With this issue’s focus on healthcare providers, it’s worth looking at how most of us actually pay for those services—through health insurance. We are once again approaching the season when anyone on an individual plan or Medicare must make decisions about their coverage for the coming year. Each enrollment period brings its own deadlines, rules and changes, and 2026 is no exception.
Before long, we’ll see familiar faces like Joe Namath, William Shatner and Jimmie Walker promoting Medicare Advantage plans. Whether you find the commercials entertaining or annoying, they serve as a reminder that Medicare’s Annual Election Period (AEP) runs October 15-December 7. This is the window when anyone eligible for Medicare can enroll in, drop, or switch Medicare Advantage and Part D prescription drug plans. Because benefits and costs change each year, it pays to review your plan annually.
There is also the Open Enrollment Period (OEP), January 1-March 31. This is more limited: it allows people already on a Medicare Advantage plan to switch to another Advantage plan or drop it and return to Original Medicare, with the option to add a Part D plan. However, switching back does not guarantee acceptance into a Medicare Supplement policy, so discuss your options with an insurance professional before making changes.
A positive development for Medicare beneficiaries has been the new annual out-of-pocket cap on Part D drug costs. In 2025, the maximum is $2,000, increasing slightly to $2,100 in 2026 due to the Inflation Reduction Act. While still a significant amount, this is a major improvement compared to just a few years ago when there was no cap at all. Even better, enrollees can spread payments out in monthly installments rather than paying large amounts up front early in the year. For those with expensive prescriptions, this provides both savings and predictability.
For individuals on non-Medicare health plans, open enrollment runs November 1-January 15. Since 2014, the Affordable Care Act (ACA) has provided Premium Tax Credits (PTCs) to help reduce premiums. In 2021, the American Rescue Plan expanded those credits, making more people eligible and increasing subsidy amounts. The Inflation Reduction Act extended the expansion through 2025. But as of now, there is no sign they will continue into 2026. If they expire, many households could see premiums rise significantly, and some may struggle to keep the coverage they’ve relied on in recent years.
The bottom line: watch for notices from your insurance carrier — by mail, email or text. Insurers send plenty of reminders, but ultimately it’s your responsibility to compare options and make timely choices. Missing the enrollment window could leave you with higher costs, fewer choices, or a plan that doesn’t fit your needs. Taking time this fall to review your options with a licensed agent experienced in Medicare and individual plans who can interpret the information, identify potential gaps and guide you toward a plan that matches your and financial needs can make a big difference in the year ahead.
