By Jim Joseph, CFP®
Medicare open enrollment is that time of year when it pays to hit “refresh” on your coverage. With so many plan options and the chance to make changes that could affect your health and finances, it can feel a bit like juggling flaming torches. That’s where we can offer guidance.
As part of our Get Wealth Planning Process™, for specialty areas that could affect your wealth and future objectives, we utilize a wide variety of resources and work collaboratively to incorporate effective strategies and recommendations into your overall plan. From reviewing any impact on other areas to leveraging tools that provide clarity and insights, we help you align your choices with both your healthcare needs and your broader financial goals.
This article breaks down some of this complexity and what you need to know for Medicare open enrollment, helping you move confidently into 2026 without the stress and with a plan that actually works for you and your own unique objectives.
What You Can Do During Open Enrollment
Let’s start by talking about how open enrollment works.
Every year, the Medicare main open enrollment period is from October 15 to December 7. During this period, you can change your Medicare health plan(s) and prescription drug coverage for the following year.
Keep in mind that open enrollment is not for people who haven’t signed up for Medicare yet. If that’s you, the initial enrollment period is determined by your birthday rather than a predetermined day on the calendar.
The open enrollment period affects each part of Medicare differently. A quick summary:
- If you currently subscribe to Medicare Parts A & B, you can switch to Part C.
- If you currently subscribe to Medicare Part C, you can switch back to Original Medicare (Parts A and B) or change to a different Medicare Advantage Plan.
- If you currently subscribe to Medicare Part D, you can switch to a different Part D plan or drop your prescription drug plan altogether.
- You can enroll for the first time in Part C or Part D.
If you don’t make any changes during open enrollment, your current coverage remains the same and rolls over to the following year.
Changes to 2026 Medicare Coverage
Below, we identify three of the bigger changes and coverage for Medicare in 2026. Now is the time to compare your plans and make any necessary adjustments during open enrollment. With significant changes on the horizon, there may be a plan that better fits your needs.
- $2,100 out-of-pocket spending cap for prescriptions. The first major change is that the Part D (prescription drug coverage) cap will rise in 2026 from $2,000 per year to just $2,100 per year on out-of-pocket spending on covered drugs. While this is still 5%, this limited increase is a big change over prior years where there were no limits on out-of-pocket expenses for participants. This limit applies to prescription coverage in Medicare Advantage plans as well as standalone Part D insurance. For approved medications, the $2,100 cap covers coinsurance, copayments, and deductibles. It doesn’t apply to meds that aren’t covered by a plan or premiums.
- Vaccines and insulin could be more affordable. Starting in 2026, all vaccines on the current CDC-recommended vaccines will be free under Part D with zero cost-sharing through 2026, despite changes occurring under the current CDC administration. If you require regular insulin, monthly costs will be hard-capped at $35 or 25% of the negotiated or “maximum fair price” (set by the Price Negotiated Program), whichever is lower.
- Increasing premiums for Part B and Part D. On the downside, Medicare recipients will see a substantial 11% increase to their Part B base premiums in 2026. Part B base premiums will rise from $185 in 2025 to $206.50 per month, while the Part D initial base premium is expected to increase by 6% from $36.78 to just about $39 per month. It’s important to note that Part D plans are offered by private companies who may not have set next year’s premiums yet, so your actual Plan D premium could be higher or lower. Some Part D plans have $0 premiums, so it may pay to shop around.
We Can Assist With 2026 Medicare Questions
Navigating 2026 Medicare open enrollment comes with a lot of important choices that can impact your retirement finances. The good news? You don’t have to figure it out on your own.
At FSA Wealth Partners, we work with our clients and allied professionals step by step, helping to implement strategies and techniques that best fit their needs and financial goals. Our focus is on giving clients the clarity and confidence to make decisions that align with what truly matters to them. Even as markets, the economy, or policies shift, we provide ongoing guidance to keep your financial priorities on track.
To learn more about how we can support you during Medicare 2026 open enrollment, or to schedule a meeting, call (301) 949-7300 or email jim@FSAwealthpartners.com.
About Jim
James Joseph, CFP®, is the President and Partner of FSA Wealth Partners (FSA), a financial services firm in Rockville, MD, with over 40 years of experience helping individuals, families, and business owners navigate the complexities of wealth management. Since joining FSA in 2004, Jim has been passionate about guiding clients with personalized financial and investment advice, simplifying complex financial topics, and providing tailored solutions—especially for those approaching or enjoying retirement.
Jim takes pride in the FSA Safety Net®, a unique strategy designed to help clients avoid major losses during market downturns. His belief that “you win by not losing” underscores FSA’s proactive approach to preserving wealth while still seeking growth. By focusing on risk management and using the FSA Safety Net®, Jim works to prevent small losses from becoming significant setbacks, keeping his clients’ goals intact. Jim emphasizes the importance of both active management and comprehensive financial planning.
Jim began his financial career in 1997, gaining experience at Charles Schwab and Morgan Stanley, where he crafted retirement strategies and managed portfolios. His extensive background, combined with his genuine dedication to helping clients reach their financial goals, has made him a trusted advisor. He particularly enjoys seeing clients succeed when they embrace his advice and transition smoothly into retirement, believing that starting early and leveraging the power of compounding can unlock future financial flexibility.
Jim holds a bachelor’s degree in Finance from West Virginia University, the CERTIFIED FINANCIAL PLANNER® designation, and over the years has shared his financial knowledge in publications such as The Wall Street Journal and Reader’s Digest. When not at work, Jim enjoys spending time with his three daughters, playing ice hockey, and cheering on his beloved Pittsburgh Penguins and Steelers. He’s also into aviation, working toward his private pilot’s license. To learn more about Jim, connect with him on LinkedIn.
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