Medicare 2026

Before AEP Starts, Know Who Gives Unbiased Help

Carlsbad is home to a large share of Medicare-eligible neighbors, and the questions that come with the program — what Part D covers, when to enroll, whether to stay with Original Medicare or try Medicare Advantage — rarely have quick answers. The good news: you don't have to figure it out alone, and you don't have to pay to get straight information.

Two kinds of local help exist side by side. One is free and unbiased. The other is licensed to walk you through specific plans. Knowing the difference is the first step.

Free, unbiased help: California's SHIP is called HICAP

Every state has a State Health Insurance Assistance Program (SHIP) funded to give Medicare beneficiaries free, one-on-one counseling. In California, it's called HICAP — the Health Insurance Counseling and Advocacy Program.

HICAP counselors don't sell insurance. They don't earn commissions. Their job is to explain your options — Original Medicare, Medigap, Medicare Advantage, Part D, Extra Help, Medi-Cal — and help you compare them based on your medications, doctors, and budget.

For Carlsbad residents, HICAP services are delivered through the San Diego County program. You can reach them by calling the statewide HICAP line at 1-800-434-0222, or by visiting aging.ca.gov and searching for HICAP. Appointments are typically free and can be done by phone or in person.

Licensed agents and brokers: a different role

Licensed insurance agents are the other main option. Unlike HICAP counselors, agents are appointed by insurance companies and paid a commission when they enroll someone in a plan.

That's not a bad thing — a good local agent can be genuinely helpful, especially if you want to compare specific Medicare Advantage or Part D options side by side. But it does mean their view is shaped by which carriers they represent. Some agents work with only a few companies; others are independent and represent many.

Before you sit down with an agent, it's fair to ask:

• Which carriers are you contracted with?
• Do you offer Medigap (Medicare Supplement) plans as well as Medicare Advantage?
• Will you still be available after I enroll if I have a claims question?

What the numbers look like around Carlsbad

Plan availability is set at the county level, not the city level. Carlsbad is in San Diego County, where CMS lists 65 Medicare Advantage plans for 2027 from 15 carriers. Compared with 2026, 26 plans are not returning, 18 are new, and 20 have been renamed; 28 continuing plans change something in their terms, detailed in each plan's ANOC. That's a lot of ground to cover on your own — one reason free counseling exists.

With more than 500,000 residents age 65 and older across the county, both HICAP offices and licensed agencies tend to be busiest right before and during the Annual Enrollment Period each fall.

Program rules worth knowing before you call

Whether you meet with HICAP or an agent, come in knowing a few program-level facts before choosing 2027 coverage:

• Part D out-of-pocket cap: $2,100 in 2026 and $2,400 in 2027. Once your spending on covered drugs reaches that amount, you pay nothing for covered prescriptions the rest of the year.
• Part D maximum deductible: $615 for 2026 and $700 for 2027 (plans can set theirs lower).
• The "donut hole" is gone as of 2025. Part D now has three phases instead of four.
• Medicare Prescription Payment Plan: an optional program that spreads your drug costs into monthly payments instead of paying at the pharmacy counter.
• IRMAA: higher-income surcharges on Part B and Part D begin above $109,000 for a single filer in 2026.

Key dates to keep on the fridge

• October 15 – December 7: Annual Enrollment Period. You can join, switch, or drop a Medicare Advantage or Part D plan.
• January 1 – March 31: Medicare Advantage Open Enrollment. If you're already in a Medicare Advantage plan, you can switch to another one or return to Original Medicare.

Outside these windows, you may still qualify for a Special Enrollment Period if you move, lose other coverage, or have certain life events.