Medicare

By the Retiree Report Editorial Team · Updated 2026-04-28 · 7 min read

This article is general information, not medical advice. Talk with a licensed clinician before making any decision about your care.

Medicare open enrollment 2026: the seven decisions before December 7

Medicare’s annual open enrollment window — what the federal government calls the Annual Election Period — runs from October 15 through December 7 every year. Anything you decide during that window takes effect January 1 of the following year. Even if you’re satisfied with your current coverage, this is the only stretch when you have full freedom to switch Medicare Advantage carriers, change Part D drug plans, or move between Original Medicare and a private Advantage plan.

This year’s review carries more weight than most. The standard Part B premium climbed to $202.90 a month, the Part D out-of-pocket cap rose to $2,100, and roughly 2.6 million Medicare Advantage members had their plan terminated at year-end, according to KFF analysis. Below are the seven specific decisions worth working through before the December 7 deadline.

1. Did you actually open the Annual Notice of Change?

Every Medicare Advantage plan and standalone Part D plan must mail or post an Annual Notice of Change (ANOC) by September 30 each year, alongside the longer Evidence of Coverage. The ANOC is the document that compares this year’s benefits to next year’s — and it’s the one most beneficiaries throw out unread.

The ANOC tells you, in plain language, whether your premium is changing, whether your deductible or copays are going up, whether your doctors and hospitals remain in network, and whether your prescriptions stay on the formulary at the same tier. Coverage rules — prior authorization, step therapy, quantity limits — can change too. If your ANOC shows a meaningful difference, that’s your trigger to compare alternatives. If everything you care about is unchanged and the plan is still being offered, you can skip the rest of this list.

2. Original Medicare or Medicare Advantage?

This is the structural choice almost every other decision depends on. Original Medicare (Parts A and B) lets you see any provider that takes Medicare nationwide, but it has no out-of-pocket maximum on Part B services unless you add a Medigap supplement. Medicare Advantage (Part C) bundles Parts A, B, and usually D into one private plan with a yearly out-of-pocket cap, but you’re locked into the plan’s network and its prior-authorization rules.

According to a KFF analysis, the average beneficiary has access to 32 Medicare Advantage plans for 2026, two fewer than in 2025. UnitedHealthcare and Humana — the two largest Advantage insurers — are exiting more counties than they’re entering. If you’re already on an Advantage plan and your ANOC shows a benefit cut, you’re not alone, and switching is a reasonable response. We’ve laid out the structural tradeoffs in our companion piece on Medicare Advantage versus Original Medicare.

3. Does your drug list still match your plan’s formulary?

A formulary is the list of drugs your plan covers and the cost-sharing tier for each. Plans rewrite their formularies every January. A medication that was a $5 generic last year can land on a higher tier — or come off the formulary entirely — for 2026. Same drug, different price, sometimes a much higher one.

Pull out a current list of every prescription you take, including the dosage and how often you fill it. The Medicare Plan Finder at medicare.gov/plan-compare lets you enter your drugs and your preferred pharmacy and compare actual yearly out-of-pocket costs across every Part D and Medicare Advantage plan in your ZIP code. CMS added an in-network provider directory and expanded supplemental-benefits filters for the 2026 cycle. The more medications you take, the more this step matters.

4. Are your doctors and hospitals still in network?

For Medicare Advantage members, this is the question with the largest ripple effect. Networks shift every year, sometimes mid-year, and a plan that contracted with your cardiologist in 2025 may not in 2026. The new provider directory feature inside the Plan Finder is the first time CMS has tried to make network checking a one-step exercise on its own site, but plan call centers and the doctor’s office itself remain the authoritative confirmation.

If your specialist or hospital system has dropped out of your Advantage plan, you have two practical options: switch to a different Advantage plan that still contracts with them, or move back to Original Medicare and pair it with a Part D plan plus, ideally, a Medigap policy. One caution: outside your initial six-month Medigap open enrollment window, insurers in most states can deny coverage or charge more based on your medical history. Talk to a licensed broker before making a Medigap move you can’t undo.

5. Have you priced the full year, not just the premium?

The cheapest premium isn’t usually the cheapest plan. A $0-premium Medicare Advantage plan can carry hundreds of dollars in copays for specialist visits or specialty drugs, while a higher-premium plan may have a lower out-of-pocket maximum. The honest comparison adds the annual premium plus expected drug costs plus expected medical copays plus the deductible.

According to the Centers for Medicare & Medicaid Services, the standard Part B premium is $202.90 a month for 2026, with an annual deductible of $283. Most people pay the same Part B premium whether they’re enrolled in Original Medicare or Medicare Advantage. What varies sharply is the Part D and Part C cost-sharing layered on top, which the Plan Finder will model out for the year using your actual prescriptions and pharmacy.

6. Will the new $2,100 Part D cap change your math?

The Inflation Reduction Act capped Medicare Part D out-of-pocket spending — first at $2,000 in 2025 and now at $2,100 for 2026. According to CMS’s final 2026 Part D redesign instructions, once your true out-of-pocket spending on covered drugs reaches $2,100, you pay nothing for covered Part D drugs the rest of the calendar year. The Part D deductible cap rose to $615; many plans set their deductible lower, and some have none.

This cap applies whether you have a standalone Part D plan or drug coverage built into a Medicare Advantage plan. For people on high-cost specialty drugs, it’s a structural change worth modeling against last year’s spend, because it can flip the answer to “which plan is cheapest” entirely. We’ve covered the mechanics of the new cap in detail in our explainer on the 2026 Part D out-of-pocket maximum.

7. Should you opt into the Medicare Prescription Payment Plan?

Every Part D plan must now offer the Medicare Prescription Payment Plan (sometimes called M3P), which lets you spread that out-of-pocket spending across capped monthly bills instead of paying the pharmacy in full at the counter. There’s no fee to participate, and the math is the same — the program just smooths cash flow.

It’s most useful if you have a costly prescription early in the year, like a specialty drug filled in January or February. Without the program, you might owe $1,200 in one month at the pharmacy; with it, that bill is divided across the remaining months of the year. Per Medicare.gov, it doesn’t reduce what you owe overall, and a missed monthly payment can result in your removal from the program. CMS finalized rule changes for 2026 that automatically re-enroll participants for the next calendar year unless they opt out.

What to do next

Your action plan, in order: open the ANOC envelope, run your prescriptions through the Medicare Plan Finder, confirm your doctors are in network, and price out your full-year cost — not just the headline premium. If you want a human, call 1-800-MEDICARE (1-800-633-4227) or your local State Health Insurance Assistance Program (SHIP), which provides free, unbiased counseling.

Decisions made by December 7 take effect January 1. If you’re already on Medicare Advantage, you also get a second window — the Medicare Advantage Open Enrollment Period from January 1 to March 31 — to switch Advantage plans once or drop back to Original Medicare. Outside of those windows, switching usually requires a special enrollment trigger such as a move, a job-based coverage change, or losing other coverage.

What to remember

October 15 to December 7 is the federal annual election window for everyone with Medicare. The biggest 2026 changes — the $202.90 Part B premium, the $2,100 Part D out-of-pocket cap, and the wave of Medicare Advantage plan terminations — should all be evaluated against what’s actually written in your ANOC. If your plan, doctors, drugs, and total annual cost still work, you don’t need to do anything. None of this is medical or financial advice; for plan-specific questions, talk to your plan, your pharmacist, or a licensed broker before making a switch you can’t undo.