Phil Moeller: What you need to know about Medicare Annual Enrollment

Medicare’s 2026 annual enrollment period begins Oct. 15 and extends through Dec. 7. New federal regulations and shifting business dynamics/conditions among private Medicare insurers could trigger an unusually large number of changes to take effect next year. Medicare beneficiaries should be on the lookout for potential changes in plan benefits, premiums, annual deductibles and co-pays. 

Specific changes are scheduled to be announced in early October by the Centers for Medicare and Medicaid Services (CMS). By then, people who already have Medicare Advantage (MA) and Part D prescription drug plans should have received notices from their health plans about any changes to the costs and terms of their coverage next year.

The summary about changes is contained in a document called the “Annual Notice of Change,” or ANOC. A full explanation of the details of coverage is presented in an EOC, which stands for “Evidence of Coverage.” CMS will also update the annual “Medicare & You” guide later in the year, which should be on your reading list, too.¹ Few people read these documents, according to health researchers at KFF.² But they should.

During annual enrollment, people with Original Medicare have the option to enroll in private MA plans, and those with MA plans can decide to switch to a different MA plan or to drop their plan in favor of Original Medicare. They also can switch to a different Part D drug plan. 

There are important differences between Original Medicare and MA:

1. Original Medicare covers enrollees for care anywhere in the U.S. from any provider who participates in Medicare. Nearly all do. MA plans usually have a plan network of providers and participating medical facilities. These networks can be quite extensive depending on where you live.
2. People with Original Medicare can purchase private Medigap (Medicare Supplement) insurance plans that help pay expenses for claims that are not paid in full by Original Medicare.
3. Many MA plans have low monthly premiums. Some even have $0 monthly premiums.
4. MA plans have annual out-of-pocket expense ceilings for members, meaning they are more protected from unexpected health care costs than those on Original Medicare. These can include separate ceilings for in-network and out-of-network care.
5. MA plans usually cover routine dental, hearing, and vision care. Original Medicare is not permitted to cover such routine care. MA plans also may offer other supplemental benefits like a gym membership.

If you are already enrolled in a Medigap plan, you do not need to do anything during the Medicare Annual Enrollment Period, as these plan benefits are standardized and do not change year to year. They are also guaranteed renewable, meaning you keep your plan as long as you pay your premium. People who wish to combine Original Medicare with a private Medigap plan also can do so at any time during the year. However, if you are outside of your initial open enrollment period, you may be denied or charged higher rates based on your health status. I advise people to confirm they can get a Medigap plan before making any changes in coverage.

Major changes in the health care landscape may influence 2026 plans:

1. CMS has announced more aggressive federal cost controls and oversight for both Medicare and private Medicare Advantage plans.^{3, 4} The agency is also beginning to implement provisions from the federal budget law passed in July. Beneficiaries should look for details on 2026 changes in their ANOC and EOC documents.
2. CMS will add a third group of high-cost drugs to the list of drugs subject to price negotiation between Medicare and drug makers, which was first announced as part of the Inflation Reduction Act (IRA).⁵
3. The maximum out-of-pocket ceiling on drugs in Part D plans is indexed for inflation and will rise to $2,100 from $2,000 this year.

I recommend that your next stop in evaluating 2026 Medicare plans should be your personal My Medicare page.⁶ It lists details about your existing Medicare coverage. You also can record a list of your prescription drugs, and Medicare will use this information to evaluate the projected costs of Part D plans available where you live.

Next, you should use Medicare’s online shopping tools to see details of your MA, Part D, and Medigap options. There are prompts to these tools on your My Medicare page. The tools will provide premiums, copays, and deductibles for different plans. They also project annual out-of-pocket costs for typical Medicare beneficiaries that include the costs of Part D drugs you take.

Insurer contact information also is included. You can switch coverage online. I recommend calling your new preferred insurers and confirming details about the plans available to you before deciding to enroll in any of those plans.

Choosing a health plan is one of the most important decisions seniors and other Medicare beneficiaries need to make each year. It is critical that you find a plan that meets your health and budget needs. Do your homework, take advantage of online tools and resources, and don’t forget to consult friends and family, too.