Medicare Part D Coverage Shrinks in 2026 Amid Plan Reductions and Cost Shifts
The Medicare Part D landscape is undergoing significant changes in the 2025-2026 enrollment cycle that require careful attention from beneficiaries.
Notably, several stand-alone Part D plans are being reduced by four per area in 2026, driven in part by Anthem's complete exit from the stand-alone Part D market. Those whose current plans are discontinued must actively select new coverage to avoid being without drug benefits in January 2026. Many plan sponsors are also consolidating offerings, which can lead to automatic enrollment into higher-premium plans if beneficiaries do not proactively switch during the Open Enrollment Period ending December 7, 2025.
Costs for beneficiaries are rising amidst these plan changes, exacerbated by the implementation of the $2,100 out-of-pocket cap on Part D prescription drug expenses. Various plans are replacing flat copayments with percentage-based coinsurance on higher-tier medications, which can substantially increase individual out-of-pocket costs. Additionally, formulary coverage is tightening, with many costly Tier 4 and Tier 5 drugs being dropped, including the absence of Humira coverage in any stand-alone plans, requiring patients to switch to biosimilars.
Coverage for essential treatments like insulin is also diminishing. While copays for insulin remain capped at $35 when covered, several insulins, including Basaglar, are no longer covered by any stand-alone or Medicare Advantage plans entering 2026. This reduction in coverage underscores the need for beneficiaries to review their plan details closely.
The article emphasizes that despite widespread information dissemination about these changes, some beneficiaries remain unaware or confused, leading to unexpected premium increases and coverage gaps. The Annual Notice of Changes and other communications are critical documents that must be reviewed carefully.
The author strongly advises all Medicare Part D enrollees to reexamine their plans and explore alternative options before the December 7 deadline, leveraging tools such as the Medicare Plan Finder or their medicare.gov accounts to avoid higher costs or loss of coverage. This proactive approach can prevent automatic enrollment into plans with less favorable terms. Overall, the evolving Part D marketplace highlights the importance of active plan management amid consolidations, cost shifts, and formulary changes impacting both premiums and drug access.