Prescription drug coverage options are shrinking for Medicare shoppers

Fewer choices may be on the menu again as Medicare patients shop for prescription coverage this fall.

The number of available, stand-alone drug plans has fallen for a few years, and that trend will continue for 2026. Most markets will still have several choices, but some options are becoming particularly sparse for shoppers with low-income subsidies. And help may be harder to find because some insurers no longer pay brokers commissions for new business.

Shoppers have from Oct. 15 to Dec. 7 to find new coverage that starts in January.

Some things to consider:

Regular Medicare, which most people qualify for after turning 65, does not come with prescription coverage, known as Part D. People must choose that separately.

About 23 million people with regular Medicare have this standalone coverage, according to the non-profit KFF, which studies health care.

Another roughly 34 million people have Medicare Advantage plans, which are privately run versions of Medicare that often come with prescription coverage.

A typical shopper will be able to choose a standalone drug plan from among eight to 12 options for 2026, according to KFF Medicare expert Juliette Cubanski. That’s down from 12 to 16 options in 2025.

Shoppers had nearly 30 choices as recently as 2021, according to the Commonwealth Fund’s Gretchen Jacobson.

Depending on the state, a range of one to four plans will be available at no premium to people who qualify for low-income subsidies, according to KFF. Eight were available in 2021.

Some insurers are reducing their presence in standalone Part D plans, while the Blue Cross-Blue Shield carrier Elevance is leaving the market entirely. Insurers and analysts who follow the industry note that the Inflation Reduction Act, which will cap annual out-of-pocket drug costs at $2,100 in 2026, puts more financial pressure on insurers. The same law now allows patients to spread the cost of prescriptions over the year.

Most markets will have several choices. But experts say Medicare Part D customers don’t like to shop, especially if they already have a plan that covers their medications. Finding affordable coverage for multiple prescriptions can be tricky.

“I think there’s a lot of inertia and, frankly, people may be concerned that if they switch, they’re going to end up worse off,” Cubanski said.

More people are being pushed to shop. Nearly 11% of those with standalone prescription drug coverage lost their plan in 2024, according to research published recently in the Journal of the American Medical Association.

Before 2023, that figure was often under 1%, said Dr. Christopher Cai, one of the researchers involved in the study.

Monthly premiums, or coverage prices, will fall nearly 10% on average to $34.50, the Centers for Medicare and Medicaid Services announced last month.

At least one option with a premium of under $20 exists in almost every region of the country, according to the consulting firm Oliver Wyman.

Individual prices will range widely, with premiums for the same plan varying by state, Cubanski noted.

But while plans may provide lower coverage prices, they could also raise deductibles or offer more limited lists of covered drugs, which are called formularies. Shoppers should check these details.

Insurers will be allowed to raise premiums by as much as $50 a month for 2026, up from a $35 increase allowed this year. But Cubanski said only some plans will hit that higher limit and not necessarily in all states.

Shoppers can use a federal government website to compare plan prices and coverage.

States also have a State Health Insurance Program created specifically to help people on Medicare find coverage.

Consumers can help themselves by checking their coverage for changes and comparing it with other plans.

Shoppers also should consider whether their pharmacy is in the network covered by any plan they are considering, said Jacobson, Commonwealth’s vice president of Medicare.

Some might also consider switching to Medicare Advantage plans with prescription coverage. But those plans can have more limited networks of covered doctors, which can pose a problem for people with fewer care choices in rural areas.

The enrollment window spans several weeks, but brokers say many people wait until that first week in December to make decisions, often after talking with family during holiday dinners.

That can create a deadline crunch that makes it harder to find help in early December.

___

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.