In mid-January 2025, I received a very ballistic email from a woman new to 65 Incorporated. It appears she was writing to anybody and everybody who might be associated with Part D, prescription drug coverage. She was angry because she was put into a new plan with a premium that was $90 more. She read everything; it seemed that nobody wrote anything about this.
It’s doubtful she read everything. There were several news stories discussing the many changes–the $2,000 cap, Medicare Prescription Payment Plan and skyrocketing premiums. I wrote one, specifically about plans that were going away in 2025.
She missed not only all those posts but also something that was sent directly to her—the Annual Notice of Changes for her drug plan. If she had paid attention to this, she would have learned that, unless she took action by December 7, she would be enrolled automatically in another plan and, as she learned, one with a much higher premium.
Five Reasons To Check Out 2026 Drug Coverage
The 2025 Open Enrollment Period has been extremely challenging so anyone with Part D drug coverage needs to check out what their plan will look like next year. Here are just a few reasons why this is important.
Just about every area will have four fewer Part D stand-alone plans in 2026. Anthem announced that it was exiting the Part D market for stand-alone plans entirely; there are a few other plans going away as well. Those who have one of these plans will not be auto-enrolled in another plan. If they want drug coverage in January, they need to pick a new plan now.
Some drug plan sponsors are reducing the number of offerings. This is what trapped the email writer. Besides the plans exiting the market, some sponsors are dropping a plan but have at least one still available. Those who do not switch during Open Enrollment will be enrolled automatically in another plan they didn’t choose and likely with a much higher premium.
Many will face increased costs. This is not a new problem, but it is becoming more significant because of the Part D $2,100 cap. Drug plans are shifting costs to beneficiaries. One example: It has been common with Medicare Advantage plans to charge a $100 copayment for a Tier 4 medication. That is changing and now several plans charge a coinsurance, such as 39% or 47%. What the plan member pays is often considerably more than $100.
More drugs will not be covered in 2026. Besides increased costs, there are significant changes to plans’ formularies. Costly medications, generally Tier 4 and Tier 5, are being dropped from formularies. Of note, no stand-alone plan will cover Humira. Those who take this drug will need to change to a biosimilar.
Insulin coverage is still a big concern. The noncoverage problem is not limited to costly drugs. The copay for insulin, when covered by a plan, is no more than $35 and, when not in a plan’s formulary, it is full retail price. During the last two open enrollment periods, I noticed plans were covering fewer insulins. Now, going into 2026, there is not one stand-alone or Medicare Advantage plan that covers Basaglar.
It’s Not Too Late to Act
If you have not read your annual notice or paid attention to 2026 changes, there is still time–six days. Review the changes and check out other plans. If there is better option, enroll in the new plan by Sunday night, December 7. The easiest way is to sign up through your medicare.gov account or the Medicare Plan Finder. You’ll avoid a long wait on hold and will not have to deal with any sales pitch, geared toward changing your mind.
Please do this now. I really don’t want to get any more angry emails in the New Year.
Read the full article here
