Original Medicare Enrollees Face Fewer Part D Choices

The number of stand-alone prescription plans drops, while the popularity of Medicare Advantage plans rises

Tony Pugh,

AARP

Comments

Published December 05, 2025

illustration of various pill and capsules on a red background with a downward arrow cutout

Rob Dobi

Key takeaways

Fewer stand-alone Part D plans than previous years.
Prescription drug coverage secure in original Medicare.
Medicare Advantage prescription coverage is stable.
Consumer-friendly legislation revamped Part D coverage.
Use Medicare open enrollment to compare drug plans.

Medicare’s market for Part D plans has shifted in response to growing enrollment in private Medicare Advantage plans, and the number of stand-alone prescription drug plans available to original Medicare beneficiaries continues to decline in 2026.

In 2020, 53 percent of Part D enrollees were enrolled in stand-alone Part D drug plans used by beneficiaries in original Medicare. By 2025, only 42 percent of Part D enrollees were in stand-alone drug plans, while 58 percent received Part D coverage through their Medicare Advantage plans.

The number of plans is decreasing amid rising drug prices, a law that shifted more Part D costs to plan sponsors and drug companies, and the emergence of Medicare Advantage as the program’s dominant — and better financed — coverage vehicle.

This year, the average original Medicare beneficiary can choose from 14 stand-alone drug plans, the fewest since the Part D program began in 2006. Next year, the overall number of plans available nationwide will drop by almost a quarter to 360, down from 464 in 2025 and 709 in 2024, according to KFF.

By contrast, the average Medicare Advantage enrollee can select from 32 plans that include drug coverage. This, too, is a slight decline from 2025.

Part D coverage choices remain strong

Despite the changes, beneficiaries will still have plenty of Part D plan options. Depending on where you live, beneficiaries in each state still can choose among eight to 12 stand-alone drug plans for 2026 coverage during Medicare open enrollment, which runs through Dec. 7, says Juliette Cubanski, deputy director of the Program on Medicare Policy at KFF. The nonprofit health care research organization has offices in Washington.

“Enrollees still have plenty of choice,” she says. “By almost any measure, in any other marketplace, having eight or 10 or 12 [plans] to choose from is still a relatively robust set of offerings.”

More than 35.3 million people, 51.2 percent of eligible Medicare beneficiaries, receive coverage through private Medicare Advantage plans from commercial insurers and other health plans. Along with medical coverage, nearly all Medicare Advantage plans also cover prescription drugs.

‘Enrollees still have plenty of choice. By almost any measure, in any other marketplace, having eight or 10 or 12 [plans] to choose from is still a relatively robust set of offerings.’

—Juliette Cubanski, KFF

Roughly 33.7 million people — 48.8 percent of beneficiaries — are in original Medicare. Of those, about 23 million get their Part D coverage through stand-alone drug plans. Many of the same insurers that sell Medicare Advantage coverage also sell the separate plans.

“They just make more money when they’ve got somebody enrolled in their Medicare Advantage plan than when they’ve got somebody enrolled in their stand-alone drug plans” because of the way the federal government pays for Medicare Advantage plans, Cubanski says.

AARP has long called for greater efficiency and value in payments to Medicare Advantage plans. “We have also championed ensuring consumers have a robust choice of both traditional Medicare and MA [Medicare Advantage] coverage, striving to keep both options strong and on a level playing field,” said a March 2024 letter to the Centers for Medicare & Medicaid Services.

Premium-free drug plans harder to find

Also declining is the number of stand-alone plans that are premium-free for people who receive financial assistance with their Part D costs through a federal program known as Extra Help. Only 88 such plans are available in 2026, also the fewest in Part D program history, according to KFF. There were 90 in 2025, down from 126 in 2024.

For people who don’t qualify for Extra Help and can’t enroll in these special plans, there are 68 stand-alone drug plans with no monthly premium available in 2026, Cubanski says. Of the 68, which vary in availability across 33 states, 20 offer better benefits, like low or no deductibles and lower cost-sharing.

But insurers that offer low- and no-premium plans often cut their costs in other ways, such as having:

Fewer drugs in their formularies.
More medications shifted to higher-priced tiers.
Higher use of prior authorization and step therapy.

Medicare Advantage plans also use these methods to reduce their cost.

Medicare Advantage drug plans are more accessible

The Medicare Advantage market enjoys a competitive advantage over Part D plans that pair with original Medicare. Medicare Advantage insurers can use rebates from the federal government to reduce or eliminate premiums for Part D prescription drug coverage, a big draw for consumers, says Kylie Stengel, a principal at Avalere Health, a Washington-based health care consulting firm.

Roughly 3 out of 4 Medicare Advantage enrollees with drug coverage who don’t receive Extra Help with their prescription costs are in a plan with no premium that will remain at zero dollars in 2026, Avalere says. In 2025, less than one-third of stand-alone plans have reduced or eliminated their deductibles, according to AARP, compared with 75 percent of Medicare Advantage plans with drug coverage.

Most Part D enrollees, however, are in plans that charge a deductible for drug coverage in 2025, including 60 percent of Medicare Advantage enrollees and 85 percent of those in stand-alone plans, says Leigh Purvis, prescription drug policy principal with the AARP Public Policy Institute.CMS expects the average monthly Part D premium for Medicare Advantage plans with drug coverage to decrease to $11.50 in 2026 after the rebates are applied.

The average stand-alone Part D monthly premium is expected to be $34.50 next year, down nearly 10 percent from 2025. Actual Part D premiums could differ since the average encompasses wide price variations.

Part D law provides more generous coverage

A law passed in 2022 redesigned the Part D benefit to provide more generous drug coverage, capping out-of-pocket spending for covered drugs at $2,100 next year and limiting future premium increases. The legislation also shifted more responsibility for Part D costs away from the government and on to insurers and brand-name drug companies.

To help ease the transition for insurers and keep premiums stable in 2025, CMS gave stand-alone plans an option to enroll in a program that provided them with a monetary incentive to keep rates stable. The program has been scaled back for 2026, which was expected to increase Part D premiums for stand-alone plans. But that didn’t happen.

“The number of plans that will have a substantial premium increase, that’s kind of weighting the average” cost of all plans toward an overall premium increase, Stengel says. But “there’s also plans that will have a premium decrease.”

Beneficiaries should compare coverage options

Part D and Medicare Advantage plans can make other coverage changes that affect your drug costs, so comparing plans during open enrollment remains important.

“It’s really important to be looking at how [your] plan is changing,” Stengel says. “Every plan will look different.”

The stand-alone Part D plans offered can vary by geographic region, and the United States has been divided into 34 regions. Medicare Plan Finder allows you to identify all the options in your area, experts say.

Counselors with your local State Health Insurance Assistance Program (SHIP) also can provide a list of Part D plans available to you.

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If you plan to use a Medicare agent or broker to help select coverage, understand that they aren’t required to inform you of all your coverage options, and they receive enrollment-based commissions and bonuses from insurers they represent. This could affect their advice and coverage recommendations.

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Tony Pugh is an award-winning writer and editor covering Medicare for AARP. He has also covered Medicare for Bloomberg Law and as a national correspondent for Knight Ridder/McClatchy Newspapers.