For retirees, many of whom are managing expenses on a fixed income, the annual open enrollment period for Medicare Advantage and Part D plans can create anxiety as plan options, premiums, and benefits may change each year. Fortunately, 2026 is shaping up to be a relatively stable year for these plans which cover tens of millions of Medicare seniors, but there are some changes that will require careful shopping by seniors to ensure they receive the highest value from their plans. Individual marketplace approaches enable broad, informed choice and in times of high, volatile healthcare cost trend, employer group plan sponsors should consider individual marketplace delivery for their retirees. What do we expect for the 2026 individual market enrollment period running from October 15 through December 7?
These comprehensive and affordable healthcare plans, which cover more than 35 million Medicare beneficiaries, are facing some changes next year, both positive and negative.
More than 50 million Medicare beneficiaries obtain prescription drug coverage through Part D, with over 23 million purchasing a standalone Part D Prescription Drug Plan (PDP). All Part D plans benefited from substantial coverage enhancements in 2025 under the Inflation Reduction Act, including a new cap on member out of pocket cost.
For 2026, PDP options remain broadly available with the average Medicare beneficiary having a choice of between 8 and 12 plans next year. Average premiums are projected to drop from about $38 per month in 2025 to about $35 per month in 2026. Some plans continue to be offered at a $0 premium. Annual deductibles can be as high as $615, but annual out of pocket costs are capped at $2,100 in 2026. And, new for 2026, federal price negotiations will reduce the cost for the highest cost brand drugs offered under Part D.
In short, affordable PDP options remain widely available, and all enjoy a valuable $2,100 cap on prescription drug out-of-pocket costs. It's important that employers understand if their group plans continue to provide any material incremental value above and beyond individual PDPs relative to their price.
For employers, an individual marketplace approach eliminates the healthcare cost trend risk employer group plans carry. For retirees, the individual marketplace provides access to a highly competitive market offering a variety of plan options to best meet their families’ needs. By partnering with an individual marketplace solution like Via Benefits, employers can help participants align their insurance needs with their budget by providing expert guidance in plan selection and support in enrollment. Via Benefits supports retirees of any age and leads the market in helping Medicare retirees whose complex healthcare needs require specialized attention in a volatile healthcare environment.
