Medicare Prescription Drug Coverage Shrinks as Enrollment Nears

Medicare beneficiaries face a reduction in prescription drug coverage options this fall, as the number of available stand-alone drug plans continues to decline. For the upcoming enrollment period, which runs from October 15 to December 7, 2025, shoppers will find fewer choices for coverage that takes effect in January 2026. This trend is particularly concerning for those receiving low-income subsidies, as options are becoming increasingly limited.

According to research from the Kaiser Family Foundation (KFF), a typical Medicare shopper will have access to between eight and twelve stand-alone drug plans in 2026, down from a range of twelve to sixteen in 2025. As recently as 2021, beneficiaries enjoyed nearly 30 options. The situation is particularly dire for low-income individuals, with the number of no-premium plans available dropping from eight in 2021 to as few as one in some states.

Several factors contribute to this decline. Notably, the Blue Cross-Blue Shield carrier, Elevance, is exiting the market entirely. Insurers are also grappling with the financial implications of the Inflation Reduction Act, which will cap annual out-of-pocket drug costs at $2,100 starting in 2026. This change increases pressure on insurers, many of whom are scaling back their offerings.

Challenges for Medicare Part D Shoppers

Despite these challenges, most markets will still provide several options. However, experts note that many Medicare Part D customers exhibit reluctance to switch plans, particularly if they already have coverage that meets their needs. Juliette Cubanski, a Medicare expert at KFF, emphasized that “there’s a lot of inertia,” with beneficiaries often fearing that a switch could result in worse coverage.

Recent findings published in the Journal of the American Medical Association revealed that nearly 11% of individuals with stand-alone prescription drug coverage lost their plans in 2024. This marks a significant increase from prior years, where the loss rate typically hovered below 1%.

The pricing landscape for Medicare Part D is also undergoing changes. The Centers for Medicare and Medicaid Services recently announced that average monthly premiums will decrease by nearly 10%, bringing them down to $34.50. Furthermore, at least one plan with a premium under $20 will be available in nearly every region. Nonetheless, while premiums may fall, insurers may respond by raising deductibles or narrowing formularies, which detail the drugs that are covered.

Guidance for Enrollment and Coverage Selection

Navigating the Medicare Part D landscape can be complex. Beneficiaries are encouraged to utilize the federal government’s website to compare plan prices and coverage options. Additionally, state health insurance programs are available to assist Medicare recipients in finding suitable coverage.

Shoppers should also be vigilant about their current plans, checking for any changes, and comparing them against new options. It is vital to ensure that preferred pharmacies are included in the networks of any plans under consideration. For those who may be contemplating a switch to Medicare Advantage plans that include prescription coverage, it is important to consider the potentially limited networks of doctors available, particularly for individuals residing in rural areas.

Many beneficiaries tend to delay their enrollment decisions until the final days of the enrollment period, often consulting with family during holiday gatherings. This procrastination can complicate the process, leading to a rush that may hinder the ability to find adequate help.

As Medicare beneficiaries prepare for the upcoming enrollment period, awareness of the shifting landscape of prescription drug coverage will be essential in making informed decisions.