For many, Advantage plans may offer attractive features, but they also come with new complexities in 2026. For those on Original Medicare, changes in Part D and drug costs could hit hard if you don’t shop your plan carefully.
The Annual Enrollment Period (AEP) is October 15 through December 7, 2025, for coverage that takes effect January 1, 2026. During AEP you can switch between Original Medicare and an MA plan, change MA plans, or enroll in, drop, or change Part D plans.
Initial Enrollment Period (IEP): For people turning 65, this is the 3-months before, the month of, and 3-months after your 65th birthday. During this time you can sign up for Part A and Part B and choose a Medicare Advantage or Part D plan.
Medicare Advantage Open Enrollment Period: January 1 through March 31, 2026. If you already are in a Medicare Advantage plan, you can switch to a different MA plan or revert to Original Medicare (with a Part D plan).
Special Enrollment Periods (SEPs): are available if you experience certain life events such as moving, losing other coverage, or certain changes in your health plan’s availability. These allow changes outside the default enrollment windows.
CMS (the Centers for Medicare & Medicaid Services) has finalized several policy and technical changes that affect Medicare Part A/B (“Original Medicare”), Part D (prescription drugs), Medicare Advantage (MA / Part C), dual eligible special needs plans (D-SNPs), and related programs.
Key changes include:
- Higher payments to Medicare Advantage plans: For 2026, MA payments are increasing by about 5.06%
- Risk adjustment model fully phased in: The 2024 CMS Hierarchical Condition Category (HCC) model will be used 100% for non-PACE MA organizations in 2026.
- Prescription drug (Part D) changes: The out-of-pocket cap for Part D increases to $2,100 (up from around $2,000 in 2025); deductibles are rising.
- Changes in Medicare Advantage: There will be more guard rails around prior authorization, more oversight of how MA plans use internal coverage criteria, clearer requirements for directory information, and limits on how MA plans handle behavioral health service cost sharing vs. Traditional Medicare.
- Talk to people who have the plan: Neighbor, friend, family member. What surprises did they get? What services do they use most?
- Ask important questions, such as:
- What will my total out-of-pocket costs be (premiums + deductibles + coinsurance) for my prescription drugs?
- Are my doctors in the network?
- How often will I need prior authorization for services I need?
- How does the plan handle coverage for mental health and behavioral health?
- What are the costs for therapies or specialists?
Medicare.gov has a Plan Finder tool where you can compare MA, Part D, and Medigap plans in your zip code. Also check CMS fact sheets. Visit Medicare.gov for more information.
