Medicare open enrollment: Why premiums could increase for some enrollees

Medicare open enrollment is under way, with several changes on tap that could raise the cost of premiums, increase out-of-pocket caps and offer fewer drug coverage options for enrollees. 

Here’s what to know about the changes for next year: 

When is Medicare open enrollment? 

Timeline: Open enrollment for Medicare plans began Thursday, Oct. 15, and ends Dec. 7.

During this time, enrollees have the opportunity to choose between traditional Medicare and privately run Medicare Advantage plans in their area, as well as prescription drug plans. Those changes go into effect on Jan. 1.

Medicare Part D changes

By the numbers:

The cap on annual out-of-pocket expenses for Medicare Part D drugs will increase to $2,400, up from $2,100 in 2026, and the standard deductible will increase from $615 to $700. 

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The Trump administration is also ending a temporary Part D premium subsidy that helped offset premiums. 

It was initially implemented by former President Joe Biden’s administration in 2024 to lower patients’ Medicare Part D prescription drug costs in response to the effects of the 2022 Inflation Reduction Act.

Higher premiums

Dig deeper:

According to KFF, a health policy research organization, enrollees in United AARP-branded Part D plans will see their monthly premiums increase by $50 or more in all 50 states if they don’t change their plans. In 37 states, the premiums will rise by more than $75 a month, and in four states that increase is more than $100. 

RELATED: Medicare Part D subsidy program will end in 2027: Here’s what to know

For the AARP Medicare Rx Saver plan, enrollees in 33 states will see their monthly premiums rise by $50 or more. 

Combined, the two plans have more than 2 million members, but KFF notes that "a majority of Part D enrollees will not be affected by premium changes and may not face premium increases of any magnitude."

Why you should ‘shop around’ for Medicare plans

There are cheaper plans to choose from, but KFF points out that "many enrollees don’t compare plans or switch during open enrollment."

What you can do:

"Higher health care costs are making it harder for older Americans to afford the care they need," AARP’s Executive Vice President and Chief Advocacy Officer Nancy LeaMond said in a statement. 

"With costs and coverage changing every year, it’s more important than ever to shop around, compare your options, and choose the coverage that’s best for you," she said. 

More drugs covered by Medicare 

New Medicare-negotiated prices, part of a Biden-era law that allows the haggling for Medicare, will go into effect for 15 drugs, including weight-loss and diabetes medications Ozempic, Rybelsus and Wegovy.

Additionally, Trelegy Ellipta, Xtandi, Pomalyst, Ibrance, Ofev, Linzess, Calquence, Austedo/Austedo XR, Breo Ellipta, Tradjenta, Xifaxan, Vraylar, Janumet/Janumet XR, and Otezla will be covered by Medicare as of Jan. 1.

The Centers for Medicare and Medicaid expects the change to lower prescription drug coverage for people enrolled in Medicare by $685 million in 2027.

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