During Medicare’s Open Enrollment period, October 15 to December 7, anyone with a Medicare drug plan, also known as “Part D,” can change their plan. That makes it a good time to double check your loved one’s coverage, even if they’ve been satisfied. Plans change every year. Medications may be dropped. Pharmacies shift in and out of networks. Out-of-pocket costs can go up or down.
For 2026, there are a few updates worthy of attention:
- The annual cap on out-of-pocket prescription costs is now indexed for inflation. In 2026, it goes up to $2,100.
- The Medicare Prescription Payment Plan spreads costs over the year. Those who enroll in 2026 will be automatically renewed in following years or must opt out.
- The monthly cost for insulin, in whatever form, is now capped at $35 (with no deductible).
- Medicare Part D enrollees are entitled to all vaccines on the federal approved list at no cost.
What to look for when comparing plans
- Medication coverage. Make sure every drug your loved one takes is still on the plan’s list (the “formulary”) and approved for their condition.
- Total costs. Look beyond the premium. Compare copays, deductibles, and pharmacy pricing. Also, depending on their income, they may qualify for the Extra Help program. Apply at gov/extrahelp.
- Preferred pharmacy. Using an “in-network” pharmacy can significantly reduce costs. Confirm this before enrolling.
- Some plans require preapproval or ask members to try lower cost drugs before covering others.
- Bundled plans. On a Medicare Advantage plan, drug coverage may be tied to specific doctor or hospital networks. Changes to drug plans could affect other care.
As a final step, check how the plan is rated. Medicare assigns each plan a star rating based on service and satisfaction. Carefully consider any plan with fewer than four stars. For more help, visit Medicare.gov, call 1-800-MEDICARE, or connect with a local, free SHIP (State Health Insurance Assistance Program) counselor at shiphelp.org.
Need help making sure your loved one has the best plan for them?
As the Delaware, and Delaware and Chester Counties in PA experts in family caregiving, we at Delaware Palliative know that the fine print can be daunting to both you and your relative. We have the experience to guide this kind of decision making or even just be a second set of eyes. Give us a call at 302-478-5707. We can help find the plan that makes sense for your loved one.
