When Holly Kluck enrolled in Medicare last year, she thought she had found a bargain — a prescription drug plan that cost only $18 per month. But recently, she was shocked to learn that her premium would rise by more than $50 next year, even though she doesn’t take any medications. Her husband, Jeff, faces a similar increase.

With all the changes coming in 2026, the couple expects their total annual Medicare premium costs to climb by nearly $2,000. As a result, they are now carefully comparing new Part D prescription drug plans during Medicare’s annual open enrollment period, which runs through December 7. Holly believes she can find a lower-cost option for herself, but her husband’s choices are limited because he requires an expensive blood thinner.

“It’s so complicated, isn’t it?” said Kluck, 66, a retired teacher living in New Jersey.

Wide Variations in Costs Ahead

The Klucks’ experience serves as a reminder for every Medicare beneficiary: review your prescription drug coverage every fall. This year, price changes vary dramatically from one plan to another, meaning that switching plans could save — or cost — hundreds of dollars.

Those who have traditional Medicare Parts A and B, along with a Medigap supplemental policy, do not need to re-evaluate that coverage. However, those enrolled in Medicare Part D or Medicare Advantage plans should take a closer look, as major policy changes under the Inflation Reduction Act (IRA) are reshaping the prescription drug market.

The IRA set a $2,100 cap on out-of-pocket spending for prescription drugs starting in 2026, providing significant relief for patients who rely on expensive medications for chronic conditions such as cancer or multiple sclerosis. While this cap protects patients, it shifts more financial risk to insurance companies.

To offset potential premium hikes, the Biden administration introduced a “premium stabilization” subsidy program for insurers who agreed to limit premium increases to no more than $35 per month in 2025. The program will continue in 2026, but the Trump administration has reduced those subsidies, arguing that insurance providers now have enough experience to better predict costs under the new system.

As a result, plans participating in the stabilization program may now increase premiums by up to $50 per month. Plans that do not participate — like the one used by the Klucks — may raise rates even higher.

Some Plans Will Cut Premiums

A recent analysis by KFF, a nonprofit health care research organization, found that most major national drug plans will not raise premiums dramatically in 2026. In fact, some are lowering them. According to KFF, four national plans will charge less in at least 30 states, and two Humana plans will reduce premiums in nearly every state.

However, the country’s most popular plan, Wellcare Value Script, will raise premiums in 32 states and Washington, D.C., remain unchanged in 16 states, and decrease in only two. Meanwhile, SilverScript Choice, another top plan, will see premiums jump by $50 in 30 states but decline in 20.

Zero-Premium Plans on the Rise

Depending on where you live, you may also have access to as many as six zero-premium Part D plans in 2026. These plans are not available everywhere, but their number continues to grow. Typically, they carry the highest possible deductible — $615 next year, up from $590 in 2025 — and are best suited for people who take few or only generic medications.

Juliette Cubanski, deputy director of the Medicare Policy Program at KFF, cautions that such plans can be risky for those who depend on brand-name or high-cost drugs. “You could end up paying much more overall if your medications aren’t well-covered,” she said.

Zero-premium plans may also see sharp price hikes in later years. “They’re designed to attract healthier customers initially,” explained Kylie Stengel, a principal at Avalere Health, a research and consulting firm. “Once the population changes, premiums can rise quickly.”

Cubanski also warns beneficiaries not to focus solely on monthly premiums. “People tend to fixate on the price tag,” she said. “But you need to look at the total picture — what drugs are covered, any restrictions, and your out-of-pocket costs.”

Medicare Advantage Enrollees Must Also Review Coverage

People enrolled in Medicare Advantage — the private, all-in-one alternative to traditional Medicare — should also pay attention. During the open enrollment period, they can switch providers or move back to traditional Medicare. However, anyone considering a switch should confirm eligibility for Medigap supplemental coverage before doing so. Outside of a limited six-month window when you first enroll in Medicare Part B, insurers in most states can deny Medigap coverage based on pre-existing conditions.

For those staying with or joining an Advantage plan for 2026, experts recommend reviewing the plan’s drug coverage just as you would for a stand-alone Part D plan. Make sure your prescriptions are covered, understand your deductibles, and check the in-network provider list to ensure your preferred doctors and hospitals are included.

This year, the government’s Medicare Plan Finder tool will include provider directories for Advantage plans, but the listings may still contain errors or omissions. “It’s best to verify directly with your doctors,” said Philip Moeller, Medicare expert and publisher of Aging in America. “Ask which plans they’ll participate in next year and whether their affiliated hospitals are covered.”

If you end up choosing a plan based on incorrect information, Medicare allows you to switch plans during the first three months of the new year. There is also a dedicated Medicare Advantage Open Enrollment Period during that same time.

Most Americans can choose from 30 or more Advantage plans, according to KFF. But availability is uneven — in four states, beneficiaries have fewer than five options.