Fewer Medicare Drug Plans, Same Prices in 2026: Why it Matters

Medicare Part D is the part of Medicare that helps pay for prescription drugs. It’s run by private insurance companies that contract with the federal government — which means prices and plan choices can change every year.

For 2026, the average monthly premium for these drug plans will stay about the same. But there’s a twist: many insurers are cutting back or pulling out entirely, which could leave some enrollees with fewer options or even without their current plan.

The changes are part of a bigger shake-up tied to recent laws that cap out-of-pocket drug costs and shift more expenses onto insurers. For everyday beneficiaries, that means this fall’s Medicare open enrollment is more important than ever.

Want to stay ahead of Medicare changes like this? Sign up for BenefitKarma; we’ll break down what’s new, what’s next, and what you can do about it.

There’ll be fewer stand-alone Part D plans in 2026.

According to new data from the Kaiser Family Foundation, the number of stand-alone Medicare Part D plans will drop again next year, the third straight year of contraction. Nationally, just 360 plans will be offered by 17 parent organizations, down about 22% from 2025.

In most states, enrollees will have only 8 to 12 stand-alone drug plans to choose from. Some big names are even leaving the market altogether:

• Elevance Health (formerly Anthem) will exit stand-alone Part D entirely.

• Centene is ending three WellCare plans.Cigna’s parent company, Health Care Service Corporation, will discontinue one of its three plans.

For people who rely on these companies, that means one of two things: you’ll have to shop for a new plan, or Medicare will automatically move you into a similar plan from a different insurer.

Premiums look stable, but that’s only half the story.

The good news? The average monthly premium for most stand-alone plans will stay flat or even potentially decrease slightly in 2026. Some areas will even offer $0-premium plans, and only a few insurers are raising rates by the maximum $50 allowed.

But… lower premiums don’t necessarily mean lower costs overall. Insurers can offset smaller premiums by:

• Covering fewer drugs or changing which tiers certain prescriptions fall under,

• Increasing copays or coinsurance, or

• Adding more prior authorization and step therapy requirements.

That means beneficiaries could end up paying more at the pharmacy, even if their monthly bill looks the same.

There’s a reason why so many insurers are pulling back.

A big factor behind these shifts is the Inflation Reduction Act (IRA). The law restructured how Medicare Part D splits drug costs between insurers, the federal government, and manufacturers. Starting in 2025, drug plans became responsible for a larger share of costs once a member’s spending passes certain thresholds.

That’s good news for consumers, especially those who take expensive brand-name drugs, but it’s making the business less profitable for insurers. Smaller or regional carriers, in particular, say the new structure makes it harder to stay competitive in the stand-alone market.

Many companies are instead focusing on Medicare Advantage (MA-PD) plans, which wrap drug coverage into a single managed-care package and tend to bring higher returns.

Here are some actions you should take this fall.

If you’re currently enrolled in a stand-alone drug plan, this year’s Medicare Open Enrollment (Oct. 15-Dec. 7) is more important than ever. Here’s what to do:

1. Read your Annual Notice of Change (ANOC): This letter explains whether your plan is ending, merging, or changing coverage.

2. Compare all available plans in your ZIP code using Medicare.gov’s Plan Finder.

3. Check your drugs: Make sure they’re still covered and on the same tier.

4. Confirm your pharmacy network: Some plans are limiting which pharmacies count as “preferred.”

5. Don’t assume automatic enrollment is in your favor. If your current plan disappears, Medicare may move you to another plan, but it may not fit your needs.

More info: How to Sign Up for Medicare

The bottom line. . .

While stable premiums may sound like good news, the shrinking number of stand-alone Part D options means many enrollees will need to shop carefully this year. The Inflation Reduction Act’s new cost-sharing structure is protecting consumers but forcing insurers to adjust, sometimes in ways that make coverage less predictable.

For most people, that means doing something they might usually skip: reviewing your Part D plan before the deadline.

Because this year, “no change” could actually mean a big change.