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How are Medicare benefits changing for 2026?
Changes to 2025 Medicare coverage include a $2,000 cap on Part D out-of-pocket costs, small reductions in the average premium for Medicare Advantage and Part D plans, increases for Medicare Part B and Part A premiums and cost-sharing, and adjustments to income-related premium surcharges for Part B and Part D.
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What is the income-related monthly adjusted amount (IRMAA)?
For 2025, high-income beneficiaries – earning over $106,000 a year – pay an IRMAA surcharge that’s added to their Part B and Part D premiums and determined by income from their income tax returns two years prior.

Medicare Open Enrollment 2026 Guide

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What is Medicare open enrollment?

Medicare open enrollment – also known as the annual election period (AEP) or annual coordinated election period – refers to an enrollment window that takes place each fall, during which Medicare plan enrollees can reevaluate their existing Medicare coverage — whether it’s Original Medicare with supplemental drug coverage, or Medicare Advantage — and make changes if they want to do so.

This guide is all about Medicare’s annual election period. If you’re interested in learning about additional opportunities to enroll or change your Medicare coverage, we’ve covered those here.

When is Medicare open enrollment?

Medicare open enrollment starts October 15 and continues through December 7 each year. (Extended enrollment opportunities are available to some people in areas where FEMA declares an emergency or major disaster that hampers their ability to complete their signup during the normal window.)

Frequently asked questions about Medicare open enrollment

What plan changes can I make during the Medicare open enrollment period?

During the Medicare open enrollment period – if you’re already enrolled in Medicare coverage – you can:

  • Switch from Original Medicare to Medicare Advantage (as long as you’re enrolled in both Medicare Part A and Part B, and you live in the Medicare Advantage plan’s service area).
  • Switch from Medicare Advantage to Original Medicare (plus a Medicare Part D plan (PDP), and possibly a Medigap plan, although medical underwriting might be required for Medigap, depending on the state and the person’s circumstances).
  • Switch from one Medicare Advantage plan to another.
  • Switch from one Medicare Part D prescription drug plan (PDP) to another.
  • Enroll in a Medicare Part D plan if you didn’t enroll when you were first eligible for Medicare. If you haven’t maintained other creditable coverage, a late-enrollment penalty may apply.

If I change my coverage at the start of the AEP, can I change my mind before the December 7 deadline?

Yes. You can change your mind and pick a different plan later in the AEP. There’s no limit on the number of plan changes you can make during the AEP.

The last plan selection you make will be the plan that takes effect January 1.

If I make a mistake when I change my coverage during the AEP, what can I do to fix it?

If you realize that you’ve made a mistake while the AEP is ongoing, you can simply pick a different plan instead (by the December 7 deadline) and the new choice will take effect on January 1.

If the AEP has ended and you’ve enrolled in a Medicare Advantage plan but believe you should have picked a different plan, you can use the Medicare Advantage Open Enrollment Period (MAOEP) to pick a different Advantage plan or switch to Original Medicare and a Part D plan.

For instance, maybe you picked an Advantage plan that doesn’t cover an expensive medication you need, or that doesn’t include a conveniently located hospital in its network. Or maybe you let your existing Advantage plan auto-renew and didn’t realize that the premium or benefits would be changing as of January. Regardless of the reason, the MAOEP gives people with Medicare Advantage one “do-over” opportunity at the start of the year.

The annual MAOEP window runs from January 1 to March 31.

If the AEP has ended and you’ve enrolled in a stand-alone Part D plan that doesn’t fit your needs, your options are more limited. There is nothing like the MAOEP to make changes to a stand-alone Part D plan. Changes to these plans can generally only be made during the fall AEP.

However, if you believe that you were given inaccurate or misleading information that led you to make the wrong plan choice, you can call 1-800-MEDICARE and explain the details. Depending on the circumstances, the call center may allow you to make a plan change at that point.1

Who’s eligible to make coverage changes during Medicare open enrollment?

If you’re currently covered by Original Medicare or Medicare Advantage, then you’re eligible to make changes during open enrollment.

However, the annual Medicare open enrollment period does not apply to Medigap plans, which – in most states – are only guaranteed-issue during a beneficiary’s initial enrollment period, and during limited special enrollment periods. So to clarify, you cannot use the annual Medicare open enrollment period to enroll in a new Medigap plan on a guaranteed-issue basis. You can certainly apply for a new Medigap plan during this window – just as you can at any time of the year. But if your six-month initial enrollment period for Medigap has ended and you’re not in a trial right period, the Medigap insurer will use medical underwriting to determine your eligibility and premium.2

(Note that as of 2026, 21 states allow for at least some annual guaranteed-issue access to new Medigap plans, although in most cases it’s limited to switching from one Medigap plan to another with equal or lesser benefits.)

In addition, if you didn’t enroll in Medicare Part B when you were first eligible, you may not use the AEP to sign up. Instead, you’ll use Medicare’s general enrollment period, which runs from January 1 to March 31. The general enrollment period is also for people who have to pay a premium for Medicare Part A and didn’t enroll in Part A when they were first eligible. (Most people do not have the pay a premium for Part A.)

Learn more about Medicare’s general enrollment period.

Can I sign up for Medigap during the AEP?

You can certainly apply for a Medigap (Medicare supplement) plan during the AEP or at any other time of the year. But unlike Part D and Medicare Advantage plans, there is not a federally required annual enrollment opportunity for Medigap plans.

If you apply for a Medigap plan after your six-month initial enrollment period has passed, however, the Medigap insurer is likely to use medical underwriting to determine your eligibility and premium.

There are 21 states (as of 2026) that offer at least an annual window during which existing Medigap enrollees can select from at least some other plans without medical underwriting, and a few of those states also extend that option to people who are newly enrolling in Medigap.

How will plan availability, costs, and benefits change for 2026 Medicare coverage?

See our detailed summary of Medicare premium and out-of-pocket changes here. But in general:

  • The Inflation Reduction Act will continue to cap the cost of insulin products at $35/month in 2026, and ensure that Part D enrollees do not have to pay for recommended vaccines.
  • More people will continue to be eligible for the full Medicare Part D Low-Income Subsidy (Extra Help).
  • Out-of-pocket costs for drugs covered under a Medicare Part D plan will be capped at $2,100 in 2026. This applies to stand-alone Part D plans as well as Part D coverage integrated with a Medicare Advantage Plan. This is an increase from the $2,000 cap that applied in 2025, as the cap is indexed annually.3
  • People with Medicare Part D will continue to have the option to have their drug costs spread out over the full year in equal monthly payments, instead of having to meet their out-of-pocket limit early in the year.4
  • Negotiated prices for ten high-cost medications will take effect in January 2026. This is a result of the Inflation Reduction Act’s provision to allow Medicare to negotiate with drug manufacturers.5
  • The standard Medicare Part B premium for 2026 is $202.90/month, up from $185/month in 20256 (high-income enrollees pay higher Part B premiums).
  • The 2026 Social Security COLA is 2.8%.7 For most Medicare beneficiaries, Part B premiums are withheld from Social Security checks, and net checks (after Part B is deducted) generally can’t decrease from one year to the next. But the 2026 COLA, which averages $56/month,8 will be more than enough to cover the increase in Part B premiums, which is less than $18/month for most enrollees.
  • 2026 Medicare Part A premiums (for those who have to pay for Part A) will be $311/month for those with at least 30 quarters of work history (up from $281/month in 2025), and $565/month for those with under 30 quarters of work history (up from $510/month in 2025).9
  • The 2026 Medicare Part A deductible will be $1,736 (up from $1,676 in 2025). The daily copays for inpatient days 61-90, lifetime reserve days, and skilled nursing facility care are also increasing.6
  • Average premiums for stand-alone Part D drug plans are decreasing from $38.31/month in 2025 to $34.50/month in 2026,10 although there continues to be considerable premium variation from one plan to another.
  • The maximum Medicare Part D deductible will be $615 in 2026, up from $590 in 2025.3 (Part D plans can have lower deductibles, or no deductible at all. But if they have a deductible, it can’t exceed $615 in 2026.)
  • The threshold for having to pay Medicare’s IRMAA (high-income surcharge) for Medicare Part D and Part B will increase again, due to indexing. The IRMAA surcharge will apply to single enrollees with an income above $109,0006 (up from $106, 000 in 2025)
  • The maximum allowable cap on out-of-pocket costs for Medicare Advantage plans (not counting prescription costs) will decrease slightly, to $9,250 for in-network costs.11 But average out-of-pocket caps are typically well below the allowable maximum.12
  • Some insurers that currently offer Medicare Advantage plans or stand-alone Part D plans have said they are exiting the market or reducing their plan offerings for 2026,13 as was the case for 2025.14,15 It’s always important for Medicare beneficiaries to open and read the mail they get from their plan each fall, but that’s especially true as we head into 2026. If your plan’s benefits or premium are changing in a way that won’t fit your needs — or if the plan is being eliminated altogether — you’ll want to comparison shop for alternatives during the October 15 to December 7 open enrollment period.
  • A new pilot program in six states (New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington) will impose prior authorization on a limited set of services under Original Medicare.16

How many people change their coverage during the AEP?

Most Medicare beneficiaries do not switch plans during Medicare’s AEP. An analysis by KFF found that over the course of a decade, the percentage of beneficiaries who switched to a different Part D plan ranged from 10% to 13% per year. And for Medicare Advantage beneficiaries it was even lower, ranging from 6% to 11%.17

More troubling is the fact that seven out of ten beneficiaries didn’t even compare their coverage options during a recent open enrollment period.18 It may well be that the plan you already have will continue to be the best option for the coming year. But there’s no way to know that without actively comparing the available alternatives, and the majority of Medicare beneficiaries aren’t doing that.

What will happen if I don’t change my Medicare coverage during the annual election period?

If you don’t make a plan change, your existing coverage will renew for 2026, assuming it will continue to be available. But that could come with cost and benefit changes. The plan you have might have changes to its drug formulary (covered drug list) or its provider network, meaning that a specific medication or doctor may no longer be covered under the plan. And the plan could also have premium and/or cost-sharing structure changes.

This is why it’s so important to actively compare the available options each fall. You’ll want to check to see how your doctors and prescription will be covered in the coming year, both by the plan you already have and by the other plans that are available in your area.

After the annual election period ends, you will not be able to make a change to your stand-alone Part D plan until the next annual election period. If you have a Medicare Advantage plan, you will still have an opportunity to use the Medicare Advantage Open Enrollment Period (MAOEP) that runs from January through March. You can make just one plan change during this window.

But it’s important to note that the new plan selection would take effect in February at the earliest (and as late as April, depending on when you make the plan selection). This means your out-of-pocket costs for the year would reset to zero when the new plan starts, regardless of how much you had spent in the early part of the year under your old plan.

So, if there’s any chance you’ll want to make a plan change, the best approach is to select your new plan by the annual election period deadline (by December 7) so that the coverage takes effect January 1 and covers you for the entire year.


Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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Footnotes

  1. Special Enrollment Periods” Medicare.gov. Accessed Nov. 17, 2025 
  2. Learn How Medigap Works” Medicare.gov. Accessed Nov. 17, 2025 
  3. Final CY 2026 Part D Redesign Program Instructions” Centers for Medicare & Medicaid Services. Apr. 7, 2025  
  4. Fact Sheet: Medicare Prescription Payment Plan Final Part One Guidance” and “Medicare Prescription Payment Plan Implementation Timeline” Accessed July 22, 2024 
  5. Selected Drugs and Negotiated Prices” Centers for Medicare & Medicaid Services. Accessed Nov. 17, 2025 
  6. 2026 Medicare Parts A & B Premiums and Deductibles” Centers for Medicare & Medicaid Services. Nov. 14, 2025   
  7. How much will the COLA amount be for 2026 and when will I receive it?” Social Security Administration. Oct. 24, 2025 
  8. Social Security Announces 2.8 Percent Benefit Increase for 2026” Social Security Administration. Oct. 24, 2025 
  9. Costs” Medicare.gov. Accessed Nov. 17, 2025 
  10. Medicare Advantage and Medicare Prescription Drug Programs Expected to Remain Stable in 2026” Centers for Medicare & Medicaid Services. Sep. 26, 2025 
  11. Final Contract Year (CY) 2026 Standards for Part C Benefits, Bid Review and Evaluation” Centers for Medicare & Medicaid Services. Apr. 16, 2025 
  12. Medicare Advantage in 2025: Premiums, Out-of-Pocket Limits, Supplemental Benefits, and Prior Authorization” KFF.org. July 28, 2025 
  13. More insurers expect to pull some Medicare Advantage plans from the market” Rise. Aug. 8, 2025 
  14. 7 payers exiting Medicare Advantage markets in 2025” Becker’s Payer Issues. Aug. 25, 2024 
  15. Mutual of Omaha Rx Exits PDP Market” PSM Brokerage. Mar. 21, 2024 
  16. WISeR (Wasteful and Inappropriate Service Reduction) Model” Centers for Medicare & Medicaid Services. Accessed Nov. 17, 2025 
  17. Medicare Beneficiaries Rarely Change Their Coverage During Open Enrollment” KFF.org. Nov. 1, 2022 
  18. Nearly 7 in 10 Medicare Beneficiaries Did Not Compare Plans During Medicare’s Open Enrollment Period” KFF.org. Sep. 26, 2024