Prescription drug coverage options are shrinking for Medicare shoppers
[October 13, 2025]
By TOM MURPHY
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:
Here's who needs a Medicare Part D plan
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.
How Medicare Part D plans are changing
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.
There are still many Medicare Part D options
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.
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Bottles of medicine ride on a conveyor belt at a mail-in pharmacy
warehouse in Florence, N.J., on July 10, 2018. (AP Photo/Julio
Cortez, File)
 Before 2023, that figure was often
under 1%, said Dr. Christopher Cai, one of the researchers involved
in the study.
Here's how Medicare Part D prices are changing
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.
Where to get help shopping for Medicare Part D plans
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.
Why delaying may not be wise
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.
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