Each year, Medicare updates rules, costs, and benefits to reflect changes in legislation, medical practice, and inflation. For 2026, many of the changes are extensions or refinements of existing reforms (especially under the Inflation Reduction Act), but there are some new features and tweaks that can matter a lot to your out-of-pocket costs, your plan choices, and how you manage your care.

The Medicare enrollment period for 2026 is October 15 to December 7, 2025. During this time, you can enroll in, unenroll from, or change your Medicare Advantage or Part D prescription drug plans. The open enrollment period for Medicare Advantage plans is January 1 to March 31, 2026. During this time, Medicare Advantage members can make one change to their plan.

Here is an overview of what to expect for Medicare in 2026 to help you during enrollment. If you are confused about what plan is right for you, or if your prescriptions or doctors will be in your plan, consider consulting with one of the licensed Medicare consultants listed on our Service Providers page here.

Key Changes in 2026

Here are some of the most important changes to be aware of in 2026.

Part D (Prescription Drugs)

The annual out-of-pocket cap for Part D is increasing to $2,100.

The maximum deductible if your plan has one may go up (to as much as $615).

The “Medicare Prescription Payment Plan” (MPPP), which spreads prescription cost burdens across the year, becomes automatic (unless you opt out) in many cases. (Kiplinger)

Changes to how Part D premiums are stabilized — the government’s “premium support” (or reduction) shrinks (from $15 to $10) and allowed premium increase limits for plans go up.

Also, more “negotiated drug pricing” under federal authority is coming, meaning Medicare will more actively negotiate prices on certain high-cost drugs. (Centers for Medicare & Medicaid Services)

 Part B (Medical & Physician Services) & Part A (Hospital)

The standard Part B premium is projected to rise (to about $206.50/month) and the deductible likewise may increase (e.g. to ~$288) (these are projections, final numbers will come in fall 2025)

Part A deductibles are expected to increase modestly.

For most people, the increases are tied to annual inflation, but they can still affect your budget significantly. (medicareresources.org)

Medicare Advantage (Part C)

Government payments to MA plans are increasing (on average by about 5.06%) to support plan services. (Centers for Medicare & Medicaid Services)

Some insurers are pulling back or reducing their offerings in certain areas, citing financial challenges.

The out-of-pocket maximum (for covered in-network services under MA) will decrease slightly to $9,250 in 2026 (down from $9,350 in 2025).

Plans must improve the accuracy and transparency of their provider directories (so you can better tell which doctors are in your network). (American Hospital Association)

Plans’ ability to reopen or reverse previously approved hospital admissions is more restricted (only in cases of obvious error or fraud). (Centers for Medicare & Medicaid Services)

What Stays Mostly the Same

• Vaccines recommended for adults (like flu, pneumonia, shingles) continue to be covered (often without cost-sharing).
• The $35 insulin cap (for eligible insulin products) is expected to remain in place.
• Original Medicare’s 20% coinsurance and deductibles for covered services still apply (unless you have supplemental insurance).
• You’ll still use the annual Open Enrollment Period (October 15 – December 7) to make changes to your Medicare Advantage or Part D plans.
• Many of the structural features of Medicare (coverage rules, benefit phases, enrollment rules) remain stable unless specifically amended.

Steps You Can Take Now

Because some of these changes affect your costs and plan choices, here are practical steps to be prepared:

1. Review your current Part D (drug) plan
   • See whether your medications are covered under your plan’s formulary.
   • Estimate what your total out-of-pocket drug cost might be under the new $2,100 cap.
   • If you struggle with paying the cost of prescriptions up front, see whether the Medicare Prescription Payment Plan (MPPP) makes sense for you (and whether you want to opt out or in).
   • Watch for notices from your Part D plan (or your Medicare Advantage plan if it includes drug coverage) for an Annual Notice of Change explaining new costs, coverage, and rules.
2. Check your Medicare Advantage plan (if you have one)
   • Confirm your doctors, hospitals, and specialists remain in your network (especially with the new rules about provider directory updates).
   • Examine limits, copays, and benefits (e.g. whether some “extra benefits” have changed).
   • If your plan is leaving your area, be ready to select a new one during Open Enrollment.
3. Budget for higher Medicare costs
   • Factor in increases in Part B premiums and deductibles.
   • Be aware that the premium hikes may absorb a portion of your Social Security cost-of-living increase (if you receive Social Security).
   • If you have Medigap (supplemental) insurance or another coverage that helps with Medicare cost-sharing, check whether it still meets your needs under the new rules.
4. Take advantage of preventive services and vaccines
   • Don’t delay recommended screenings (e.g. cancer, bone density) or immunizations — they remain some of the best value in terms of health outcomes and cost avoidance.
5. Keep an eye on communications from Medicare, your plans, and CMS
   • In fall 2025, CMS will publish the “Medicare & You 2026” handbook, which contains the finalized rates and coverage changes.
   • Watch your mailbox and plan notices carefully — changes in your benefit design or cost-sharing will be spelled out there.
   • Use trusted sources for help: the State Health Insurance Assistance Program (SHIP) in your state offers free, unbiased counseling.
6. Decide about the Prescription Payment Plan (MPPP)
   • If automatic enrollment is imposed, think whether you want to stay or opt out (depending on how it affects your cash flow).
   • Understand how the MPPP spreads payments and how interest or adjustments might apply (your plan will send you a notice with terms).

Watch Out for Risks & Uncertainties

• Some of the projected increases (premium, deductible) are not final — the final 2026 numbers will be set later.
• Insurers might reduce plan choices or withdraw from less profitable areas, which can limit your options locally.
• If you have high-cost medications not well covered under your plan, hitting the new out-of-pocket cap may still leave you with substantial cost.
• Mistiming a plan change (or missing deadlines) could leave you stuck in a less favorable plan for a year.
• For those in states selected for prior-authorization pilot programs (under Original Medicare), certain services in some years may require review — that could affect timely access in a few regions.
• As always, fraud and misleading sales practices are risks around Medicare Advantage / Part D marketing. Be cautious and rely on official sources or trusted advisors.

Help and Resources

If you’re 65 or older (or otherwise enrolled in Medicare), don’t wait. Start reviewing your plan now, talk with your doctors and insurance counselor, and begin modeling your expected out-of-pocket costs for 2026.

Find licensed, highly rated, Medicare consultants on our Service Providers Page HERE.

You can view, download, save, or print the 2026 Medicare Handbook on our Resources Page Here.

Find more information online at medicareresources.org