Fewer choices may be on the menu again as Medicare patients shop for prescription coverage this fall.

The number of available, standalone drug plans has fallen for a few years, and that trend will continue for 2026. Most markets will still have several choices, but some options are becoming particularly sparse for shoppers with low-income subsidies. And help may be harder to find because some insurers no longer pay brokers commissions for new business.

Shoppers have to Dec. 7 to find new coverage that starts in January.

Some things to consider:

Here’s who needs a Medicare Part D plan

Regular Medicare, which most people qualify for after turning 65, does not come with prescription coverage, known as Part D. People must choose that separately.

About 23 million people with regular Medicare have this standalone coverage, according to the nonprofit KFF, which studies health care.

Another roughly 34 million people have Medicare Advantage plans, which are privately run versions of Medicare that often come with prescription coverage.

How Medicare Part D plans are changing

A typical shopper will be able to choose a standalone drug plan from among eight to 12 options for 2026, according to KFF Medicare expert Juliette Cubanski. That’s down from 12 to 16 options in 2025.

Shoppers had nearly 30 choices as recently as 2021, according to the Commonwealth Fund’s Gretchen Jacobson.

Some insurers are reducing their presence in standalone Part D plans, while the Blue Cross-Blue Shield carrier Elevance is leaving the market entirely. Insurers and analysts who follow the industry note that the Inflation Reduction Act, which will cap annual out-of-pocket drug costs at $2,100 in 2026, puts more financial pressure on insurers. The same law now allows patients to spread the cost of prescriptions over the year.

There are still many Medicare Part D options

Most markets will have several choices. But experts say Medicare Part D customers don’t like to shop, especially if they already have a plan that covers their medications. Finding affordable coverage for multiple prescriptions can be tricky.

“I think there’s a lot of inertia and, frankly, people may be concerned that if they switch, they’re going to end up worse off,” Cubanski said.

More people are being pushed to shop. Nearly 11% of those with standalone prescription drug coverage lost their plan in 2024. Before 2023, that figure was often under 1%.

how Medicare Part D prices are changing

Monthly premiums, or coverage prices, will fall nearly 10% on average to $34.50, the Centers for Medicare and Medicaid Services announced last month.

At least one option with a premium of under $20 exists in almost every region of the country. Individual prices will range widely, with premiums for the same plan varying by state, Cubanski noted.

But while plans may provide lower coverage prices, they could also raise deductibles or offer more limited lists of covered drugs, which are called formularies. Shoppers should check these details.