Big changes coming in 2026.
PLYMOUTH, MA… It’s the final quarter of 2025, otherwise known as Medicare Advantage Open Enrollment Period (OEP), which means it’s time to reshop prescription drug plans (Part D) for 2026.
“This is not the year to ignore those mailings from your Medicare plan. There are an unusual number of changes happening across most Part D and Part C plans. Don’t miss the opportunity to get a better plan. OEP runs from October 15th to December 7th,” explained nationally-known retirement planning guru, author and speaker Marcia Mantell.
As the founder of Mantell Retirement Consulting, Inc., a retirement education and marketing communications firm based in Plymouth, MA which is now celebrating 20 years, Mantell is renowned for “translating” Social Security and Medicare rules and complex retirement topics into language that consumers can understand. Over the years, she has developed innovative retirement income planning workshops for advisors, and comprehensive retirement education programs for plan participants and consumers at all levels of wealth.
Medicare Madness
This year, it’s imperative for consumers to review existing Medicare plans. Many Part D standalone plans have been discontinued. In Massachusetts, there were 14 Part D plans in 2025, but only 11 in 2026. A plan may no longer exist or, may have changed names. If consumers have a standalone Part D plan in 2025 that is discontinued for 2026, they MUST find a new Part D plan during OEP.
Mantell shares a few tips:
Open those envelopes from your current insurers. This includes your Medicare Part D prescription drug insurance plan. And your Annual Notice of Change from the insurer where you get your Medicare Part C (advantage) plan. Carefully review each plan’s coverage and cost, as now is the time to make changes if needed.
Review your premiums. Did you know the monthly premium for Wellcare Value Script Prescription Drug Plan (Part D) is increasing 75 percent for 2026 in Massachusetts? If you do nothing, your monthly premium will jump from $12.40 in 2025 to $21.70 in 2026. And to think it was only $0.50 in 2024 (yes, only fifty cents per month just two years ago). And Wellcare is no longer the least expensive plan in Massachusetts. This is just one example.
Check the pharmacy “in-network” status. Besides checking whether your prescriptions are covered or not, take a good look at the pharmacies in your area to make sure a pharmacy is “preferred, in-network” or just “in-network” which tend to offer better prices than “out-of-network”. Mail order is often the most cost-effective option.
Know that the out-of-pocket spending limit is higher in 2026. The new $2,100 cap on total out-of-pocket (OOP) spending for 2026 only applies to the costs of drugs included in each Part D plan’s approved list—their covered drugs. It’s not necessarily your complete cost. You need to budget for premiums and drugs that are not covered.
If you use a broker or agent, do your homework upfront. Many brokers are no longer receiving commissions from insurers in 2026, which means they may not be able to get you into the least expensive plan. So, how will you find out if you are getting the lowest cost Medicare Part D plan for 2026? You won’t if you don’t do some homework up front. Use the Plan Finder on Medicare.gov to get the full view of all plans offered in your zip code. Then, ask your broker or agent directly about the plan they are recommending. You should feel comfortable asking them why they are recommending a particular plan for you, especially if it is not the cheapest.
Unfortunately, insurers do not send any easy-to-use paper-based documents for older Americans to see if their plans will be covered in the following year. Everything has moved to online.
“Medicare is the only health insurance plan for those 65 and older once they leave their employer group plan – and it is wildly complicated,” explained Mantell. “We should not ask our older and most vulnerable citizens to try to navigate the insurance industry, the healthcare industry, and rapidly changing technologies when even Ph.D.s and other experts can’t figure out the US healthcare system. It is a labyrinth of disjointed pieces and parts, a Medicare maze. We need to do more to simplify getting high quality healthcare when we need it most.”
For more Medicare plan information, visit Medicare.gov or call 1-800-MEDICARE.
Marcia Mantell shares additional detail about Medicare’s Open Enrollment Period on her website: https://boomerretirementbriefs.com/medicare-part-d-open-enrollment-period-is-here
About Marcia Mantell
Marcia Mantell is a nationally-known keynote speaker, author, retirement planning guru and Baby Boomer. For over 30 years, Marcia Mantell has helped the country’s foremost financial services firms and advisors increase their knowledge of complex retirement concepts and regulations. She has a remarkable ability to translate those concepts into everyday language that educates and motivates real people to take the right steps to achieve the retirement they desire. Marcia has been named an IA25 Honoree by ThinkAdvisor—one of the “advisors, experts and leaders in financial services who are pushing the industry forward.”
Mantell is the author of four must-read books (available on Amazon.com) for everyone who wants to retire. Her lively how-to discussion guide and workbook, Cookin’ Up Your Retirement Plan, was featured in the Wall Street Journal article, “5 Books to Help You Build a Bigger Nest Egg” (July 2025). Her other titles include What’s the Deal with Retirement Planning for Women, Creating Your Medicare Recipe, and her latest book, Social Security: Lightly Toasted, Not Burnt.
Mantell owns and operates Mantell Retirement Consulting, Inc., a retirement education and marketing communications firm based in Plymouth, MA — now celebrating 20 years. She regularly partners with financial institutions in the U.S. and Canada to help support the customers they serve across the retirement spectrum—from a focus on saving, to the transition into retirement, and then, how to organize and manage income to last a lifetime.
Mantell is a go-to pro for expert level retirement planning, retirement income, Social Security, and Medicare throughout the retirement industry and for reporters and journalists around the country.
For additional background on Marcia Mantell and her work with Mantell Retirement Consulting, visit https://mantellretirementconsulting.com/.
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