Medicare open enrollment begins Oct. 15. Here's what to know about changes in Pa., N.J. and Del.

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More than 5 million people in the tri-state area get health insurance through Medicare, a federal program for people 65 and older. One of the few times they can make changes to their coverage or switch plans is during annual open enrollment, which begins this week.

Local Medicare counselors, insurance companies and organizations that support older adults say people need to be on the lookout for changes in telehealth options, prescription drug costs and some Medicare Advantage plans that will be eliminated.

Medicare's annual open enrollment runs from Oct. 15 through Dec. 7.

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"I think the worst thing you can do is just say, 'I'm going to stick with what I have,' or 'I don't want to spend the time to try to find a different plan,'" said Chris Widelo, state director of AARP New Jersey.

"It really is important to do your homework," he said. People should evaluate their medical needs, the prescription drugs they take and their budgets.

Medicare 101: Plan options, changes in costs and covered health services

Traditional or original Medicare includes Part A, which covers inpatient hospital stays, hospice and care in skilled nursing facilities. This coverage is free for most people because they or a spouse has paid Medicare taxes for at least 10 years, but enrollees still have to pay deductibles or copays on services they use.

It also includes Part B, which covers outpatient visits to primary care doctors and specialists, lab work and testing, medical equipment like wheelchairs and walkers and preventative services, including cancer screenings and vaccines.

Most people pay a set standard premium for Part B. It was $185 a month for coverage this year, but it is expected to rise to $206 a month in 2026, according to a June Medicare trustees report.

People with traditional Medicare can also buy Part D prescription drug plans to get coverage for medications.

In Delaware, 10 different Part D plans will be offered with some of them free, costing as low as $0 per month in premiums. Pennsylvania and New Jersey will each have 12 plans available, with the lowest monthly premiums set at $6.60 and $4.40, respectively.

The other bucket of Medicare coverage options fall under Medicare Advantage, which are health insurance plans sold and managed by private insurance companies like UnitedHealthcare and Humana.

These plans, also known as Part C, include the benefits of original Medicare Parts A and B, but also often bundle in Part D prescription plans and other health care services like dental, vision and hearing.

Medicare Advantage plans may require people to use specific health care systems, doctors or pharmacies in a certain region to get in-network coverage.

The average monthly premium cost for a Medicare Advantage plan will drop in Delaware and Pennsylvania for 2026 coverage, according to federal reports. But New Jersey residents will see a slight increase, with the average premium going from $22.50 per month in 2025 to $25.23 in 2026.

Independence Blue Cross is one of the largest insurance companies with Medicare Advantage plans in southeastern Pennsylvania, offering nine different options during open enrollment this year.

Higher use of pharmaceutical drugs and health care services overall among older adults is affecting how insurance companies are pricing their plans and determining the kinds of plans it will offer this year, said Kortney Cruz, senior vice president of government markets at Independence Blue Cross.

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For example, Independence is eliminating three Medicare Advantage preferred provider organization, or PPO, plans for 2026. These plans can come with higher monthly premiums, but they offer people more flexibility to see doctors and specialists in other health systems, regions or states.

Instead, Cruz said the company is highlighting its health maintenance organization plans, commonly known as HMOs. They can be cheaper, but usually require patients to have a primary care provider and sometimes have smaller networks of doctors, hospitals and specialists.

As people get older, Cruz said having a regular primary care provider can become more important. Medicare enrollees with Independence HMO plans on average saw their health care providers more regularly than those with PPO plans, she said.

"The dynamics that happen as you age, particularly post 75, really that relationship with the primary care provider is paramount," Cruz said. "So, we think it's critically important that people really think about, 'Do I really need a PPO? Am I really traveling half the year? What is my relationship with my primary care physician look like?' And we really believe HMO products really kind of help to enhance that."

Medicare open enrollment counseling

Every state is required to provide people with free Medicare counseling under the national State Health Insurance Assistance Program, also called SHIP.

Trained counselors based with regional or county departments offer independent, unbiased one-on-one assistance for people who are newly enrolling in Medicare once they reach age 65, or as people shop for plans during annual open enrollment.

They can also help people figure out if they're eligible for Medicare financial assistance programs that may pay for parts of their premiums, deductibles and other out-of-pocket costs.

SHIP is available in New Jersey counties through the Department of Human Services, and in Delaware through the state's Medicare Assistance Bureau.

In Pennsylvania, the SHIP program is called PA MEDI and includes counselors that provide assistance in person, virtually over Zoom and by phone.

In Chester County, PA MEDI local coordinator Sarah Milam encourages older residents to seek out counseling appointments and bring with them all their current insurance information, a list of their prescription drugs and the names of doctors, nurses and health care systems they go to.

"Then, we can get a good idea of what plans are good for them, the cost of the drugs, your primary care physician, what that cost is going to be, if they go to the hospital, if they're getting an MRI or something like that, just kind of to get a general idea of what it's going to cost them for the next year," she said.

Just because a doctor or a prescription drug is covered by their Medicare insurance this year, that doesn't mean that same plan will cover the same health care providers and medications next year, Milam said.

"Providers can go in and out of the network anytime during the year, which is not great, but you definitely want to look at that for sure," she said.

Milam is also warning people this year of changes to telehealth options. During the COVID-19 pandemic, Medicare plans and providers were allowed to provide certain health care services virtually or over the phone for the first time.

But those telehealth flexibilities were tied to a pandemic-era federal policy that expired on Sept. 30 after Congress did not extend them. Milam said a lack of telehealth options going forward could affect the kind of Medicare plan someone chooses, depending on how far they must travel for primary or specialty care in their region.

When people get Medicare counseling on these nuanced circumstances and situations, Milam said it can be helpful for people to bring someone with them.

"Some of the people are really older and it is nice that they bring a family member who's going to help them, family members who are helping their parents," she said.

Budgeting for Medicare health insurance

People 65 and older may be retired and living on limited fixed incomes, which can make paying for health insurance challenging no matter what plan they choose, said Widelo.

AARP provides a Medicare assistance program, but it also has long-term financial planning services that can help people figure out how to budget for health care, housing and property taxes, utilities and energy costs and other lifestyle needs.

"They're so intertwined," Widelo said. "When we think about retirement, we think about things like Social Security and your personal savings and retirement savings, and health care is really that fourth leg. If you're healthy, hopefully your costs are going down. And we know that health care is expensive, so the healthier that we can make sure people are, hopefully that helps contribute to financial stability."

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