We will be probably be “Riding the Storm Out” for another two years as insurance companies try to keep their Medicare Drug Plans and Medicare Advantage Plans afloat.

This year marks the 20th anniversary of Medicare Part D–our nation’s prescription drug benefit for seniors and people with disabilities. As someone who has helped Medicare beneficiaries navigate drug coverage since the fall of 2005, I’ve seen the program evolve. Nothing compares to the changes we’re seeing in 2025 and 2026.

These are real changes, and they stem from the Inflation Reduction Act (IRA)–a law passed in 2022 to lower prescription drug costs. While the law includes important reforms, it has also triggered a wave of cost-shifting that’s hitting Medicare beneficiaries hard.

Here’s what’s happening:

• Drug copays are disappearing. Most plans are replacing fixed copays with coinsurance–meaning you now pay a percentage of the drug’s cost. If you were paying $47 per month for a brand-name drug with no deductible last year, you might now pay up to $615 deductible and up to 25% coinsurance until you hit the $2100 maximum out of pocket for 2026.

• Deductibles are rising. The maximum deductible for Part D plans is increasing to $615 in 2026.

• Supplemental benefits are shrinking. Medicare Advantage plans are cutting back on dental, vision, hearing, and wellness perks to offset financial pressures caused by cost shifting under the Inflation Reduction Act.

• Plan designs are shifting. Over 80% of standalone drug plans now use coinsurance for multiple tiers. Medicare Advantage plans are following suit.

Here is a real life example: A tier 3 drug that has a retail price of $643 is still a $47 copay with no deductible this year with one of the most popular plans in Iowa. We save money doing mail order and our cost ends up at $470 for nthe year. The insurance company is losing money and hoping to stop the bleeding in 2026 so they can continue to offer a plan in the future. The same plan in 2026 will have a $300 deductible and 20% coinsurance and our cost for the year goes to $1555 if we do not change plans. So much for lower drug costs.

Why is this happening? Because while the Inflation Reduction Act of 2022 capped your out-of-pocket drug costs at $2,000 for 2025 and $2100 for 2026. It also forced insurers to absorb more of the cost burden. Insurers are already limited to a maximum of 15% of revenue for administrative costs and profit, but there’s no limit on how much they can lose. And in 2025, many are losing money. To stay afloat, they’re redesigning plans in ways that shift costs back to us Medicare beneficiaries.

Only 16% of Medicare beneficiaries are expected to see savings of $1 up to a maximum of $1800 under the new law. Meanwhile, approximately 29% will pay more. And, benefits are deteriorating for approximately 54% of all Medicare beneficiaries that have Medicare Advantage plans. I’m in that boat.

To many, this feels like a bait-and-switch. We were promised affordability, predictability, and relief. Instead, we’re facing higher deductibles, unpredictable coinsurance, and fewer benefits. The bait was lower drug costs. The switch is cost-shifting–passed down from insurers to members as plans scramble to survive under new financial pressures.

During this annual enrollment period form October 15th – December 7th. It might be a good idea to talk to your insurance agent or SHIIP volunteer to review you coverage especially if you have one or more brand-name drugs.

If the current administration and Congress truly want to protect seniors, it must recognize that cost doesn’t disappear–it just moves. And right now, it’s moving in the wrong direction.

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Mark Rohde is a Medicare insurance agent with

Assured Partners in Marshalltown.