Helping Medicare Beneficiaries Plan for & Navigate Coverage in 2026
Chris Herman, MSW, LICSW, Senior Practice Associate–Aging
December 2025
Four NASW Publications Available
Many social workers have been wondering how the recent shutdown of the federal government affected Medicare annual enrollment for calendar year 2026. Similarly, questions have arisen regarding the impact of recent changes within the U.S. Department of Health and Human Services (HHS) and the enactment of the July 2025 budget reconciliation law (P.L. 119-21, also known as H.R. 1) on Medicare coverage for the upcoming calendar year. This four-part series of Tips & Tools for Social Workers addresses those questions and provides additional updates.
The first publication in this series provides an overview of the Medicare annual enrollment period (AEP) and resources that can inform beneficiary decision making regarding original Medicare or Medicare Advantage (MA). It addresses the impact of Medicare enrollment decisions and the social work role in helping beneficiaries navigate the AEP and anticipate coverage for 2026. The publication concludes with a brief resource list.
The second publication provides tools and resources for Medicare annual enrollment: 1-800-MEDICARE, live chat, and Medicare Plan Finder, all offered by the federal Centers for Medicare & Medicaid Services; Benefits Enrollment Centers and BenefitsCheckUp®, both offered by the National Council on Aging; and the Medicare Rights Center’s National Helpline. The publication addresses two changes to the online Medicare Plan Finder tool: expanded information about MA supplemental benefits and the integration of Medicare Advantage provider Directories within Plan Finder. Special enrollment periods (SEPs) for Medicare outside of annual enrollment, including a temporary SEP throughout 2026 for errors related to inaccurate Medicare Advantage provider directories in Medicare Plan Finder, are described. The publication concludes with a brief resource list.
The third publication in this series lists beneficiary cost sharing amounts for Part A, Part B, Medigap, Part D, and Medicare Advantage coverage in 2026. It also addresses Medicare coverage of medications (including the Monthly Prescription Payment Plan and price-negotiated drugs), vaccines, and certain health screenings and tests. The publication describes several programs that assist Medicare beneficiaries with out-of-pocket health costs: Medicare Savings Programs (MSPs), Part D Extra Help (Low-Income Subsidy, or LIS), the Limited Income Newly Eligible Transition (LI NET) program, State Pharmaceutical Assistance Programs (SPAPs), and the AIDS Drug Assistance Program (ADAP). The publication mentions nongovernmental financial resources briefly and concludes with a short resource list.
The final publication in this series addresses the introduction of artificial intelligence (AI)–powered prior authorization to original Medicare (the “WISeR” pilot program). It describes limitations on supplemental benefits available under Medicare Advantage plans and the impact of decreased commissions for Medicare Advantage and Part D agents and brokers on beneficiary enrollment. The publication reviews the impact of the July 2025 budget reconciliation law (P.L. 119-121) on Medicare in 2026 and beyond: the current and impending exclusion of many immigrants with “lawfully present” status from coverage; decreased nursing home staffing and quality; and potential funding reductions to the Medicare program. It concludes with information regarding Medicare coverage of telemental health services and a brief resource list.
Relevant Content Excluded from This Series
Please visit NASW’s Practice Alert for the fall 2022 Medicare annual enrollment period (https://bit.ly/NASW-MedicareOEP22) for an overview of the following Medicare coverage options:
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Medicare Part A and Part B (original Medicare)
- Medicare Part D
- Medigap, also known as Medicare supplemental insurance
- Medicare Advantage—privatized plans, such as such as Health Maintenance Organization (HMO) plans and Preferred Provider Organization (PPO) plans; also known as Part C
- Program of All-Inclusive Care for the Elderly (PACE)
Terminology Used in This Series
The autumn Medicare annual election (enrollment) period (AEP, also known as the annual coordinated election period) is often referred to as the Medicare Open Enrollment Period (OEP) or Medicare open enrollment. In previous years, NASW used the “open” terminology for consistency with public-facing messaging from CMS. However, some beneficiary advocates have used the terms “annual enrollment” and “AEP” to distinguish the autumn enrollment period for all Medicare beneficiaries with the Medicare Advantage OEP (January 1 through March 31); likewise, some CMS materials have incorporated this change. For this reason, NASW uses “annual enrollment” or AEP throughout this series, other when quoting other materials, and we will continue to use this terminology going forward.