Medicare 2026

Medicare Open Enrollment 2026: Your Gaithersburg Guide to Dec. 7

GAITHERSBURG, Md. — The window that decides how millions of people pay for health care next year is open. From October 15 through December 7, 2025, Medicare's Annual Enrollment Period lets you review, switch, or drop your coverage for 2026. Whatever you pick — or don't pick — takes effect January 1.

This year the stakes feel a little different. A new $2,100 cap on out-of-pocket prescription costs takes effect in 2026 under Part D, and plans across the country are adjusting formularies, pharmacy networks, and premiums to match. That makes it worth a fresh look, even if you liked your plan last year.

What you can actually do between October 15 and December 7

The Annual Enrollment Period, or AEP, is the one time each year when almost everyone with Medicare can make changes. During this window you can:

• Switch from Original Medicare (Parts A and B) to a Medicare Advantage plan (Part C), or the other way around.
• Switch from one Medicare Advantage plan to another.
• Join, drop, or switch a Part D prescription drug plan.

Any change you make now starts January 1, 2026. If you do nothing, your current plan generally rolls over — but the plan itself may not be the same. That's the catch we'll get to next.

Read your Annual Notice of Change first

By late September, your current Medicare Advantage or Part D plan should have mailed you an Annual Notice of Change (ANOC). It's the document that spells out what's different for 2026 — premiums, drug tiers, copays, provider networks, and pharmacy partners.

If yours is sitting in a pile of mail, dig it out. A plan that fit perfectly in 2025 can look different in 2026, especially with the new Part D cap reshaping how drug costs are structured.

What's new for 2026

A few program-level changes worth knowing before you compare anything:

• $2,100 out-of-pocket cap on Part D drugs. Once your covered prescription costs hit that amount, you pay $0 for covered drugs the rest of the year.
• Part D deductible maximum is $615. Plans can charge less, but not more.
• No more "donut hole." Part D now has three phases: deductible, initial coverage, and catastrophic.
• Medicare Prescription Payment Plan. This optional program lets you spread your yearly drug costs across monthly payments instead of paying a big bill at the pharmacy counter. You can opt in for 2026.
• IRMAA. Higher-income enrollees pay surcharges on Part B and Part D. For 2026, those surcharges begin above $109,000 in income for a single filer (based on 2024 tax returns).

What Gaithersburg residents should know locally

Gaithersburg is in Montgomery County, and Medicare plan availability is set at the county level. That means when you use Medicare's Plan Finder, you'll be comparing the Medicare Advantage and Part D plans offered across Montgomery County — not just plans "in Gaithersburg." Your ZIP code narrows down which providers and pharmacies are considered in-network.

If your doctors are at Adventist HealthCare Shady Grove, Holy Cross Germantown, or one of the MedStar or Johns Hopkins locations nearby, check each plan's provider directory before you enroll. Networks change every year.

How to decide without getting overwhelmed

You don't need to compare every plan on the market. A short, honest checklist works better:

1. List your medications, including doses. Small formulary differences can matter more than premium differences. 2. List your doctors and preferred pharmacies. Confirm they're in-network for any plan you're considering. 3. Think about how you use care. Frequent specialist visits? Travel outside Maryland often? Those answers point you toward or away from certain plan types. 4. Look at total cost, not just premium. Deductibles, copays, and drug costs together tell the real story. 5. Check Star Ratings on Medicare.gov. They're a quality signal from CMS — one input among several, not a verdict.

If you want a human to walk through it with you, Maryland's State Health Insurance Assistance Program (SHIP) — locally called SHIP/MAP (Senior Health Insurance Assistance Program / Maryland Access Point) — offers free, unbiased counseling. You can reach the Montgomery County office through the county's Aging & Disability Services line.

If you miss December 7

You get one more shot, but it's narrower. From January 1 through March 31, 2026, the Medicare Advantage Open Enrollment Period lets people already in a Medicare Advantage plan switch to a different Advantage plan or drop back to Original Medicare (and add a Part D plan). It does not let someone in Original Medicare switch into Medicare Advantage for the first time.

Outside those two windows, you generally need a Special Enrollment Period — triggered by things like moving, losing other coverage, or qualifying for Extra Help.