Medicare Annual Enrollment Period: What ​To ​Know ​Before October 15th

The Medicare enrollment period, also known as the Annual Enrollment Period (AEP), is just around the corner. Are you ready to review your coverage?

From October 15 to December 7, Medicare beneficiaries have the opportunity to make changes for the year ahead. Whether you’re considering switching plans, adjusting your drug coverage, or simply double-checking that your current plan still fits, now is the time to prepare.

While the structure of Medicare remains familiar, some important updates are coming in 2026, especially around drug costs and Medicare Advantage plans. We’ll break down what you need to know so you can make confident, informed decisions this fall.

Not sure what each Medicare part covers? Here’s a quick refresher:

Before we review the changes for 2026, let’s clarify the different parts of Medicare and what each part covers:

Part A – Hospital Insurance

• Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.
• Most people don’t pay a premium for Medicare Part A if they or their spouse paid Medicare taxes for at least 10 years.
• For 2026, the Part A deductible and coinsurance amounts may change slightly. As of mid-2025, final amounts have not been released, but beneficiaries can expect modest annual adjustments based on inflation.

Part B – Medical Insurance

• Covers doctor visits, outpatient care, durable medical equipment, preventive services, and some home health care.
• Medicare Part B requires a monthly premium. The standard premium for 2026 will be announced in late 2025. In 2025, it was just under $175/month.
• There is also an annual Part B deductible ($240 in 2025), which may rise slightly in 2026.
• If your income is above a certain level, you may pay an Income-Related Monthly Adjustment Amount (IRMAA) in addition to your premium.

Part C – Medicare Advantage

• Medicare Advantage is offered by private insurers and includes Parts A and B coverage.
• These bundles often include extra benefits like dental, vision, and prescription drugs.
• Premiums and out-of-pocket costs vary by plan; some have $0 premiums.
• You must still pay your Part B premium.
• Plans and benefits may change each year — review your plan during AEP.

Part D – Prescription Drug Coverage

• Medicare Part D helps cover the cost of prescription medications.
• Available as a standalone plan or bundled in many Part C plans.
• Each plan has a formulary and different cost tiers—review carefully.
• In 2026, the $2,000 annual out-of-pocket cap remains in place.
• Plan details and drug coverage can change yearly — compare during AEP.

Not sure which parts you need or how they work together? A quick conversation with The Baldwin Group can help clear up the confusion and ensure you’re on the right track.

When can you change your Medicare plan? Know these key enrollment windows:

Medicare has several defined enrollment periods that determine when you can enroll in or make changes to your coverage.

Initial Enrollment Period (IEP)

If you’re turning 65, your Initial Enrollment Period is your first opportunity to enroll in Medicare. This period spans seven months:

• It begins three months before your 65th birthday
• Includes the month you turn 65
• And continues for three months after your birthday month

If you are already receiving Social Security retirement benefits when you turn 65, you’ll be automatically enrolled in Part A and Part B. However, you’ll still need to actively choose a Part D plan or a Medicare Advantage plan (Part C) if you want additional coverage. On the other hand, if you’re still working, read this.

If you’re not automatically enrolled, you might be wondering, “How do I sign up for Medicare?” The process is straightforward, but timing is important. You’ll need to enroll during your Initial Enrollment Period to avoid late penalties and ensure your coverage starts when you need it.

Annual Enrollment Period (AEP)

The Annual Enrollment Period runs from October 15 to December 7 each year. Any changes made during the Medicare open enrollment dates will take effect on January 1, 2026.

There are no special AEP requirements to switch plans—you simply need to be enrolled in Medicare. During AEP, Medicare beneficiaries can:

• Switch from Original Medicare to a Medicare Advantage plan (Part C)
• Change from one Medicare Advantage plan to another
• Enroll in or change a Part D prescription drug plan
• Drop your Medicare Advantage plan and return to Original Medicare

Remember, it’s a short window for AEP, and choosing the right plan now can make a big difference for next year. If you’re unsure where to start, The Baldwin Group can guide you through your options and deadlines.

Special Enrollment Period (SEP)

Under specific circumstances—such as moving to a new area, losing employer-based health coverage, or experiencing other qualifying events—you may be eligible for a Special Enrollment Period (SEP). SEPs allow you to enroll in or make changes to your Medicare coverage outside the standard enrollment periods.

General Enrollment Period (GEP)

If you missed your Initial Enrollment Period and are not eligible for a Special Enrollment Period, the General Enrollment Period offers another opportunity to sign up for Medicare. This window runs from January 1 to March 31.

Enrollment during the GEP typically results in coverage beginning July 1, and in many cases, a late enrollment penalty may apply.

Medicare Advantage Open Enrollment Period (MA OEP)

Running concurrently with the General Enrollment Period—from January 1 to March 31—this window is specifically for individuals already enrolled in a Medicare Advantage (Part C) plan.

During the MA OEP, beneficiaries may:

• Switch to another Medicare Advantage plan
• Drop their Advantage plan and return to Original Medicare (with the option to enroll in a Part D plan)

This period does not allow individuals to join a Medicare Advantage plan for the first time.

Medicare Changes for 2026: What’s New and How Your Plan Might Be Affected

While parts A and B remain structurally stable, there are several important updates—especially in parts C (Medicare Advantage) and part D (prescription drug plans)—that will impact beneficiaries beginning in 2026.

Part A – What to Expect

• Premium: Still free for most beneficiaries.
• Deductible & Coinsurance: Will increase slightly in 2026; exact figures will be released in fall 2025.
• For those who pay a premium (less common): The monthly premium may rise slightly from $505 in 2025.

Part B – How Costs and Coverage Are Changing

• Monthly Premium: A small increase is expected; finalized rates will be announced later in 2025.
• Deductible: Also expected to increase modestly, though no major structural changes are planned.
• Late Enrollment Penalty: Still applies if you delay enrolling without having qualifying coverage.

Part C – What to Watch for This Year

• Plan Structure: Offered by private insurers, these plans bundle parts A, B, and often part D into a single plan.
• CMS Payment Increase: Payments to Medicare Advantage plans may rise by 5% or more, which may result in better benefits or more competitive premiums, depending on the plan and region.
• Supplemental Benefits Oversight: Services like home safety modifications or food delivery will be under stricter CMS oversight, requiring stronger documentation that they improve health outcomes.
• Weight-Loss Drug Coverage: Medications like Wegovy are still not required to be covered unless prescribed for approved uses such as diabetes.

Part D – Big Changes for Drug Coverage

• Annual Out-of-Pocket Cap:
  • Total out-of-pocket costs for covered prescriptions will be capped at $2,100 a year.
  • This includes deductibles, copays, and coinsurance.
  • Once you reach the cap, you pay $0 for the remainder of the year.
• Monthly Payment Option:
  • The Medicare Prescription Payment Plan allows you to spread your annual drug costs evenly over 12 months.
  • This option auto-renews annually unless you opt out.
  • Pharmacies must provide real-time out-of-pocket estimates at the point of sale.
• Higher Deductible:
  • In 2026, the standard part D deductible will rise slightly to $615 (up from $590 in 2025). This means you’ll pay the full cost of your covered prescriptions until you’ve met that amount.
• Drug Price Negotiation Begins:
  • CMS will apply negotiated pricing to an initial group of 10 high-cost drugs starting January 1, 2026.
  • These negotiated prices are expected to reduce both individual and federal spending.
• Stricter Rules for Employer Drug Plans:
  • Starting in 2026, employer and union drug plans must cover at least 72% of expected costs to stay Medicare-approved.
  • If yours doesn’t meet that standard, you could face penalties—so it’s smart to check now.

Simple Steps to Prepare for AEP 2026

Not sure what to do during AEP? Preparing for Medicare’s Annual Enrollment Period doesn’t have to be overwhelming. Here are five things you can do to get a head start:

Still Have Questions? We’re Here to Help

Medicare changes for 2026 can feel overwhelming, but 2026 brings meaningful updates — especially around prescription drug costs and Medicare Advantage oversight. These changes could work in your favor, but only if you take time to review your coverage.

Not sure how to apply for Medicare or which plan makes sense for you? The Baldwin Group is here to help. Our team can walk you through your options and offer guidance that makes the process clearer — and your decisions more confident.

Here’s How We Can Connect:

• You can call us at 813.939.5288
• Request a call by providing some info online.

Meet in person—see if we have an office in your area.