The Medicare Annual Enrollment Period (AEP) is your yearly opportunity to review and change your Medicare coverage. With significant new benefits for 2026—including negotiated drug prices on 10 medications and a $2,100 out-of-pocket cap—this year's review is more important than ever.
Meta Description: Medicare's Annual Enrollment Period runs October 15 – December 7. Learn how to compare Medicare Advantage and Part D plans for 2026, understand new benefits like the $2,100 drug cap and negotiated prices, and get help from NC Medicare agents.
Short Description: The Medicare Annual Enrollment Period (AEP) is your yearly opportunity to review and change your Medicare coverage. With significant new benefits for 2026—including negotiated drug prices on 10 medications and a $2,100 out-of-pocket cap—this year's review is more important than ever.
If you live in North Carolina, our dedicated local Medicare agents can answer your questions about the Annual Enrollment Period and help you understand your Medicare health plan options.
Medicare's Annual Enrollment Period runs from October 15 to December 7 each year. Any changes you make during this period will take effect on January 1 of the following year. For example, if you switch plans on November 5, 2025, your new coverage begins January 1, 2026.
During the AEP, you can make several types of changes to ensure you have the best Medicare coverage for your needs:
Switch from Original Medicare to a Medicare Advantage plan
Switch back to Original Medicare from a Medicare Advantage plan (and add a Part D drug plan and/or Medigap)
Switch to a different Medicare Advantage plan that better suits your health needs
Enroll in a Medicare Part D prescription drug plan
Switch to a different Medicare Part D plan
Drop prescription drug coverage (though late enrollment penalties may apply if you rejoin later)
Important: If you don't make changes during the AEP, your current plan will usually auto-renew. However, costs and benefits often change year to year, so it's essential to review your coverage even if you plan to stay with your current plan.
2026 brings significant changes to Medicare that could affect your coverage decisions:
Part D Prescription Drug Benefits:
$2,100 out-of-pocket cap: Your annual out-of-pocket spending on covered prescription drugs is capped at $2,100 (up from $2,000 in 2025). After reaching the cap, you pay $0 for covered drugs the rest of the year.
Medicare-negotiated drug prices: For the first time, 10 high-cost medications will be available at Medicare-negotiated prices starting January 1, 2026. Discounts range from 38% to 79% off list prices. Drugs include Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, and NovoLog/Fiasp.
Maximum deductible: $615 in 2026 (up from $590 in 2025). Many plans have lower or no deductibles.
Automatic renewal for Prescription Payment Plan: If you enrolled in the Medicare Prescription Payment Plan (which spreads drug costs into monthly payments), you'll be automatically re-enrolled for 2026 unless you opt out.
$35 monthly insulin cap continues: No deductible applies to insulin.
Fewer Part D plans available: Stand-alone Part D plans are decreasing from 464 nationwide in 2025 to 360 in 2026. In North Carolina, there will be 12 stand-alone Part D plans for 2026 (down from 16 in 2025).
Medicare Part B Costs:
Standard premium: $202.90/month in 2026 (up from $185 in 2025—a 9.7% increase)
Annual deductible: $283 in 2026 (up from $257 in 2025)
Medicare Advantage Changes:
Average premium decreasing: The average monthly Medicare Advantage premium is projected to decline from $16.40 in 2025 to $14.00 in 2026.
Supplemental benefits reduced in some plans: Some Medicare Advantage plans are scaling back supplemental benefits, such as over-the-counter allowances (66% of plans in 2026 vs. 73% in 2025), meal benefits (57% vs. 65%), and transportation (24% vs. 30%).
Lower out-of-pocket maximum: The maximum out-of-pocket limit for in-network services decreases to $9,250 in 2026 (down from $9,350 in 2025).
Behavioral health cost-sharing improvements: Medicare Advantage plans must match or improve upon Original Medicare's cost-sharing for mental health and substance use disorder services.
Plan availability: Approximately 5,600 Medicare Advantage plans will be available nationwide in 2026. Some insurers are reducing their service areas or discontinuing plans—verify your plan is still offered in your area.
New Special Enrollment Period for inaccurate directories: For 2026 only, if you enroll in an MA plan using Medicare Plan Finder and discover within the first three months that your doctor was listed incorrectly, you have a one-time opportunity to switch plans or return to Original Medicare.
If you're looking to make changes to your Medicare coverage during the AEP, follow these steps to ensure you get the right plan:
For Medicare Advantage: You must already be enrolled in Medicare Part A and Part B. Check if your desired plan is available in your area—some plans only serve specific counties in North Carolina.
For stand-alone Part D: You must have Medicare Part A and/or Part B. Verify the plan you want is available in your area.
If you're enrolled in a Medicare Advantage or Part D plan, you should have received your Annual Notice of Change (ANOC) by September 30. This document outlines changes to your plan for the coming year. Pay close attention to:
Premium changes: Are your monthly costs increasing?
Drug formulary changes: Have any of your medications been removed or moved to a higher cost-sharing tier?
Provider network changes: Are your doctors and hospitals still in-network?
Supplemental benefit changes: Have any extra benefits (dental, vision, OTC allowances, meals, transportation) been reduced or eliminated?
Copay and deductible changes: Are your out-of-pocket costs for services and prescriptions increasing?
If you have Original Medicare, review the 2026 Medicare & You handbook for coverage and cost changes.
Before deciding on a plan, consider your current and anticipated healthcare needs:
What healthcare services have you used recently?
Do you have any planned procedures or new prescriptions for next year?
Do you need coverage that Original Medicare doesn't include, like dental, vision, or hearing?
Do you take any of the 10 drugs with new Medicare-negotiated prices in 2026?
Remember: Original Medicare doesn't include prescription drug coverage. You'll need a separate Medicare Part D plan or a Medicare Advantage plan that includes drug coverage.
If you have prescription drug coverage from another source (like a retiree plan or VA benefits), verify it's "creditable coverage"—meaning it's expected to pay at least as much as standard Medicare Part D coverage. If your current coverage isn't creditable and you go without it for more than 63 consecutive days after your Initial Enrollment Period, you may face late enrollment penalties when you sign up for Part D later.
If you have other health insurance—such as retiree benefits, veterans' benefits, or employer coverage—check how it coordinates with Medicare. In some cases, enrolling in a Medicare Advantage plan or Part D could affect your existing coverage. Contact your insurance company to understand the implications before making changes.
Our North Carolina Medicare agents can help answer questions about combining Medicare with other insurance.
When comparing plans, consider these key factors:
Provider Networks:
Are your current doctors, specialists, and hospitals in the plan's network? If they're not listed, you'll pay significantly more for out-of-network care—or the plan may not cover it at all.
Total Cost (Not Just Premiums):
Consider the whole picture: monthly premiums, deductibles, copayments, coinsurance, and out-of-pocket maximums. A plan with a $0 premium but high copays and a $9,000 out-of-pocket maximum may cost more than a plan with a $50 premium and better coverage.
Prescription Drug Coverage:
Check the plan's formulary (drug list) to confirm your medications are covered. Drugs are typically organized into tiers with different cost-sharing; the same medicines may cost significantly more or less depending on which plan you choose.
Star Ratings:
All Medicare Advantage and Part D plans are rated from 1 to 5 stars for quality and customer satisfaction. A 5-star rating indicates excellent quality. Use these ratings to help compare plan performance.
Supplemental Benefits:
If you're considering Medicare Advantage, compare the extra benefits offered—dental, vision, hearing, fitness programs, over-the-counter allowances, and more. These benefits vary significantly between plans and may be reduced from year to year.
Medicare Advantage Open Enrollment Period (MA-OEP): January 1 – March 31. If you're already enrolled in a Medicare Advantage plan, you can switch to a different MA plan, drop your MA plan and return to Original Medicare, or add a Part D plan. You can only make one change during this period.
5-Star Special Enrollment Period: December 8 – November 30 each year. If a 5-star Medicare Advantage or Part D plan is available in your area, you can switch to it once during this period.
Special Enrollment Periods (SEPs): Various circumstances—like moving, losing other coverage, or qualifying for Extra Help—may trigger a Special Enrollment Period that allows you to make changes outside of the AEP.
Getting the right Medicare coverage shouldn't be complicated. With all the changes coming in 2026—from negotiated drug prices to reduced supplemental benefits in some plans—reviewing your coverage during the Annual Enrollment Period is more important than ever.
Our North Carolina Medicare agents are passionate about helping people find the perfect coverage at a cost they can afford. We can help you:
Compare Medicare Advantage and Part D plans available in your area
Verify your doctors and medications are covered
Determine if you'll benefit from the new negotiated drug prices
Understand how 2026 changes may affect your coverage and costs
Explore Blue Cross NC Medicare Advantage plans and other options