Urgent Warning for Americans with Medicare Advantage or Part D Prescription Drug Plans / Is America ready for the changes to 2026 Medicare Part D plans?

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Big changes are coming to Medicare Advantage and Medicare Part D prescription drug plans, and more than 69 million Americans could be affected. This is a timely story your audience needs to hear now. Medicare’s Open Enrollment runs from October 15 through December 7, and the new changes take effect on January 1, 2026. Millions of Medicare enrollees must review their plans to make sure their prescriptions will still be covered next year. If they miss this window, there are no do-overs, and many could see their prescription costs rise sharply in 2026. 

Because of the Inflation Reduction Act, Medicare was able to negotiate directly with manufacturers on 10 high-cost brand-name Part D drugs: Eliquis, Xarelto, Januvia, Jardiance, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, and NovoLog/Fiasp (insulin aspart), with price changes effective January 1, 2026. 

Many plans are increasing premiums and adjusting which medications they cover, and some enrollees are already seeing premium notices and dropped drugs for 2026. Toni King urges enrollees to visit Medicare.gov now to compare 2026 plans and confirm coverage. Adult children should also check in with their parents to be sure they understand these changes and take action before the deadline. 

Toni:

Currently, I am on a stand-alone Part D plan with a Medicare Supplement plan G because of my serious health issues. Last week, I received information about the changes to the 2026 Medicare Part D plan I am currently enrolled in, and the premium is increasing by $50 per month from $44.80 to $94.80 beginning January 1. The Part D plan also informed me that two of my expensive prescriptions for my heart and rheumatoid arthritis issue will no longer be covered on this specific plan beginning January 2026.

Toni, please explain in easy-to-understand terms what I need to do to change to a Part D plan that will cover all of my prescriptions before Medicare’s Open Enrollment Period ends on December 7. I have read your articles for years and now I need your Medicare guidance.

---Tammy         

Tammy:

The 2026 Part D plans became available to the public at www.medicare.gov on Wednesday, October 1 and there are serious changes with Part D premiums increasing. Medicare.gov is where America can find which Medicare Part D plan is affordable and covers their current prescription drugs.

The good news is that Medicare negotiated directly with manufacturers for the price of certain expensive brand-name Part D drugs and the price change will be effective January 1 for Eliquis, Xarelto, Januvia, Jardiance, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, and NovoLog/Fiasp (insulin aspart). 

For 2026, Medicare Part D will have three main stages: deductible, initial coverage, and catastrophic coverage. Costs and maximum-out-of-pocket are as follows:          

• Initial deductible is $615.
• 6 Drug Tiers of Initial Coverage are: Drug Tier 1: Preferred Generic Drugs; Drug Tier 2: Generic Drugs; Drug Tier 3: Preferred Brand Drugs; Drug Tier 4: Non-Preferred Drugs; Drug Tier 5: Specialty Drugs and, beginning January 1, 2026, Drug Tier 6: Select Care Drugs begins for the first time.
• Initial Coverage Stage: During the initial coverage period with the six drug-tiers, the Part D plan pays its share of the cost of your drugs, and you pay your share of the cost until the maximum amount of $2100 out-of-pocket is met. Then you move to the catastrophic coverage stage.
• Catastrophic coverage: There is a $0 out of pocket when a Medicare beneficiary enters the catastrophic coverage stage. Medicare will pick up all costs of the prescriptions whether brand name or generic with a stand-alone Medicare Part D plan or a Medicare Advantage with a Part D plan included and you will pay $0.
• On January 1 of each year, the process starts all over again with a new Medicare Prescription Drug plan and new initial deductible and maximum initial coverage limit that leads you to the catastrophic coverage stage.

The Medicare Prescription Payment Plan is a payment option which began January 1, 2025, to help manage your out-of-pocket drug costs by spreading your monthly prescription drug costs throughout the year from January to December. For more information about the payment plan, visit www.medicare.gov or call your Medicare Part D plan.

Toni Says Tips to help you find a Part D plan:

• Visit medicare.gov to view 2026 Medicare stand-alone Part D and Medicare Advantage with Part D plans attached. The website has a tool for helping you narrow your search for a new Medicare Prescription Drug plan.
• Talk to your primary care and specialty doctors about which brand name drugs can be changed to generics.
• Get samples from your doctor to help control costs.
• Search various prescription drug programs such as GoodRx, Single Care or Amazon for less expensive prescription drug costs. Wal-Mart, Kroger, HEB and Costco also have discount prescription drug plans.

Readers, your prescription drug needs can change with each yearly Medicare Open Enrollment Period. Review your options carefully, because with Medicare, what you don’t know WILL hurt you! Email [email protected] with your Medicare questions.

Toni offers a free How To Enroll in Medicare Guide: https://tonisays.com/free-download-how-to-enroll/

Toni's Podcast Medicare Moments is new every Wednesday. 

Toni's books are available at www.tonisays.com 

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Toni King is an author and columnist on Medicare, Social Security and long-term care issues. She has spent nearly 30 years as a top sales leader in the field. If you have a Medicare question, email [email protected] or call 832-519-8664. Sign up for the Toni Says newsletter at www.tonisays.com to keep up to date on Medicare changes. See Toni King on Fox 26 in Houston: