Medicare Open Enrollment: What You Need to Know

Medicare open enrollment for 2026 begins October 15 and runs through December 7. This is a good time to look back at your healthcare usage over the last year and think about where you have had high out-of-pocket expenses or gaps in your coverage. If you have, then a change in coverage could help.

Please note these new items for 2026:

• Price increases (at time of this blog was published): It is estimated the Part B monthly premium for most individuals will be $206.50 and the Part B deductible for 2026 is $288. The standard Part D deductible is $615 in 2026.
• The prescription drug out-of-pocket maximum is $2,100. This includes deductibles and co-pays. This means you will not pay more than $2,100 for Part D covered medications in 2026. The donut hole and catastrophic phases of Part D coverage have been eliminated.
• Medicare Prescription Payment Plan (M3P) – Medicare prescription drug plans and Medicare Advantage plans with prescription drug coverage must offer enrollees the option of paying out-of-pocket drug costs in capped monthly installments (instead of having to pay all at once).
  • New for 2026: Re-enrollment in M3P is automatic unless you change your plan. If you get a new Part D plan for 2026, you will need to re-enroll in M3P.

A Note About WISeR

The Wasteful and Inappropriate Service Reduction Model (WISeR) is a pilot project that could require prior authorization for some medical procedures and devices for Medicare recipients in Arizona, New Jersey, Ohio, Oklahoma, and Texas. At this time, chemotherapy and radiation ARE NOT going to need prior authorization. Learn more about WISeR.

What can I change during open enrollment?

• Add or change your Medicare Part D (drug) plan
• Change to a different Medicare Advantage plan
• Switch from Original Medicare to a Medicare Advantage plan
• Switch from a Medicare Advantage plan to Original Medicare (compare Original Medicare & Medicare Advantage)
• Purchase or change your Medigap (Medicare Supplemental Insurance) plan

What can’t I change during open enrollment?

• You cannot add Part B coverage during open enrollment if you didn’t elect it during your initial coverage period.
  • The general enrollment period for Part B is from January 1 to March 31 every year. Coverage begins the month after you enroll.
  • You may have a late enrollment penalty added to your monthly premiums if you did not elect Part B during your initial enrollment period.
• You cannot purchase a Medigap plan if you have a Medicare Advantage Plan.

Tip: Before you make a change to your coverage, be sure to research any restrictions or limitations that may apply. 

What else should I consider?

• If this is the first time you are electing a Part D plan, you may be subject to Part D late enrollment penalties.
• Prices for Medigap plans may be better during open enrollment. Remember: If you buy a gap plan after your initial coverage period, the insurance company can look at your pre-existing conditions and potentially deny coverage for those conditions for a period of time.
• Eligibility for the Low-Income Subsidy (LIS/Extra Help) was expanded in 2024 and continues in 2026. If eligible, this program can lower your prescription drug costs and pay your Part D premiums.

Review Medicare plan options for 2026.

Get help navigating open enrollment:

If you have questions or would like assistance as you explore your options, help is available:

1. If there is a financial navigator at your treatment center, they may be able to help you understand your choices and guide you through open enrollment.
2. The State Health Insurance Assistance Program (SHIP) provides local insurance counseling for Medicare-eligible individuals, their families, and caregivers. SHIP counselors are available nationwide.
3. Our Cancer Support Helpline offers free, personalized navigation by phone and online for people impacted by cancer, including financial navigation. Our financial navigation specialists are trained in cancer-specific issues and resources that may impact your open enrollment decisions. To be connected with one of our financial specialists, call CSC-867-5309.