare.
Some individuals might consider switching to Medicare Advantage plans with prescription coverage. However, these plans often have more limited networks of covered doctors, which can be a challenge for those in rural areas with fewer care options.
The Importance of Timely Action
The enrollment window spans several weeks, but brokers often see a surge of decisions made during the first week of December, often influenced by family discussions during holiday dinners. This can lead to a deadline crunch, making it harder to find assistance in early December. So, don't delay - take action now to ensure you have the coverage you need for the coming year.
Originally Published: October 11, 2025, at 3:52 PM CDT
