Attention all Medicare beneficiaries: Your prescription drug plan options are shrinking, and it’s time to take notice. But here’s where it gets controversial—while fewer choices might seem like a setback, some argue it could simplify decision-making for seniors. Either way, here’s what you need to know as you navigate this year’s Medicare Part D landscape.
For years, the number of standalone Medicare Part D prescription drug plans has been declining, and 2026 is no exception. While most areas will still offer several options, this is the part most people miss—low-income beneficiaries relying on subsidies are finding their choices particularly limited. Adding to the challenge, some insurers are cutting broker commissions, making it harder to find expert guidance during this critical enrollment period.
From October 15 to December 7, millions of Medicare recipients will need to select coverage that begins in January. But who exactly needs a Medicare Part D plan? Unlike regular Medicare, which kicks in for most at age 65, prescription drug coverage (Part D) isn’t included and must be chosen separately. Currently, about 23 million people with traditional Medicare have standalone Part D plans, according to the nonprofit KFF. Meanwhile, roughly 34 million are enrolled in Medicare Advantage plans, which often bundle prescription coverage.
Here’s the kicker: For 2026, the average shopper will see only 8 to 12 standalone drug plan options, down from 12 to 16 in 2025. Just three years ago, there were nearly 30 choices available, notes Gretchen Jacobson of the Commonwealth Fund. For low-income beneficiaries, the situation is even starker—depending on the state, they’ll have access to just one to four no-premium plans, compared to eight in 2021.
Why the decline? Some insurers are scaling back their Part D offerings, with Elevance Health (formerly Blue Cross-Blue Shield) exiting the market entirely. Industry experts point to the Inflation Reduction Act as a key factor. While the law caps annual out-of-pocket drug costs at $2,100 starting in 2026 and allows patients to spread prescription costs throughout the year, it also places greater financial strain on insurers. Is this a fair trade-off? We’d love to hear your thoughts in the comments.
Despite the shrinking options, many markets will still offer multiple plans. However, experts note that Medicare Part D enrollees are often reluctant to switch plans, especially if their current coverage meets their needs. “There’s a lot of inertia,” explains KFF’s Juliette Cubanski. “People worry they’ll end up worse off if they change.” Yet, nearly 11% of standalone Part D enrollees were forced to switch plans in 2024, up from less than 1% in previous years, according to a recent JAMA study.
On the pricing front, there’s some good news: Monthly premiums are expected to drop by nearly 10% on average, to $34.50, according to the Centers for Medicare and Medicaid Services. In most regions, at least one plan will be available for under $20. However, here’s the catch—while premiums may be lower, some plans are raising deductibles or narrowing their formularies (lists of covered drugs). Shoppers must scrutinize these details to avoid surprises.
For those seeking assistance, the federal government’s Plan Finder tool (www.medicare.gov/plan-compare) is a great starting point. State Health Insurance Assistance Programs (SHIPs) also offer free, personalized guidance. When comparing plans, don’t forget to check if your preferred pharmacy is in-network. Alternatively, consider switching to a Medicare Advantage plan with prescription coverage, though these often have more limited provider networks—a potential drawback for rural residents.
Finally, don’t wait until the last minute. While the enrollment window runs through December 7, brokers warn that procrastinating until early December can lead to a scramble for help. Start exploring your options now to ensure you find the best fit for your needs.
What’s your take on the shrinking Part D landscape? Do you think fewer options simplify or complicate the process? Share your thoughts below!
