Open Enrollment For 2026 Coverage Through Medicare & Covered California

Open Enrollment Periods (OEPs) are certain times of year when individuals can change their health care coverage. This resource provides basic information on the annual OEPs in Medicare (Medicare.gov) and Covered California (CoveredCA.com) for the 2026 plan year and highlights issues that are of particular relevance to assisting low-income older adults.

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Medicare Open Enrollment

Medicare enrollees have the opportunity to change their current health and prescription drug coverage during the Medicare OEP beginning October 15. It’s particularly important for enrollees in Medicare Advantage (MA) and Prescription Drug Plans to review their coverage options each year as plans can change their cost-sharing, provider networks, and drug formularies from year to year.

Who: Individuals currently enrolled in Medicare Parts A or B (Traditional Medicare), Part C (Medicare Advantage), and Part D (prescription drug coverage) should review their coverage to make sure they choose the most affordable options to meet their needs in 2026.

When: October 15 to December 7, 2025.

What: Medicare enrollees currently in Traditional Medicare can:

Remain in their current coverage;
Switch to a new Prescription Drug Plan; or
Join a Medicare Advantage plan.

Medicare enrollees currently in Medicare Advantage can:

Remain in their current coverage;
Switch to a new Medicare Advantage plan; or
Go back on Traditional Medicare by enrolling in a standalone Prescription Drug Plan.

Any changes to coverage take effect January 1, 2026.

How: Encourage your clients to make an appointment with the Health Insurance Counseling & Advocacy Program (HICAP) (1-800-434-0222) for free assistance. Coverage changes can be made at Medicare.gov or 1-800-MEDICARE.

Tips for using Medicare Plan Finder

The Centers for Medicare and Medicaid (CMS) offers an online tool called the “Medicare Plan Finder” for comparing Medicare Advantage and Part D Prescription Drug Plan options.

Medicare Plan Finder offers many details about plan options, including:

The plan’s premiums, deductibles, cost-sharing, and out-of-pocket maximum;
Whether a medication is currently on the plan’s formulary, and whether it is subject to prior authorization or other utilization management restrictions;
For supplemental benefits (e.g., vision, dental, in-home care), what limits and cost-sharing apply. Please note that some supplemental benefits are limited to a subset of enrollees; these eligibility limits may not appear on Medicare Plan Finder.

Medicare Plan Finder allows users to filter by type of plan, including Special Needs Plans designed for individuals enrolled in both Medicare and Medicaid (known as dual eligible special needs plans, or D-SNPs). The California Medi Medi Plan D-SNPs are expanding to 29 new counties, are now open for 2026 enrollment, and can be found on Medicare Plan Finder. The Medi Medi Plans are offered by the same insurance companies operating Medi-Cal plans and offer enhanced coordination with Medi-Cal services.

When using Plan Finder, here are a few things to consider:

Provider networks: If your client would like to continue seeing their providers next year, reviewing the Medicare Advantage plan network and asking whether their providers will be in-network is important. Depending on the plan, seeing an out-of-network provider can result in a denial of coverage or higher cost sharing for your client. This only applies to Medicare Advantage plans. Provider directories can be found on plan websites, and (newly for this year) may also appear on Medicare Plan Finder. Directories can be quite inaccurate; if there is a provider that your client wants to make sure is covered, it’s a good idea to contact that provider and ask if they will be in network.
Prescription drug needs: If your client takes prescription medications, the plan’s formulary or list of covered drugs, will also be important to review. If one or more prescription medications are not on the plan’s formulary, this will result in a denial of coverage subject to the Part D appeals process. This applies to both Medicare Advantage plans and standalone Prescription Drug Plans.
Pharmacy networks: If your client has a local pharmacy that they would like to continue to go to, and to ensure that they save the most money, it will be important to review the plan’s preferred pharmacy network list. Going to a non-preferred pharmacy can result in higher cost sharing for your client. This applies for both Medicare Advantage plans and standalone Prescription Drug Plans.
Supplemental benefits: Review eligibility and coverage limitations carefully. If your client is dually enrolled in Medi-Cal and Medicare, consider whether supplemental benefits offered overlap with Medi-Cal coverage. This applies to Medicare Advantage plans.

The amount of information to consider can be daunting. HICAP counselors have been trained on plans in the local area as well as changes to the Plan Finder tool. They are aware of issues with how information is presented that may be confusing and are in the best position to ensure enrollees are making informed choices. As an additional resource when considering Medicare Advantage plan selection, see Justice in Aging’s Dual Eligible Special Needs Plans FAQ and the Medicare Rights Center’s Questions to Ask before Joining a Medicare Advantage Plan.

Tips for Making Sure Your Clients Are Not Overpaying for Medicare Coverage

When clients are reviewing their coverage and enrollment options, it is also an opportunity to make sure that they are enrolled in all programs for which they qualify. Despite being eligible, many people are not enrolled in the Part D Low Income Subsidy (LIS or “Extra Help”) program, which reduces prescription drug costs, or the Medicare Savings Programs, such as the Qualified Medicare Beneficiary (QMB) program, which pays for premiums and cost-sharing including both Part B premiums and also Part A premiums for people without free Part A. Helping clients get enrolled in these programs can save them thousands of dollars per year and enable them to access care they might otherwise forgo due to cost.

As is the case with other Medicare enrollees, plan choice can affect the amount that LIS enrollees pay in Part D premiums. Six hundred thousand Medicare enrollees with the LIS pay a Part D premium because they are not enrolled in a premium-free plan (also known as a “benchmark” plan). Open Enrollment is the best opportunity for these individuals to review their coverage and change plans if necessary to better meet their needs and save money.

Here are tips on how to help your clients avoid overpaying for their coverage:

Familiarize yourself with the tan “Choosers” notice sent to LIS enrollees so you can help your clients understand their options.
Ask all your low-income clients whether they are paying a Part D premium. If they are or don’t know, urge them to review their options with a HICAP counselor.
Remember that LIS enrollees can change plans on a monthly basis. If at any time during the year, you learn that an LIS client is paying Part D premiums, urge the client to review all plan options and consider changing plans.

Tips for Changing Medicare Coverage During Other Times

Sometimes, individuals can change their Medicare Advantage or Part D Prescription Drug Plan outside of the annual Medicare OEP. For example, if a person has recently lost Medi-Cal coverage, moved, or experienced changes in the plan options available to them, they could be eligible for a Special Enrollment Period designed to help individuals join plans, switch plans, or disenroll from Medicare Advantage.

People dually enrolled in Medicare and Medi-Cal, individuals enrolled in LIS, and individuals living in nursing homes are some of the individuals who have Special Enrollment Periods available to them. Medicare Advantage enrollees can also change plans or switch to Traditional Medicare between January 1^st and March 31^st of the year during the Medicare Advantage Open Enrollment Period.

A new and temporary Special Enrollment Period will be available in 2026 for enrollees who obtained incorrect Medicare Advantage provider directory information from Medicare Plan Finder. For a full list of the different events and situations that can merit changes to Medicare coverage outside of a designated enrollment period, see CMS’ Special Enrollment Periods.

Covered California Open Enrollment

Older adults who are not eligible for Medicare and do not have other health insurance can use the annual fall Marketplace Open Enrollment Period (OEP) to enroll in or change 2026 coverage through Covered California. This is an option for some older immigrants who are ineligible for Medi-Cal and must pay a premium for Part A because they do not have sufficient work history.

(Note that H.R. 1 takes away premium tax credit eligibility for people with income below 100% FPL who are ineligible for Medicaid because of their immigration status).

It is important to carefully review plans, especially this year. Premiums are expected to nearly double on average in California next year if Congress does not act to extend enhanced premium tax credits expiring December 2025.

Who: Consumers who are not eligible for Medicare and do not have other health insurance coverage can enroll in or change coverage during open enrollment. Those who are eligible for Medicare but must pay a premium for Part A coverage also have the option to enroll in a Covered California plan but will pay penalties if they later decide to switch to Medicare. See Medicare and the Marketplace.

Note: Consumers should enroll in Medicare as soon as they are eligible to avoid incurring late penalties. Enrolling in Covered California does not postpone an individual’s Medicare initial enrollment period and could expose the individual to late enrollment penalties as well as liability for any tax credits received for Covered California coverage. Consumers unsure about choosing Covered California or Medicare with premium Part A should contact the HICAP to better understand costs and options.

When: This year, the Covered California Open Enrollment period is November 1, 2025 to January 31, 2026. Consumers who want their plan to start on January 1, 2026 must sign up by December 31, 2025.

Note: The open enrollment period in California is longer than the Marketplaces operated by the federal government. Applications for Medi-Cal and Covered California financial assistance can be submitted year-round. Any changes in income or household size for current enrollees should be reported as soon as they occur.

What: Consumers can enroll in or change health and dental plans available through Covered California. Consumers can also choose to be screened for premium tax credit and cost-sharing reduction eligibility as well as Medi-Cal eligibility.

How: Consumers can visit www.coveredca.com or call 1-800-300-1506 to apply and to update information. Local, free in-person assistance is also available through www.coveredca.com/find-help/.

Note: HICAPs, 1-800-Medicare, and Covered California provide free interpreter services for individuals with limited English proficiency (LEP). Advocates should encourage their clients to ask for language assistance so that they can better understand their choices and get all their questions answered. Advocates should also remind clients that throughout the year, they can ask their plans for free interpreter assistance when they do not understand a plan communication or if they need other assistance.

Tips for Changing Covered California Coverage During other Times

Sometimes, individuals can change their Covered California coverage outside of the Marketplace OEP. For example, if an individual has recently lost Medi-Cal, or experienced a life change like moving, marriage, or death of a household member, they may be eligible for a Special Enrollment Period. Learn more at Covered California: Special Enrollment.

Upcoming Changes to Marketplace Coverage

Marketplace enrollment, premium subsidy eligibility and verification, and special enrollment periods may all be subject to significant changes under the passage of budget reconciliation this summer and the finalization of a Marketplace rule. Many of these changes are currently stayed by litigation, but this may change in the future. Encourage your clients to make sure they are receiving and reviewing notices about their plans, in case additional actions are required by rule changes.