By Steven Rubalcaba
October 2025 | 2025 Fall Newsletter
The Medicare Annual Enrollment Period (AEP) runs October 15–December 7, 2025, for coverage starting January 1, 2026. This is when Medicare beneficiaries can review their health and drug plans and make changes to better fit their needs.
Sourcewise Health Insurance Counseling & Advocacy Program (HICAP) provides free, unbiased counseling via phone, video, or in-person sessions at community locations. Counselors can help you compare plans, review your medication list, and choose the best option for your health and budget.
Each fall, Medicare Advantage and Part D plans may change premiums, benefits, or costs. You will get an Annual Notice of Change in September. During AEP, you can:
- Enroll in, switch, or drop a Medicare Part D prescription drug plan
- Join or change a Medicare Advantage (Part C) HMO or PPO plan
- Return to Original Medicare and add a Part D plan or Medigap for greater provider choice.
What’s new in 2026:
- Lower Drug Prices: Medicare negotiated prices for 10 high-cost drugs. Reduced prices take effect January 1, 2026
- Part D Cap: The annual Part D out-of-pocket limit rises to $2,100 in 2026 (from $2,000 in 2025). After you reach this cap, you pay nothing more for covered Part D drugs that year
- Medi-Cal Enrollment Freeze: In 2026, Medi-Cal will freeze new enrollment for undocumented, Medicare-eligible older adults and people with disabilities without satisfactory immigration status. Current enrollees keep coverage
- Medi-Cal Asset Test Returns: Medi-Cal will reinstate an asset test. Eligibility limits are $130,000 for a single person and $195,000 for a couple, excluding a home, vehicle, and certain items
- Annual Recertification: Medi-Cal recipients must recertify each year; coverage could end at recertification if you no longer meet requirements
How to prepare:
Create a Medicare.gov account to review prescriptions and coverage. Ask about Extra Help (Low-Income Subsidy) to lower Part D costs. Many Medi-Cal beneficiaries may qualify automatically. Bring a list of current medications to appointments.
Get support:
HICAP offers AEP presentations titled “Medicare’s 2025 Annual Enrollment Period and Updates for 2026” via Zoom and at community sites across Santa Clara County. To attend an in-person or virtual presentation, visit mysourcewise.com/calendar. To schedule a one-on-one counseling session, visit mysourcewise.com/programs-services/medicare-options/appointments or call (408) 350-3288.
The Medicare Annual Enrollment Period (AEP) runs October 15–December 7, 2025, for coverage starting January 1, 2026. This is when Medicare beneficiaries can review their health and drug plans and make changes to better fit their needs.
Sourcewise Health Insurance Counseling & Advocacy Program (HICAP) provides free, unbiased counseling via phone, video, or in-person sessions at community locations. Counselors can help you compare plans, review your medication list, and choose the best option for your health and budget.
Each fall, Medicare Advantage and Part D plans may change premiums, benefits, or costs. You will get an Annual Notice of Change in September. During AEP, you can:
- Enroll in, switch, or drop a Medicare Part D prescription drug plan
- Join or change a Medicare Advantage (Part C) HMO or PPO plan
- Return to Original Medicare and add a Part D plan or Medigap for greater provider choice.
What’s new in 2026:
- Lower Drug Prices: Medicare negotiated prices for 10 high-cost drugs. Reduced prices take effect January 1, 2026
- Part D Cap: The annual Part D out-of-pocket limit rises to $2,100 in 2026 (from $2,000 in 2025). After you reach this cap, you pay nothing more for covered Part D drugs that year
- Medi-Cal Enrollment Freeze: In 2026, Medi-Cal will freeze new enrollment for undocumented, Medicare-eligible older adults and people with disabilities without satisfactory immigration status. Current enrollees keep coverage
- Medi-Cal Asset Test Returns: Medi-Cal will reinstate an asset test. Eligibility limits are $130,000 for a single person and $195,000 for a couple, excluding a home, vehicle, and certain items
- Annual Recertification: Medi-Cal recipients must recertify each year; coverage could end at recertification if you no longer meet requirements
How to prepare:
Create a Medicare.gov account to review prescriptions and coverage. Ask about Extra Help (Low-Income Subsidy) to lower Part D costs. Many Medi-Cal beneficiaries may qualify automatically. Bring a list of current medications to appointments.
Get support:
HICAP offers AEP presentations titled “Medicare’s 2025 Annual Enrollment Period and Updates for 2026” via Zoom and at community sites across Santa Clara County. To attend an in-person or virtual presentation, visit mysourcewise.com/calendar. To schedule a one-on-one counseling session, visit mysourcewise.com/programs-services/medicare-options/appointments or call (408) 350-3288.