Medicare Open Enrollment – and New Benefits – Are on the Way

Medicare open enrollment is approaching. Now is the time to review your current Medicare coverage and consider whether you need to make changes.

Thanks to the Inflation Reduction Act (IRA), Medicare beneficiaries will see several important changes. Some changes are already in place, while others will take effect in the coming years.

Key Medicare Changes to Know

Medicare Open Enrollment

Medicare open enrollment occurs once each year. For 2024, the open enrollment period runs from October 15 through December 7. Any changes made during this period will take effect on January 1, 2025.

During Medicare open enrollment, you can:

• Join, leave, or switch Medicare Advantage Plans.
• Add or remove Medicare prescription drug coverage.
• Switch from Original Medicare to Medicare Advantage.
• Switch from Medicare Advantage back to Original Medicare.

According to Medicare.gov, reviewing your coverage every year can help ensure your plan still meets your healthcare and prescription needs.

Medicare Advantage Open Enrollment Period

If you are already enrolled in a Medicare Advantage Plan, you also have another enrollment period from January 1 through March 31.

During this period, you can:

• Switch to another Medicare Advantage Plan.
• Return to Original Medicare.
• Join a separate Medicare prescription drug plan.

Lower Prescription Drug Prices for Medicare Members

One of the biggest Medicare changes from the Inflation Reduction Act involves prescription drug pricing.

The law allows the federal government to negotiate prices for certain high-cost medications covered by Medicare. The goal is to reduce prescription costs for beneficiaries and lower overall Medicare spending.

The first negotiated prices will take effect in 2026. These changes apply to 10 commonly used prescription drugs selected because they have high costs and do not currently have generic or biosimilar alternatives.

Medicare Drug Price Negotiations Beginning in 2026

The following table shows the first 10 Medicare drugs affected by negotiated pricing. Prices are rounded estimates based on Wholesale Acquisition Costs (WACs) for a 30-day supply.

Drug	Commonly Treated Condition	2023 List Price	Discount	2026 Negotiated Price
Januvia	Diabetes	$527	79%	$113
Fiasp, NovoLog products	Diabetes	$495	76%	$119
Farxiga	Diabetes, heart failure, chronic kidney disease	$556	68%	$178.50
Enbrel	Rheumatoid arthritis, psoriasis, psoriatic arthritis	$7,106	67%	$2,355
Jardiance	Diabetes, heart failure, chronic kidney disease	$573	66%	$197
Stelara	Psoriasis, Crohn’s disease, ulcerative colitis	$13,836	66%	$4,695
Xarelto	Blood clot prevention and treatment	$517	62%	$197
Eliquis	Blood clot prevention and treatment	$521	56%	$231
Entresto	Heart failure	$628	53%	$295
Imbruvica	Blood cancers	$14,934	38%	$9,319

The Centers for Medicare & Medicaid Services (CMS) provides updated information about Medicare drug price negotiations.

If you take any of these medications, monitor updates carefully. The lower prices will not begin until 2026, so planning ahead can help you make informed decisions during future enrollment periods.

Additional Medicare Drug Price Changes Coming

The Medicare drug negotiation program will continue expanding.

• CMS will select additional Part D drugs for negotiation beginning in 2027.
• Beginning in 2028, additional Part B and Part D medications will be selected.
• After 2028, CMS may select up to 20 additional drugs each year for negotiated pricing.

Americans Continue Paying More for Prescription Medications

Although Medicare drug negotiations will lower costs for certain medications, prescription prices remain high in the United States.

According to The Commonwealth Fund, Americans spend significantly more per person on prescription drugs compared with residents of many other developed countries.

A 2022 study published by JAMA found that some older adults reduce medication use because of cost concerns. Some individuals delay filling prescriptions, reduce doses, or make other changes that may negatively affect their health.

More Medicare Changes Under the Inflation Reduction Act

The Inflation Reduction Act includes additional Medicare changes designed to help beneficiaries manage healthcare expenses.

Medicare Prescription Drug Out-of-Pocket Cap

Starting in 2025, Medicare Part D beneficiaries will have an annual limit on out-of-pocket prescription drug costs. The cap is set at $2,000.

Insulin Cost Limits

Medicare beneficiaries with prescription drug coverage may pay no more than $35 per month for covered insulin products.

Coverage may vary depending on the insulin product and plan. Check with your healthcare provider or Medicare plan for details.

Free Recommended Vaccines

Recommended vaccines covered under Medicare prescription drug plans are available without cost sharing.

Expanded Medicare Extra Help Program

The Medicare Part D Low-Income Subsidy program, also known as Extra Help, has expanded eligibility.

Individuals with income up to 150% of the federal poverty level may qualify for assistance with prescription costs.

Drug Price Inflation Rebates

Drug manufacturers that increase certain medication prices faster than inflation must provide rebates to Medicare.

Frequently Asked Questions About Medicare Changes

When is Medicare open enrollment?

Medicare open enrollment occurs annually from October 15 through December 7.

When will Medicare drug price reductions begin?

The first negotiated Medicare drug prices will take effect in 2026.

Can I change my Medicare plan during open enrollment?

Yes. During open enrollment, Medicare beneficiaries can review options and make changes to Medicare Advantage and prescription drug coverage.

Learn More About Medicare and Late-Life Planning

Medicare rules and healthcare options can be complex. An estate planning attorney or healthcare professional can help you understand how these changes may affect your personal situation and future planning needs.