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As we look toward 2026, Medicare beneficiaries should prepare for important changes that may impact their healthcare and budgets. While the Centers for Medicare & Medicaid Services (CMS) will release official figures later in 2025, early projections suggest increases in Part B and Part D premiums, largely due to higher prescription drug spending and expanded benefits. Understanding what’s ahead now can help individuals and families plan for the future.
One key area driving these changes is prescription coverage. With more high-cost specialty drugs entering the market, Medicare Part D spending continues to rise. While recent reforms aim to lower out-of-pocket costs for beneficiaries, premiums are expected to reflect these broader system changes. Part B premiums, which cover outpatient services such as doctor visits and preventive care, are also projected to increase modestly.
The good news? Starting in 2025, Medicare will roll out the Prescription Payment Plan (MPPP), allowing enrollees to spread the cost of medications into monthly payments instead of paying large amounts at once. This should help balance affordability, even with higher premiums. Additionally, 2026 will mark the expansion of Medicare’s negotiated drug prices, a historic shift intended to drive down overall drug costs.
For beneficiaries, the most important step is preparation. Review your current coverage, compare options during the Medicare Annual Enrollment Period (October 15 – December 7, 2025), and budget for potential premium increases. Staying informed now ensures peace of mind as Medicare continues evolving to meet the healthcare needs of millions of Americans.
Choosing health insurance can feel overwhelming, especially with so many options available. For individuals without employer-sponsored coverage, two main pathways exist: ACA Marketplace plans and private health insurance plans. While both provide essential coverage, there are significant differences in cost, eligibility, and flexibility that can impact your decision.
ACA Marketplace Plans (sometimes called “Obamacare” plans) are designed to make healthcare affordable for individuals and families. They offer income-based subsidies—premium tax credits and cost-sharing reductions—that lower the cost of monthly premiums and out-of-pocket expenses. These plans also guarantee coverage for essential health benefits such as preventive services, maternity care, and prescription drugs. For many middle- and lower-income households, Marketplace coverage provides the best balance of affordability and comprehensive care.
On the other hand, private health insurance plans are purchased directly from insurance carriers, often outside the Marketplace. These plans may appeal to higher-income individuals who don’t qualify for subsidies or those looking for broader provider networks and more flexible plan designs. However, without government assistance, premiums can be significantly higher.
The right choice depends on your unique circumstances. If you qualify for subsidies, Marketplace plans can provide substantial savings while meeting essential coverage needs. If you value flexibility and can afford higher premiums, a private plan may offer more freedom in choosing doctors and hospitals. Working with a licensed advisor ensures you compare both options carefully, so you don’t leave money—or coverage—on the table.
Open Enrollment is the most important time of the year for reviewing and updating your health insurance coverage. Whether you’re on Medicare or enrolled in an ACA Marketplace plan, these enrollment windows are your chance to make changes, adjust your coverage, and ensure you’re prepared for the year ahead.
For Medicare beneficiaries, the Annual Enrollment Period (AEP) runs from October 15 to December 7, 2025. During this time, you can switch from Original Medicare to a Medicare Advantage plan, change your Part D prescription drug coverage, or move back to Original Medicare if needed. Even if you’re satisfied with your current plan, reviewing your coverage is important because formularies, provider networks, and out-of-pocket costs can change each year.
For those under 65 or without employer-sponsored insurance, the ACA Marketplace Open Enrollment Period begins November 1, 2025, and runs through January 15, 2026. During this window, you can apply for subsidies, renew your plan, or shop for a new one. Keep in mind that subsidy amounts will change in 2026, with many households expected to see reductions in financial assistance. To keep subsidies, you’ll need to verify your annual income and update your enrollment information on time.
The best way to prepare for both Medicare and ACA enrollment is to get organized early. Gather your income documentation, review your prescriptions and provider lists, and think about your healthcare needs for 2026. By planning ahead, you’ll make more confident decisions and avoid gaps in coverage. Remember: Open Enrollment is not just a deadline—it’s your opportunity to take control of your healthcare and financial future.
