By Patricia Prewitt
My Personal Rx Adviser
By now you have likely received the Annual Notice of Change (ANOC) for 2026 for your Medicare Insurance (supplemental gap or Medicare Advantage) plan, and/or your Medicare Part D Prescription Plan. Take a look at the changes for 2026. In my own case, Rx’s that had been a $10 copay increase to $15, and the $15 Tier 2 jumped to $20.
Some insurance companies have chosen to leave states or regional markets. Industry news sources cite an expectation of rising premiums, and a reduction in those “extra” benefits offered from private Medicare Advantage plans like dental coverage, glasses, and gym memberships.
You can make changes during the Open Enrollment period between October 15 and December 7 2025. Advertising will be quite heavy this fall – buyer beware!
In this time of uncertainty, what actions could I be taking to help control my prescription costs in 2026?
First: Be informed! Open your mail/email to review the changes to your existing Prescription Part D Plan. If you are enrolled in a Medicare Advantage (Plan C), review those changes. Make a list of your current Rx’s for coverage and tier levels for pricing. Do not assume that medication coverages stay the same in 2026. You might want to change your plan to save money or gain more cost effective coverage.
Use the Medicare.gov Plan Finder tool (https: www.cms.gov/medicare/coverage/prescription-drug-coverage) and select 2026 to find which plans cover needed medications at a favorable price. If you are not good with a computer, ask a trusted friend or family member to help you.
What if I don’t have anyone and need help? This stuff is too confusing!
Most independent medical insurance brokers/agents represent up to 20+ different carriers. They help people review plans and enroll, usually at no cost. Contact your local Council on Aging to book an appointment with specially trained SHINE counselors who work by appointment during open enrollment.
Second: If you are 65 (or will be in 2026) still working, and have employer insurance, make sure your employer plan has “creditable coverage” for prescriptions. Without credible coverage (defined by ACA) future Medicare Med D penalties might be assessed.
Caution for the newly retired: I am required to use a contracted entity (ViaBenefits) in order to maintain my employer retiree health benefits. Follow the guidelines of your former employer to avoid losing access to any accrued retiree benefits.
What else? For Medicare enrollees, in 2026 the out-of-pocket maximum costs for coverage prescriptions is $2,100. The costs accrued will be determined by each carrier as it relates to copayments, coinsurance, and deductibles for each plan’s rules. The standard deductible for Part D prescription plans rises to $615 in 2026. You may opt-in for a budget plan to smooth prescription costs over 12 months.
Is there any good news? The first 10 medications contracted for cost reductions go into effect in 2026. Check the Extra Help tab on the Medicare.gov website to read about the federal program and see if you may qualify.
Content provided is for educational purposes only, and is not intended as a substitute for advice from a qualified medical professional. The opinions expressed within are those of the author.
About the Author: Patricia Prewitt is a local Massachusetts resident who spent more than 30 years in the pharmaceutical industry. Tricia is a consumer education advocate, and loves helping people find ways to save money on their prescriptions. More information and free resources are available on her website at https://mypersonalrxadvisor.com/resources or call her at 508-507-8840. Favorite Quote: “Act as if what you do makes a difference. It does.” – William James
