Merck Employees: What to Know About Medicare During a Government Shutdown (With Guidance from Brent Wolf, CFP®)

Healthcare Provider Update: Healthcare Provider for Merck Merck & Co., Inc., commonly known as Merck, is a global leader in the healthcare sector, renowned for its innovative pharmaceuticals, vaccines, and biologic therapies. As a prominent healthcare provider, Merck delivers a wide array of health solutions targeting various health conditions, particularly in areas such as immunology, oncology, and infectious diseases. Potential Healthcare Cost Increases in 2026 In 2026, healthcare costs are projected to rise significantly, primarily driven by the anticipated expiration of enhanced federal premium subsidies associated with the Affordable Care Act (ACA) and growing medical expenses. Faced with an average premium increase of 18%, healthcare consumers may experience out-of-pocket costs climbing by over 75%. This situation is exacerbated by surging medical care prices, as hospitals and providers seek to balance inflationary pressures while maintaining profitability. As a result, many individuals may find themselves priced out of adequate health coverage, prompting essential discussions on the need for policy interventions. Click here to learn more

'Merck employees navigating Medicare during a government shutdown should take extra care to verify provider networks and prescription coverage mid-enrollment, as delays in updates can create costly surprises if decisions are rushed.' – Paul Bergeron, a representative of The Retirement Group, a division of Wealth Enhancement.

'Merck employees should approach this year’s Medicare enrollment with patience and diligence, since delayed federal updates may require a mid-window review to avoid expensive mistakes.' – Tyson Mavar, a representative of The Retirement Group, a division of Wealth Enhancement.

In this article, we will discuss:

1. How the government shutdown may affect Medicare’s open enrollment process.

2. Key updates for 2026 Medicare Advantage (Part C) and Part D prescription drug plans.

3. Action steps Merck retirees can take to help prevent costly enrollment mistakes.

Medicare and the Government Shutdown

(Advice from Brent Wolf, CFP® at Wealth Enhancement)

For coverage starting in 2026, Medicare's open enrollment period is October 15–December 7, 2025. Enrollment is one of the essential Medicare programs that remains fully available despite the current government shutdown. However, Merck retirees should note there may be delays in some federal updates, such as plan details posted to Medicare.gov. Because of this, it’s crucial to carefully review all information before making decisions.

As Brent Wolf notes, 'Open enrollment is still your once-a-year chance to fix expensive mistakes.' Before you switch, verify your doctors, your medications, and your entire out-of-pocket exposure, not just the premium. Information may lag during a shutdown, so double-check and enroll once.

Activities During Open Enrollment (October 15–December 7)

Enrollees may do the following within this annual window:

• - Change between Medicare Advantage (Part C) and traditional Medicare.

• - Adjust Part D prescription medication coverage.

• - Switch to a different Medicare Advantage program.

Importantly, open enrollment does not involve Medigap (Med Supp) policies. Although state-specific regulations or medical underwriting may be applicable, applications are accepted at any time. Merck retirees should be prepared for some delays.

2026 plan previews can still be seen on Medicare.gov, but formal updates may be delayed due to the ongoing shutdown. Therefore, rather than waiting until the last minute, it is advisable to begin reviewing options in the middle of the window. This approach provides time to account for updates that are posted later.

Important Updates and Reminders for Part D Prescription Drug Plans in 2026

It is anticipated that the average overall cost will drop, from $38 in 2025 to an anticipated $34 per month in 2026. ¹  Individual plans will differ, though, and some consumers might pay more.

Often, however, the sticker price is less important than the drug tiers and formulary. Merck employees should thoroughly examine the cost-sharing plan, preferred pharmacy network, and tier of each prescription.

Prescription medication out-of-pocket caps will increase from $2,000 in 2025 to $2,100 in 2026. ²

Action Step:  Examine current and expected expenditures for 2026 using the Annual Notice of Change. If favored pharmacies are no longer listed or if drugs have changed tiers, reshop.

Part C of Medicare Advantage

It is anticipated that average premiums will modestly decrease, with many plans available at no cost. These often include added services like vision, hearing, and fitness benefits in addition to bundled drug coverage.

Network coverage and cost-sharing regulations determine actual expenses. Compared to traditional Medicare combined with Medigap, HMO networks could be more restrictive, and major medical events can result in higher point-of-care costs. For Merck retirees, this makes provider network confirmation especially critical.

It can be difficult to switch back afterward. To get supplemental coverage after the first six-month Medigap window (with some state exclusions), medical underwriting may be necessary.

Action Step:  Before enrolling, confirm provider networks and hospitals. Instead of focusing only on premiums or benefits, calculate total annual spending under worst-case scenarios.

Useful Checklist

• - For information on changes to networks, cost-sharing, formularies, and premiums, consult your Annual Notice of Change.

• - Compile a list of all your prescriptions, including monthly refills and dosages, and make sure your insurance includes them.

• - To confirm 2026 network membership for any Medicare Advantage plan, contact providers directly.

• - Calculate the likely overall expenditures, including prescription drug costs, deductibles, copays, coinsurance, premiums, and potential emergency expenses.

• - Appointments with State Health Insurance support Program (SHIP) counselors fill up quickly, so make an appointment early for unbiased support.

• - Allow enough time for enrollment to account for any delays in carrier confirmations or government updates.

When to Make a Decision

'Start comparing now, but don't rush to submit on day one,' advises Wolf, emphasizing patience. Allow time for Medicare.gov and carriers to post final files. Once provider networks and medication pricing have been verified, aim to make a decision in the middle of the window. For Merck employees, this timing may help reduce last-minute stress, particularly if the shutdown impacts federal updates.

This year's registration window requires careful planning because of rising premiums, shifting out-of-pocket caps, and the possibility of the government shutdown slowing updates.

According to recent studies, people’s usage of primary care and outpatient services increases by roughly 14% and 31%, respectively, after they first qualify for Medicare at age 65. ³  This rise reflects pent-up demand among older populations.

Summary

Learn about the effects of the government shutdown on 2026 Medicare open enrollment. With advice from Brent Wolf, CFP®, discover important developments on Medicare Advantage, Part D prescription drug coverage, and out-of-pocket drug caps. Merck retirees should review expected formulary adjustments, network requirements, premium changes, and important reminders when comparing Medigap, Medicare Advantage, and traditional Medicare plans. Recognize how to calculate total yearly expenditures, examine drug coverage tiers, and confirm provider networks. Careful review of the Annual Notice of Change and mid-enrollment action can help retirees steer clear of costly errors.

Managing Medicare open enrollment during a government shutdown is similar to preparing for a lengthy cross-country trip while traffic updates are delayed due to road work. Some road signs may be displayed late, leaving travelers uncertain of the best path, but the highways and exits—the dates for Medicare enrollment and basic services—remain open. Enrollees must verify provider networks, prescription tiers, and out-of-pocket expenses before making a change, just like a careful driver double-checks the map before turning. Costly detours can be minimized by planning in advance rather than rushing at the start or end of the journey.

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Sources:

1. MedicalNewsToday. ' Medicare costs: 3 key changes in 2026, ' by David Mills. 17 Oct. 2025.

2. Centers for Medicare & Medicaid Services (CMS).  Final CY 2026 Part D Redesign Program Instructions (Fact Sheet) .  CMS, 7 Apr. 2025.

3. National Library of Medicine. ' Medicare Enrollment Increased Visits To Primary Care Providers But Not Mental Health Care Providers, 2014-21 ,' by Donghoon Lee, Jing Li. PMID: 39761455; DOI: 10.1377/hlthaff.2024.00666. Jan. 2025