On October 15, despite the ongoing federal government shutdown, the Medicare open enrollment window began.This important annual opportunity allows seniors to select their Medicare coverage, including Medicare Part D prescription drug plans, for 2026. Next year is the 20th anniversary of Medicare Part D coverage, a landmark achievement which reduced the share of Medicare- aged seniors without prescription drug coverage from 25% in 2005 to 11% while costing taxpayers 35% less than anticipated and offering an average monthly premium of $34.50 in 2026 – well below what the Congressional Budget Office estimated premiums for the program would be.
The success of Part D is directly attributable to the program’s structure. Participating insurers must negotiate drug prices with manufacturers and pharmacies, driven by the need to compete for seniors’ business with low premiums and broad formularies.While the federal government provides benchmarking requirements for pricing and drug coverage, plan structures are negotiated and set by the private insurers. Then, using tools available online, over the telephone, or in-person, seniors can compare their complete list of prescriptions and dosages against available plans to find the most cost-effective way to obtain their needed medications in the coming year.
During open enrollment, seniors also have the opportunity to choose whether to participate in traditional Medicare Parts A and B or in Medicare Advantage, a program which allows private insurers to offer comprehensive Medicare coverage through a competitive structure similar to Part D. Medicare Advantage plans may include drug coverage or require a separate Part D plan. I am always looking for ways to improve access to high quality Medicare Advantage options in rural parts of our country like Nebraska’s Third District, where population density can make offering competitive plans challenging.
