Medicare’s big signup season is here, and 70 million Americans need to pay attention. Starting today, October 15, 2025, people can change their health insurance plans through December 7. Any changes you make will start on January 1, 2026.
This year brings major changes that could affect your wallet and your doctor visits. Some changes are good news, while others might force you to find a new plan.
Even though the federal government shutdown started on October 1, Medicare enrollment continues. The program uses money from payroll taxes, not regular government funds. This means you can still sign up and make changes. However, you might face delays getting help from Medicare offices. Website updates could be slower than usual.
Good news for your budget: Medicare premiums are going down for most people. The average prescription drug plan will cost $34.50 per month in 2026, down from $38.31 this year. That saves you about $46 per year. Medicare Advantage plans with drug coverage will drop from $13.32 to $11.50 monthly.
These lower prices happen because of a government program that gives money to insurance companies. The program helps keep your costs down, even though healthcare expenses keep rising.
But here’s the catch: Not everyone will see lower prices. Your costs depend on which state you live in and which plan you choose. Some popular plans will cost more in certain states but less in others. The price differences can be huge—from $0 to over $100 per month for the same plan in different places.
Big insurance companies are leaving Medicare Advantage in many areas. UnitedHealthcare, the biggest provider, is pulling out of 109 counties. This affects about 180,000 people who must find new plans. Other major companies like Aetna, CVS Health, and Blue Cross Blue Shield are also cutting back.
Almost one million people might lose their Medicare Advantage coverage compared to last year. The number of prescription drug plans dropped from 464 to just 360 nationwide.
Why are insurers leaving? They say healthcare costs keep going up, people use more services, and the government pays them less money. Bobby Hunter from UnitedHealth said these problems create “obstacles that no organization can overlook.”
Plans that stay available might cost more or offer fewer benefits. You need to check if your current plan still works for you in 2026.
Here’s what’s changing with prescription drugs:
- The maximum you’ll pay out-of-pocket rises from $2,000 to $2,100 for the year
- Once you hit that limit, your plan pays 100% of covered drug costs
- The highest deductible increases from $590 to $615
- Ten expensive medications will cost much less starting January 2026
Those ten negotiated drugs include treatments for diabetes, cancer, blood clots, and arthritis. These lower prices could save Medicare patients $1.5 billion in 2026. If these prices existed in 2023, Medicare would have saved $6 billion.
Traditional Medicare is changing in six states: Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington. For the first time ever, doctors might need approval before doing certain procedures. This affects 17 types of outpatient treatments, including some bone, nerve, and skin procedures.
This prior authorization program runs through 2031. It tries to stop wasteful or unnecessary medical services. Computers and artificial intelligence will help review requests, but real doctors make the final decisions.
Medicare added a helpful new tool to its website. You can now see which doctors accept each Medicare Advantage plan without leaving the site. Before, you had to visit each insurance company’s website separately.
If you switch plans and find out your doctor isn’t covered, you get a special chance to change plans again in 2026. This only works if the Medicare website gave you wrong information.
What you should do now: Check your Annual Notice of Change letter from your insurance company. This letter tells you if your plan is available next year and what’s changing. Don’t assume your current plan still works best for you.
With so many insurers leaving and benefits changing, experts say everyone should review their options. More than a million seniors need to find new coverage because their current plans won’t exist in 2026.
If you’re thinking about switching from Medicare Advantage back to original Medicare, remember that supplemental insurance companies can reject you in most states. This makes it hard to get good coverage after leaving Medicare Advantage.
The enrollment window closes December 7, so don’t wait. Take time to compare plans, check if your doctors are covered, and look at prescription drug costs for your specific medications. What worked this year might not be your best choice for 2026.
