As the Medicare Annual Enrollment Period (AEP) approaches—from October 15 to December 7, 2025—beneficiaries have a critical opportunity to review and adjust their coverage for 2026. With significant changes coming to Medicare, including drug price negotiations, automatic enrollment in the Medicare Prescription Payment Plan (M3P), and plan transitions, it’s more important than ever to plan ahead.
What Is AEP?
AEP is the time when Medicare beneficiaries can:
- Switch from Original Medicare to a Medicare Advantage plan (Part C)
- Change from one Medicare Advantage plan to another
- Join, drop, or switch a Medicare Part D prescription drug plan
- Return to Original Medicare from a Medicare Advantage plan[1]
Changes made during AEP take effect on January 1, 2026.
10 Drugs Selected for Medicare Price Negotiation
Under the Inflation Reduction Act, Medicare has begun negotiating prices for high-cost drugs. For 2026, the following 10 drugs have been selected, with significant discounts compared to 2023 prices:
| Drug Name | Common Use | 2026 Price | 2023 Price | Discount |
| Januvia | Diabetes | $113 | $527 | 79% |
| NovoLog (Fiasp, FlexTouch, PenFill) | Diabetes | $119 | $495 | 76% |
| Farxiga | Diabetes, Heart Failure, CKD | $178.50 | $556 | 68% |
| Enbrel | Arthritis, Psoriasis | $2,355 | $7,106 | 67% |
| Jardiance | Diabetes, Heart Failure, CKD | $197 | $573 | 66% |
| Stelara | Psoriasis, Crohn’s Disease | $4,695 | $13,836 | 66% |
| Xarelto | Blood Clots, Artery Disease | $197 | $517 | 62% |
| Eliquis | Blood Clots | $231 | $521 | 56% |
| Entresto | Heart Failure | $295 | $628 | 53% |
| Imbruvica | Blood Cancers | $9,319 | $14,934 | 38% |
These negotiated prices will help reduce out-of-pocket costs for millions of Medicare Part D enrollees[2].
Understanding M3P: Medicare Prescription Payment Plan
Starting in 2025, Medicare Part D enrollees can opt into the Medicare Prescription Payment Plan (M3P), which allows them to spread out-of-pocket drug costs over the year in monthly payments instead of paying all at once at the pharmacy[3].
Key Features:
- Available to all Medicare Part D enrollees
- Monthly bills instead of point-of-sale payments
- No additional cost to participate
Out-of-pocket cap of $2,000 in 2025, rising to $2,100 in 2026[4]
Automatic Enrollment in 2026:
If you opt into M3P in 2025 and stay on the same plan in 2026, you will be automatically re-enrolled unless you choose to opt out[4].
Important Considerations for AEP 2025
When reviewing your Medicare plan options, here are critical factors to evaluate:
1. Premiums
Plans may adjust their monthly premiums for 2026. Some may increase, while others may offer lower-cost options. Review your Annual Notice of Change (ANOC) to see how your premium will change.
2. Plan Availability
Not all plans renew each year. If your current plan is discontinued, you’ll need to select a new one during AEP. CMS requires insurers to notify beneficiaries if their plan will not be available[1].
3. Plan Transitions
Some plans may transition to new plan structures or merge with others. This can affect your benefits, premiums, and provider access. Be sure to compare the new plan’s details carefully.
4. Network Changes
Medicare Advantage plans often update their provider networks. Confirm that your preferred doctors, hospitals, and specialists are still in-network for 2026.
5. Copays and Coinsurance
Changes in drug formularies and negotiated prices may impact your copays and coinsurance. Review your plan’s updated drug list and cost-sharing structure.
6. Supplemental Benefits
Medicare Advantage plans may revise or remove extra benefits like dental, vision, hearing, or fitness programs. Check if these benefits are still included.
How to Verify Plan Information
To make informed decisions:
- Review your Annual Notice of Change (ANOC) mailed by your plan provider
- Use the compare plans tool to compare plans
- Use the Medicare Plan Finder Tool to check drug coverage, costs, and provider networks
- Contact David for personalized help.
Final Thoughts
Planning for AEP 2025 is more than just checking a box—it’s about ensuring your Medicare coverage aligns with your health needs and financial goals. With drug price negotiations, M3P automatic enrollment, and plan transitions, this year’s AEP carries more weight than ever.
Take time to:
- Review your current plan
- Compare new options
- Understand how changes affect your costs and care
By doing so, you’ll be ready to make confident choices that support your well-being in 2026 and beyond.
Resources
- CMS Medicare Prescription Payment Plan[3]
- Medicare.gov Plan Finder
- HealthPartners AEP Guide[1]
- CMS 2026 Policy Changes[4]
References
[1] Medicare Annual Enrollment Period Guide 2025 – HealthPartners
[2] Medicare Selected Drug Negotiated Prices IPAY2026_0
[3] Medicare Prescription Payment Plan | CMS
[4] Contract Year 2026 Policy and Technical Changes to the Medicare …