Medicare open enrollment has started: Key details to know

(NewsNation) — Medicare open enrollment is now in progress, giving beneficiaries a chance to review and change their coverage before the deadline.

The choice can affect medication and health care expenses for millions of Americans, but a new poll found that 60% of older adults spend less than an hour comparing plans during open enrollment.

University of Michigan health researcher Dr. Mark Fendrick said this year’s enrollment decision could be the most consequential in 25 years. Government policy changes and shifts among insurance companies that work with Medicare have had broad effects, especially for prescription drug coverage.

What changed in Medicare drug plans?

The government increased the maximum deductible by $85, which means some people could pay as much as $700 out of pocket.

People who can use generic medications may be able to fill prescriptions at no cost. It is worth looking for plans that offer a $0 copay for certain drugs.

The annual cap on out-of-pocket prescription drug spending has also climbed to $2,400, which is $300 more than in 2026.

When comparing Medicare prescription plans, check the drug list and make sure the medications you need are covered at the correct doses. Each plan has its own formulary, and if a drug appears on more than one list, the amount you pay can differ depending on how it is tiered.

Some plans may also require prior approval from a doctor or clinician for certain medications. In some cases, your provider may also have to show that you first tried other drugs that did not work, a process known as step therapy.

By 2027, formularies will include 25 drugs that have been negotiated with drug companies at a lower out-of-pocket cost. The negotiated price covers all forms and dosage levels of those drugs. That is the amount the insurance company pays, and those savings should be passed along to enrollees.

Ways to cut Medicare drug costs

The Medicare Prescription Payment Plan is free and available to anyone enrolled in Medicare. It helps spread out-of-pocket drug costs across the calendar year, yet only 5% of eligible people are enrolled.

People with limited income may qualify for Extra Help, a program that assists with Medicare drug plan deductibles, coinsurance, premiums and other expenses, according to the Medicare website. If you receive Supplemental Security Income from Social Security, are enrolled in Medicaid, or participate in a state Medicare Savings Program, you are automatically enrolled.

You may qualify if you are married and earn less than $32,460, or if you are single and earn less than $23,940.