Top current and former officials from the Centers for Medicare and Medicaid Services (CMS) are urging Medicare beneficiaries to carefully reassess their coverage during this year's open enrollment, warning that recent policy overhauls have made the program more intricate and that sticking with the same plan could come with unexpected costs.
Speaking at The Hill's "Bang for Your Buck" event, held in partnership with the Alliance for Aging Research, CMS Deputy Administrator John Brooks and former CMS Chief Operating Officer Jonathan Blum highlighted how the Inflation Reduction Act (IRA) — including the Medicare Drug Price Negotiation Program — has fundamentally altered the way benefits are structured and delivered.
Why shopping around matters more now
Brooks emphasized that even beneficiaries satisfied with their current plans should not assume continuity. "On average, beneficiaries will be able to choose among 28 or so plans in Medicare Advantage, and 97 percent of beneficiaries will have access to 10 or more plans," he said. However, he cautioned that "averages can conceal the fact that healthcare is local," and that "in different healthcare markets and with specific plans, there can be a lot of changes from year to year."
The enrollment landscape has grown more volatile as the IRA's provisions take effect. For 2026, the first year of negotiated drug prices under the program, some beneficiaries have reported higher copays for certain medications. Brooks explained that while plans negotiate lower prices with manufacturers, the savings do not always translate directly to lower patient costs. "The drug plan itself negotiates with the drug manufacturer to get the price that it's paying, but the beneficiary is usually paying a much lower price than that," he said. "And so you can have these changes in how the difference between what the plan is paying and what the beneficiary is paying shift over a year over year, and so some of those changes could be just as significant in terms of patient out of pocket, even if the drug plan itself is paying a lower amount."
Adjusting to a new Part D reality
Blum, who served in both the Obama and Biden administrations, said both insurers and patients are still adapting to the IRA's sweeping changes. The law restructured Medicare Part D, introduced a $2,100 cap on out-of-pocket spending for 2026, and created the Medicare Prescription Payment Plan, which lets beneficiaries spread prescription costs across the year rather than facing a large upfront bill.
"The IRA — whether you support the IRA, don't support the IRA — we all have to agree that it made fundamental changes to the Part D program," Blum said. "It changed the benefit structure, gave catastrophic coverage for the first time for drug benefits. Those changes were put in place very, very quickly … meaning that plans have to adjust their premiums; they have to get used to these new benefits."
He added that the program is still in a transition period, and Congress will need to address how to finance it sustainably. "We have to think about the program really adjusting to the new world that we're in," he said. "And so that I think is going to be one of the key questions that Congress has to consider going forward is, how do we finance the program?"
As Medicare enrollment for 2027 begins, beneficiaries are advised to compare plans not just on premiums but on drug formularies and out-of-pocket limits, especially as personal finances remain strained for many households. The evolving landscape also comes amid broader political debates over healthcare costs, with leadership uncertainties in Congress potentially shaping future Medicare policy.
