Medicare Changes to Note for 2026

As we head into 2026, there are a number of updates to Medicare that everyone on Medicare should know about. Some of these changes affect your monthly costs, others could change how you plan for care, and a few may affect how your drug coverage works. Understanding what’s new can help you avoid surprises and get the most out of your benefits.

Part B Premiums and Deductibles Increase

One of the most important changes for 2026 is an increase in the Medicare Part B premium and deductible. The standard monthly premium for Part B, which covers doctor visits and outpatient services, will be $202.90 per month, up from $185 in 2025. This increase means many beneficiaries will see higher monthly costs for their doctor and outpatient care. The annual Part B deductible will be $283, up from $257 last year.

If you receive Social Security benefits, this premium is typically deducted from your monthly payment. It’s worth planning ahead for the increase so it doesn’t come as a shock early next year.

Prescription Drug Costs Have a New Out‑of‑Pocket Cap

Another major update affects Medicare Part D prescription drug coverage. In 2026, Part D plans will cap out‑of‑pocket drug costs at $2,100 for covered drugs. Once you reach that annual limit, your Part D plan will cover the full cost of covered medications for the rest of the year. This cap is slightly higher than the 2025 limit and helps protect people who take multiple or high‑cost medications from excessive drug expenses.

This change continues to make prescription costs more predictable and manageable, especially for those with ongoing medication needs.

Negotiated Drug Prices Begin in 2026

In 2026, Medicare will begin using newly negotiated prices for a group of commonly used and expensive prescription drugs. These are part of a broader drug price negotiation program aimed at reducing overall costs for seniors. You may notice lower prices on some medications as these negotiated prices take effect.

Medicare Advantage Out‑of‑Pocket Limit Changes

For those enrolled in Medicare Advantage plans, the maximum limit on in‑network out‑of‑pocket costs for medical services will decrease slightly in 2026. The federal maximum will be $9,250, down from the 2025 cap of $9,350. Most Advantage plans set their limits below the federal maximum, but it’s still worth checking your plan’s specific out‑of‑pocket limit when choosing coverage during Annual Enrollment.

Original Medicare Prior Authorization Pilot Begins

Another notable development involves Original Medicare (Parts A and B). Starting in 2026, a pilot program will require prior authorization for certain services in six states (Michigan is not one). The goal is to reduce fraud, waste, and improper billing, while ensuring patients still get care when needed. This is a change for traditional Medicare, which has historically required little to no pre‑approval for services.

Fewer Standalone Part D Plans Available

The number of standalone Medicare Part D prescription drug plans is set to decrease in 2026, which means fewer choices in some areas. This could make it more important than ever to review available plans during the Annual Enrollment Period and compare coverage carefully.

Plan Finder and Payment Plan Changes

Some tools and features are also being updated to make it easier to find and compare plans. People who enrolled in the Medicare Prescription Payment Plan in 2025 will be automatically reenrolled in 2026 unless they opt out, which helps spread out drug costs throughout the year.

Bottom Line

Medicare is changing in ways that affect your costs and coverage in 2026. Higher Part B premiums, a clear drug cost cap, lower out‑of‑pocket limits for Advantage plans, negotiated drug prices, and the start of a prior authorization pilot for Original Medicare are all changes you’ll want to understand.

If you want help reviewing these updates and seeing how they apply to your plan before Annual Enrollment begins, we’re here to help.