Medicare open enrollment opens Oct. 15 and runs through Dec. 7, and every drug-plan shopper has the same question: what’s this going to cost me next year? The Journal’s editorial board took up the Part D numbers on Monday’s A16, wrapped in an argument about which party deserves the blame and the credit. That argument isn’t ours and we’ll leave it on the page. Strip it out and what’s left is a genuinely useful set of figures from the Centers for Medicare and Medicaid Services — the ones you’d want in hand before the mailers start arriving.
The headline is calm. The average premium for a stand-alone Part D plan rises by less than $1 a month, to $36, for 2027. Most low-income beneficiaries have premiums fully covered by subsidy, and of everyone else, 93% have access to at least one plan that costs under $6 a month. Inside Medicare Advantage — where about half of beneficiaries get their coverage — the drug portion of the premium is expected to fall 38%, to $7 a month; an insurer that runs the whole plan can offset drug costs with what it saves on the medical side, such as fewer hospital stays. Underneath all of it, the broad trend helps: prescription drug prices are down 2.9% over the past year in the consumer price index, as new generics and biosimilars land. And the $2,100 annual cap on what you pay out of pocket for drugs stays in place.
Fewer plans, and a date to circle
Here’s what the calm headline hides. The number of Part D plans has shrunk by 60% over the past five years. That’s a market that went through a shock — insurer bids for basic coverage jumped to $179.45 a month for the 2025 plan year from $34.71 in 2023 — and a federal subsidy program that cushioned premiums has now ended, with premiums coming in flatter than many expected. A separate set of plan subsidies written into the 2022 drug law runs out after 2029, and a former CMS official who helped design the program warned in Health Affairs that what follows could be unsustainable premium increases and more insurers leaving. The Congressional Budget Office has raised its Part D cost projection by some $700 billion through 2035. Whatever you think of the causes, a retiree reading that should hear one thing: the plan you have today may not exist, or may not be cheap, in three years.
Our read
This is Health Costs, and for anyone on Medicare it’s a Retirement (M10) line item that moves once a year, on a schedule. The mistake we see most is letting a drug plan auto-renew because the premium didn’t change much. A $36 average is an average: your number depends on your own drug list, which pharmacies the plan treats as preferred, and whether a drug you take moved to a pricier tier. With 60% fewer plans than five years ago, the odds that your current plan is still the best fit for your prescriptions have gone down, not up, even in a year when premiums held.
The planning move is a two-hour job between Oct. 15 and Dec. 7: list every prescription and its dose, run the list through Medicare’s plan finder, and compare total annual cost — premium plus what you’d actually pay at the counter — rather than premium alone. The $2,100 cap is your worst case for covered drugs; the plan you pick sets how close you get to it. And pencil in 2029 as a year to expect real change in the Part D market, whatever Washington decides between now and then. You don’t wait for the first drop to find the umbrella. Open enrollment is the forecast — if the drug list has grown since last year, it’s worth a look with us before Dec. 7.