Open Enrollment For 2026 Coverage Through Medicare & The Marketplace—Basics For Advocates

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 the Marketplace (HealthCare.gov and state-based exchanges) 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 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 a State Health Insurance Program (SHIP) counselor 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).

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 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 Medicaid and Medicare, consider whether supplemental benefits offered overlap with Medicaid coverage. This applies to Medicare Advantage plans.

The amount of information to consider can be daunting. SHIP 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 SHIP 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 Medicaid 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 Medicaid, 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.

Health Insurance Marketplace 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 the Affordable Care Act’s Health Insurance Marketplaces. Marketplace coverage also is an option for some older immigrants who are eligible for Medicare coverage but, because they do not have sufficient work history, must pay a premium for Part A.

(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).

Individuals can enroll in Marketplace coverage through HealthCare.gov. For 2026 enrollment, the following states are operating their own state-based exchanges on state platforms: California, Colorado, Connecticut, District of Columbia, Georgia, Idaho, Kentucky, Maine, Maryland, Massachusetts, Minnesota, Nevada, New Jersey, New Mexico, New York, Pennsylvania, Rhode Island, Vermont, Virginia, and Washington. Links to each state’s marketplace website are also available on HealthCare.gov.

It is important to carefully review plans, especially this year. Premiums are expected to rise dramatically 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 Marketplace 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 Marketplace coverage 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 Marketplace coverage. Consumers unsure about choosing a Marketplace plan or Medicare with premium Part A should contact the SHIP to better understand costs and options.

When: This year, the Marketplace Open Enrollment period is November 1, 2025 to January 15, 2026. Consumers who want their plan to start on January 1, 2026, must sign up by December 15, 2025.

Note: Some state-based Marketplaces have longer open enrollment periods. On both state and federal Marketplaces, applications for Medicaid and Marketplace 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 in their state for the 2026 plan year. Applicants can also choose to be screened for premium tax credit and cost-sharing reduction eligibility as well as Medicaid eligibility.

How: Consumers can visit HealthCare.gov or call 1-800-318-2596 to apply, change plans, or find free in-person assistance. HealthCare.gov information is available in other languages.

Note: SHIPs, 1-800-Medicare and the Marketplace 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 Marketplace Coverage During other Times

Sometimes, individuals can change their Marketplace coverage outside of the Marketplace OEP. For example, if an individual has recently lost Medicaid, or experienced a life change like moving, marriage, or death of a household member, they may be eligible for a Special Enrollment Period.

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 H.R. 1 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.