Medicare Open Enrollment 2026: What New Jersey Residents Should Know

Hey New Jersey! It’s that time of year again. Medicare Open Enrollment is officially underway, running from October 15 to December 7, 2025. Whether you’re new to Medicare or have been enrolled for years, this is your annual chance to make sure your coverage still fits your needs.

Even if you’re happy with your current plan, it’s worth taking a few minutes to double-check. Plans can change and so can your health needs.

What’s Changing in Medicare for 2026?
Here are some of the biggest updates coming to Medicare next year:

Lower Prices on 10 High-Cost Drugs
Starting January 1, 2026, Medicare will offer negotiated prices on these 10 expensive medications, Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, and NovoLog/Fiasp., providing treatment for arthritis, cancer, diabetes, and blood clots. These price cuts are expected to save beneficiaries $1.5 billion in out-of-pocket costs next year alone. For example:

• Januvia: $113 (down from $527) — a 79% discount
• Enbrel: $2,355 (down from $7,106) — a 67% discount
• Imbruvica: $9,319 (down from $14,934) — a 38% discount

These savings apply to Medicare Advantage prescription drug plans and stand-alone Part D plans.

Part D Drug Deductible and Spending Cap Increase
In 2026, your annual out-of-pocket costs for covered Part D drugs will be capped at $2,100 a $100 increase. Once you hit that amount, you won’t pay any more copays or coinsurance for the rest of the year. Also increasing is the maximum Part D deductible. It will be $615, up from $590 in 2025. Some Part D plans will have lower deductibles or none at all.

Prior Authorization Pilot Program in New Jersey
Here’s something new that Original Medicare beneficiaries in New Jersey should know: Starting in 2026, Medicare is launching a six-year prior authorization pilot program in six states and New Jersey is one of them.

This pilot, part of the WISeR (Wasteful and Inappropriate Services Reduction) model, will require prior approval for certain medical services. This pilot program aims to speed up coverage decisions and reduce wasteful spending on at least 16 devices, procedures and services that are considered vulnerable to fraud or inappropriate use, especially those related to pain management. The goal is to reduce unnecessary services and ensure treatments are medically necessary.

If you’re on Original Medicare in New Jersey, this could affect how quickly you get certain services. It’s a good idea to talk to your doctor and make sure they’re aware of the new requirements.

Why You Should Review Your Plan
Even if you’re satisfied with your current coverage, it’s smart to compare plans. Costs, coverage, and provider networks can change every year.

How to Get Started
Here’s how to make the most of Open Enrollment:

1. Review your Annual Notice of Change from your current plan.
2. Use the Medicare Plan Finder to compare options.
3. Call 1-800-MEDICARE for help or visit Medicare.gov.

Watch Out for Medicare Scams During Open Enrollment
Open Enrollment is also prime time for fraud. Scammers may pose as Medicare representatives or offer “free” medical equipment in exchange for your Medicare number. It’s sneaky and it’s happening more often.

Here’s the golden rule: Medicare will never call, email, or text you out of the blue to ask for personal information or payment. If you get a suspicious message or call, hang up and call 1-800-MEDICARE to verify. It’s always better to be safe than sorry.

AARP New Jersey Is Here for You
Whether you live in Newark, Trenton, or down the shore, AARP is ready to help you navigate Medicare with confidence. Visit our aarp.org/medicare page for timely information, resources and the Ask AARP tool where you can get your Medicare questions answered.

Need more help?

• Call Medicare Helpline 1-800-MEDICARE
• Download the Medicare & You 2026 Handbook
• Explore AARP’s Medicare resources
• NJ State Health Insurance Assistance Program (SHIP) Website

Source:

• 7 changes coming to Medicare in 2026
• Medicare and You 2026 handbook
• AARP Urges Seniors to Review Medicare Plans During Open Enrollment