Medicare Open Enrollment 2026: Key Changes and How to Choose the Right Plan

Each year Medicare plans and pricing shift—and 2026 brings a cluster of important updates that affect premiums, drug formularies and provider networks. For retirees and soon-to-be-enrolled beneficiaries, making the right choice during Open Enrollment can mean thousands in savings and fewer headaches accessing care. Below is an accessible guide to the changes and a step-by-step decision framework.

Major changes in 2026

• Premium volatility: Some Medicare Advantage plans adjusted premiums downward in competitive markets while raising copays in specialty care. That makes total cost comparisons more important than premiums alone.
• Drug formulary shifts: Several Part D plans updated formularies to include newer generic entrants and exclude certain high-cost brand drugs unless covered under prior authorization.
• Telehealth coverage: Post-pandemic telehealth adoption continues; some Medicare Advantage plans now offer expanded telehealth services and remote monitoring benefits at no extra cost.

Step 1: List your priorities

Start by listing what you value most: low monthly premiums, broad provider networks, low drug copays, dental/vision benefits, or minimal out-of-pocket maximums. Assign weight to each factor so you can compare plans objectively.

Step 2: Check provider networks and drug coverage

Use the plan's provider directory to confirm your primary care physician and specialists are in-network. For prescriptions, enter your exact medication list into the Part D plan finder to calculate annual drug costs including deductibles, copays and coverage gaps.

Step 3: Evaluate supplemental benefits

Medicare Advantage plans increasingly include supplemental benefits like hearing aids, meal delivery after discharge, transportation to medical appointments and gym memberships. Decide if these benefits are genuinely useful to you or simply marketing features that add complexity.

Step 4: Consider cost-sharing and worst-case scenarios

Don't just compare typical annual costs—model a high-need scenario: a hospitalization, a complex surgery, or a year of increased specialist visits. Compare maximum out-of-pocket limits and whether the plan has reinsurance or stop-loss mechanisms.

Step 5: Use trusted help

If you're overwhelmed, consider a free SHIP (State Health Insurance Assistance Program) counselor who can give objective, local guidance. Avoid sales-driven agents if you just need objective comparison; ask direct questions about commissions and incentives.

Common pitfalls

• Choosing the plan with the lowest premium without checking drug coverage.
• Failing to verify if a favorite hospital or specialist remains in-network for the coming year.
• Mixing up Medicare Supplement (Medigap) and Medicare Advantage—the two are not compatible; you must have Original Medicare to use Medigap.

'A plan that looks cheap on paper can be costly if it disrupts your access to key medications or specialists.' — Medicare Counselor

Checklist for enrollment

1. Gather your current plan ID, list of medications, and preferred providers.
2. Use the Medicare Plan Finder and Part D tool with exact e-prescription names.
3. Compare total annual costs under both typical and high-need scenarios.
4. Confirm enrollment deadlines and whether you need to disenroll from an existing plan to switch.

Closing advice

Open Enrollment is not a time for guesswork. Spend an hour comparing plans based on your prioritized needs. If you expect health changes, choose plans that provide predictable provider access and manageable out-of-pocket exposure. Document your decision and set a calendar reminder to revisit annually—plans and needs both change.

For a downloadable comparison worksheet and printable questions to ask plan representatives, see our Medicare toolkit page.