Medicare Open Enrollment Starts Oct. 15. What to Check If You Have Cancer

Medicare open enrollment runs from Oct. 15 to Dec. 7. For people with cancer, the plan you pick can mean thousands of dollars of difference, and access to the treatments your oncologist recommends.

The Good News: A Cap on Drug Costs

Thanks to the Inflation Reduction Act, Medicare Part D now caps what you pay out of pocket for covered prescription drugs each year. In 2026, that cap is $2,100. The old "donut hole" coverage gap is gone.

People on expensive oral cancer drugs may reach the cap within the first two months of the year. You can also sign up for the Medicare Prescription Payment Plan, which spreads those costs into monthly payments instead of a large bill at the pharmacy.

The cap matters especially because people in Medicare generally can't use drug manufacturers' copay assistance programs.

What to Check Before You Choose

1. Is every drug you take on the plan's formulary for next year? Formularies change annually.
2. What is next year's out-of-pocket cap? It is adjusted each year, so check the figure listed in plan materials.
3. What are the premiums? Health policy experts warn that standalone Part D premiums may rise sharply.
4. Are your oncologist and cancer center in network? This matters most for Medicare Advantage plans.
5. What are the prior authorization and step therapy rules? They are common in Medicare Advantage and can delay treatment.
6. Does the plan use a specialty pharmacy, and how quickly can it deliver?

Where to Get Help

Several resources are available to help people with cancer navigate Medicare open enrollment. Medicare's online Plan Finder at Medicare.gov allows beneficiaries to enter their prescription medications, compare available plans and estimate their annual drug costs. This can help patients identify plans that provide coverage for their medications while keeping expenses manageable.

Patients can also contact their State Health Insurance Assistance Program (SHIP), which provides free, unbiased Medicare counseling. SHIP counselors can help individuals understand their coverage options, compare prescription drug benefits and review potential out-of-pocket expenses. Those who need additional guidance can find their local program through SHIP's website.

Another valuable resource is a cancer center's financial counselor or patient navigator. These professionals can help patients understand how different insurance plans may affect their treatment costs, identify potential coverage restrictions and connect them with financial assistance programs. Speaking with a financial counselor before changing plans may also help patients avoid unexpected expenses or disruptions in their cancer care.

Ultimately, people with cancer should evaluate more than just the monthly cost of a Medicare plan. Confirming medication coverage, provider networks and treatment requirements before the Dec. 7 deadline can help ensure they have access to the care they need in the coming year.

References

1. AJMC. "Medicare Cap Eases Patient Costs as Negotiation Squeezes Practices." Sept. 28, 2026.
2. Doshi, Jalpa A., et al. "Inflation Reduction Act Provisions and Medicare Part D Out-of-Pocket Costs for Specialty Drugs." JAMA Health Forum, 2025.

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