Editor’s note: This op-ed was originally published in STAT on Oct. 15, 2025.
Nearly 69 million Americans who are disabled or 65 or older receive health insurance through Medicare. Most of them must select a private insurance plan to receive all of their medical benefits, prescription drug coverage, or supplemental coverage. They are about to receive a deluge of insurance company mail during the eight-week enrollment period that opens Wednesday, urging them to switch plans for 2026.
As a behavioral researcher and a former chief operating officer at Medicare, we know that switching could save beneficiaries hundreds — perhaps thousands — of dollars per year, depending on how their insurer has changed their plan and how their coverage needs have changed.
But most beneficiaries won’t switch, or even look at whether there is a better plan available for them. A KFF survey found that nearly 7 in 10 Medicare beneficiaries did not compare plans of any kind for their 2022 coverage. Among those with stand-alone prescription drug plans, half did not compare options for 2024 coverage, according to a USC Schaeffer Institute survey that one of us co-authored.
It’s understandable. Navigating Medicare’s alphabet-based features can be overwhelming. Original Medicare covers hospital visits (Medicare Part A) and doctors’ services (Medicare Part B), and permits beneficiaries to use any Medicare-enrolled provider. For most beneficiaries, only Part B has a premium, but Parts A and B have different deductibles. Prescription drug coverage (Medicare Part D) can additionally be bought from an often long list of private insurers who have Medicare contracts. Alternatively, many join a Medicare Advantage Plan (Part C) run by a contracted insurer, which combines drug coverage with Part A and B. But all of these plans differ in terms of premiums, deductibles, copays, and what they cover.
Add to this the plethora of plans on offer. Although older adults report wanting on average no more than four options for their health insurance, the average Medicare beneficiary had 48 plans to consider for their 2025 coverage. This included 14 Part D plans, and 34 Medicare Advantage plans. The Centers for Medicare and Medicaid Services recently announced that Medicare beneficiaries will again have a huge number of choices made available to them for 2026.
Theories of rational choice say that having more options should be better. It should allow everyone to select the plan they like the most given their health care needs and preferences. If all Medicare beneficiaries selected their preferred plan every year, then insurers would be incentivized to improve their plans to give beneficiaries what they want.
But in reality, most beneficiaries can rarely predict exactly what prescription drugs or health care they will need the following year. One beneficiary we interviewed for an ongoing USC Schaeffer Institute study said, “I have no basis, none whatsoever, on which to base a decision.”
So most beneficiaries end up automatically reenrolledin their current plan, to which their insurer can make changes every year. This past year was especially turbulent: many Part D plans significantly raised deductibles and beneficiary costs for common brand-name drugs, due to changes enacted by the Inflation Reduction Act. Beneficiaries who do not switch their Part D plan from year to year are less likely to be enrolled in their financially optimal plan, given the medications they take.
Beneficiaries who do compare Part D plans tend to be those savvy enough to work with the Medicare Part D plan finder website or to find an adviser who can help them. But the plan finder website can be confusing to use, especially for older adults who do not like going online. And beneficiaries who work with advisers do not always know whether their adviser is being paid by an insurer, meaning they may be getting biased advice. Few beneficiaries seem to know that they can get one-on-one counseling from an unbiased volunteer adviser through their local State Health Insurance Assistance Program.
Policymakers could do much more to simplify beneficiaries’ plan choices — after all, that’s what beneficiaries want.
Policymakers could do much more to simplify beneficiaries’ plan choices — after all, that’s what beneficiaries want. They could build on previous CMS actions that limited the number of plans offered by any one insurer and discourage duplicate plans with low enrollment. Or make plan features more standardized to help beneficiaries make comparisons. Or allow beneficiaries to stay with their selected plan for longer than a year without any coverage changes, so they won’t have to make choices as often. Or provide increased funding for unbiased SHIP advisers to proactively reach out to beneficiaries whose plans are being changed.
There have also been calls to stop automatically reenrolling beneficiaries into their previous plan, especially if their insurer has significantly raised costs, though this requires figuring out who would qualify and how to assign them to a plan better aligned with their preferences.
Most people don’t want to spend their time maximizing difficult choices. Facing health issues already produces enough anxiety. Making annual Medicare choices shouldn’t add to it.
If you need help with your Medicare choices, please contact your local State Health Insurance Assistance Program to get help from an unbiased adviser.
Wändi Bruine de Bruin is director of the Behavioral Sciences and Policy Initiative at the USC Schaeffer Institute for Public Policy and Government Service. Jonathan Blum is a nonresident senior scholar at the USC Schaeffer Institute and the former principal deputy administrator and chief operating officer at the Centers for Medicare and Medicaid Services.
