The Future of Medicare PDPs: Stability and Key Changes
The Medicare Prescription Drug Plan (PDP) market faces a critical year in 2026. How it performs could affect premiums, plan availability, and the long-term viability of traditional Medicare. The future of Medicare PDPs is especially important for some rural beneficiaries who rely more on stand-alone PDPs than Medicare Advantage plans.
Why Stability Matters
Almost half of Medicare beneficiaries use traditional Medicare as opposed to a Medicare Advantage plan. For them, drug coverage usually comes from a PDP, and for Low-Income Subsidy (LIS) enrollees, certain PDPs are the only way to get premium-free coverage. PDP availability is shrinking; average options dropped from 30 in 2021 to 14 in 2025. While the average benchmark LIS plan options went from 8 to just 2. Meanwhile, MAPD options have grown from 27 to 34.
Key 2026 Changes
- Out-of-Pocket Max: $2,100 (up from $2,000)
- Deductible: $615 (up from $590)
- Insulin/Vaccines: $35 monthly cap for insulin, $0 for ACIP vaccines remain
- Prescription Payment Plan: Auto-re-enrollment unless opted out
- Premium Stabilization: Subsidy drops to $10/month; cap on annual premium hikes rises to $50; risk corridors end
- Base Premium: $38.99 max (up from $36.78)
- Drug Price Negotiations: First year of capped prices for 10 high-cost drugs
- Risk Adjustment: Updated to reflect negotiated prices and other changes
If you are an agent who is ready to join the team at Crowe; click here for an online contract.
What’s at Stake
If PDP choices keep declining, traditional Medicare could become less practical; especially in rural areas. Rising deductibles and premiums may be offset by negotiated drug savings, but market stability will be crucial to ensuring affordable coverage.
Medicare PDPs: 2025 vs. 2026 at a Glance
| Category | 2025 | 2026 |
|---|---|---|
| Avg. PDP Options | 14 | Likely similar, low |
| Benchmark PDPs (LIS) | 2 | Risk of staying low |
| Avg. MA-PD Options | 34 | Stable or growing |
| Out-of-Pocket Max | $2,000 | $2,100 |
| Deductible | $590 | $615 |
| Insulin Cap | $35/mo | $35/mo |
| Vaccine Cost | $0 | $0 |
| Payment Plan | Opt-in yearly | Auto re-enroll |
| Premium Subsidy | $15 | $10 |
| Premium Increase Cap | $35 | $50 |
| Risk Corridors | Yes | No |
| Base Premium | $36.78 | $38.99 |
| Drug Price Negotiations | No | Yes – 10 drugs |
| Market Trend | PDPs shrinking | Stability uncertain |
Bottom Line
The 2026 Medicare PDP landscape is about more than just new costs and benefit structures. It’s about the balance between traditional Medicare and Medicare Advantage, and whether beneficiaries, especially in rural America, will have access to affordable and adequate drug coverage. Reviewing plans annually, staying informed about legislative changes, and understanding the shifting market dynamics is key for beneficiaries and agents alike.
Leave a Comment