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Fewer choices may be on the menu again as Medicare patients shop for prescription coverage this month.

The number of available, stand-alone drug plans has fallen for a few years, and that trend will continue for 2026.

Most markets will still have several choices, but some options are becoming particularly sparse for shoppers with low-income subsidies. And help may be harder to find because some insurers no longer pay brokers’ commissions for new business.

Shoppers have from Oct. 15 to Dec. 7 to find new coverage that starts in January. Here are some things to consider:

Who needs a Medicare Part D plan?

Regular Medicare, which most people qualify for after turning 65, does not come with prescription coverage, known as Part D. People must choose that separately.

About 23 million people with regular Medicare have this standalone coverage, according to the nonprofit KFF, which studies healthcare.

Another roughly 34 million people have Medicare Advantage plans, which are privately run versions of Medicare that often come with prescription coverage.

How Medicare Part D plans are changing

Virginia residents can choose from nine standalone drug plans, down from a dozen last year, while Marylanders will have 10 to choose from, down from 18 in 2024. There are around 14 plans to choose from in Washington, D.C.

Yet shoppers had nearly 30 choices as recently as 2021, according to the Commonwealth Fund’s vice president of Medicare, Gretchen Jacobson.

A range of one to four plans will be available at no premium to people who qualify for low-income subsidies, according to KFF. In addition, Americans with limited income can receive assistance with their prescription drug coverage from the federal Medicare Rx Extra Help.

Some insurers are reducing their presence in standalone Part D plans, while the Blue Cross Blue Shield carrier Elevance is leaving the market entirely.

Insurers and analysts who follow the industry note that the Inflation Reduction Act, which will cap annual out-of-pocket drug costs at $2,100 in 2026, puts more financial pressure on insurers. The same law now allows patients to spread the cost of prescriptions over the year.

Still many Medicare Part D options

Most markets will have several choices. But experts say Medicare Part D customers don’t like to shop, especially if they already have a plan that covers their medications. Finding affordable coverage for multiple prescriptions can be tricky.

“I think there’s a lot of inertia and, frankly, people may be concerned that if they switch, they’re going to end up worse off,” said Juliette Cubanski, deputy director of the Program on Medicare Policy at KFF.

More people are being pushed to shop. Nearly 11% of those with standalone prescription drug coverage lost their plan in 2024, according to research published recently in the Journal of the American Medical Association.

Before 2023, that figure was often under 1%, said Dr. Christopher Cai, one of the researchers involved in the study.

Slight drop in cost

Monthly premiums, or coverage prices, will fall nearly 10% on average to $34.50, the Centers for Medicare and Medicaid Services announced in September.

At least one option with a premium of under $20 exists in almost every region of the country, according to the consulting firm Oliver Wyman.

Individual prices will range widely, with premiums for the same plan varying by state, Cubanski noted.

But while plans may provide lower coverage prices, they could also raise deductibles or offer more limited lists of covered drugs, which are called formularies. Shoppers should check these details.

Insurers will be allowed to raise premiums by as much as $50 a month for 2026, up from a $35 increase allowed this year. But Cubanski said only some plans will hit that higher limit and not necessarily in all states.

Where to get help shopping for plans

Shoppers can use a federal government website to compare plan prices and coverage.

States also have a State Health Insurance Program created specifically to help people on Medicare find coverage. In Maryland, call (410) 767-1100; in D.C., contact (202) 727-8370, and in Virginia, call (800) 552-3402.

Consumers can help themselves by checking their coverage for changes and comparing it with other plans.

Shoppers also should consider whether their pharmacy is in the network covered by any plan they are considering.

Some might also consider switching to Medicare Advantage plans with prescription coverage. But those plans can have more limited networks of covered doctors, which can pose a problem for people with fewer care choices in rural areas.

Why delaying may not be wise

The enrollment window spans several weeks, but brokers say many people wait until that first week in December to make decisions, often after talking with family during holiday dinners.

That can create a deadline crunch that makes it harder to find help in early December.

—AP