The shift to cooler weather, the kids going back to school and the sudden need for a flu vaccine are all reminders that Open Enrollment is coming – a time with important decisions, especially for patients managing chronic conditions. For some, it slips by unnoticed, but for others, it can feel like a scramble to navigate confusing plan choices and deadlines.
At CCPA, we know a patient can face coverage gaps, rising out-of-pocket costs, or losing access to trusted doctors and medications which can disrupt care and impact their health.
With the right approach, open enrollment can be your opportunity to take charge of your coverage, protect your access to treatment, and bring more peace of mind.
What Is Open Enrollment?
Open Enrollment is the annual window when you can sign up for health coverage, switch plans, update your coverage or renew existing coverage for the year ahead without needing a special exception or qualifying life event.
- Medicare Open Enrollment runs from October 15 to December 7, 2025, for coverage beginning January 1, 2026.
- Marketplace/Medicaid Open Enrollment runs from November 1, 2025 to January 15, 2026. Enroll by December 15 and your coverage starts January 1; enroll between December 16–January 15 and coverage begins February 1.
- If you receive insurance through your employer, the enrollment period depends on your company’s schedule and the options it provides. Your HR department can give you exact dates and instructions for making changes.
Why It Matters
Health insurance isn’t one-size-fits-all. For patients, especially those managing complex or chronic conditions, the decisions you make during open enrollment directly affect:
- Your doctors: Whether your trusted physicians and specialists remain in-network.
- Your medications: How your prescriptions are covered and what you’ll pay out of pocket.
- Your budget: Premiums, deductibles, and co-pays can shift dramatically from year to year.
- Your quality of life: The right coverage offers peace of mind and stability before the unexpected happens.
Questions You Should Ask About Your plan Options:
- Is your doctor(s) still available to you?
- If you are on medications, are those specific medications still available without prior authorization?
- What are your copays going to be for your medications and other types of care?
- What are the premiums going to be?
What’s New for Medicare In 2026
With several major changes take effect in 2026, this year’s enrollment is a crucial time to review your plan and ensure it meets your needs:
- Inpatient Admission Protections: Once a Medicare Advantage plan approves an inpatient admission, it generally cannot retroactively deny coverage (except in cases of fraud or error). This offers patients more stability and reduces the risk of surprise bills.
- Prescription Cost “Smoothing” & Auto-Renewal: The new Medicare Prescription Payment Plan (launched in 2025) lets you spread high drug costs over the year instead of paying all at once at the pharmacy. Beginning in 2026, enrollees are automatically re-enrolled each year unless they opt out. If you enrolled in the program in 2025, you will be automatically re-enrolled in 2026 unless you actively opt out. However, if you did not opt in last year, you must take action during this open enrollment period to sign up.
- Annual Out-of-Pocket Drug Cost Cap: Part D enrollees will see their yearly prescription drug spending capped at $2,100 in 2026 (up from $2,000 in 2025). This cap brings predictability and protection for those with expensive medications.
- Premiums & Deductibles Adjusting: The standard Part D deductible will rise to $615 in 2026 (up from $590 in 2025). Part D premiums are also projected to increase, making plan comparison more important.
- Drug Price Negotiations: 2026 is the first year Medicare’s negotiated “maximum fair prices” for certain drugs take effect. This may impact the medications you are taking.
- Insulin & Vaccine Protections Continue: Adult vaccines covered under Part D remain $0, and insulin costs stay capped at $35 per month.
- Inflation Rebates for Drugs: Drug manufacturers must pay rebates if they raise prices faster than inflation. These rebates are designed to lower costs for Medicare and directly benefit enrollees by helping keep premiums and out-of-pocket costs down.
- WISeR Prior Authorization Pilot in Six States: CMS will launch the Wasteful and Inappropriate Service Reduction (WISeR) Model, a six-year pilot in New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington. It introduces AI- and clinician-enabled prior authorization for 17 outpatient services.
These new changes aim to reduce cost uncertainty but remind us why it’s essential to reassess your coverage every year.
Making Open Enrollment Work For You
Just like the leaves change each fall, every year brings different and personal changes for you, last year’s plan may no longer be the best fit. By reviewing your current plan, comparing options, and acting before the deadline, you can secure the right coverage for you and your family, avoid gaps in care, potentially save money, and set yourself up for a successful and healthy year.
For more information, visit the Health Insurance Marketplace® at https://www.healthcare.gov/ and explore plans here.
View Medicare plans here.