7 Medicare Changes Coming in 2026

Managing your health care costs is key to your financial health, especially as you get older. For those over age 65, anticipating your expenses requires staying on top of the updates to Medicare every year, and 2026 is no exception.

You can expect several important changes to the government program that will affect how you get care and how much you’ll have to pay. Some of those changes may be welcome, although many recipients could be responsible for a bigger share of their expenditures.

1. Cap on Prescription Drug Expenses Is Going Up

The limit on out-of-pocket expenses for Medicare Part D, which covers prescription drugs, is indexed to inflation. Unfortunately, that means you’ll face higher caps in the coming year.

For 2026, the maximum you’ll have to pay for medications is $2,100, which represents a $100 increase from the current year.

The annual deductible for Part D is also going to edge upward, albeit slightly. In 2026, you’ll see a $25 increase to $615. You’re on the hook for all of your covered prescription drug costs until you reach that limit, at which point you pay 25% coinsurance.

2. Automatic Re-Enrollment in Prescription Payment Plan

Starting in 2025, you could enroll in the Medicare Prescription Payment Plan (MPPP) to spread out the cost of more expensive drugs throughout the year.

For 2026, you will be automatically re-enrolled in the MPPP if you signed up for this feature. Should you choose to leave the plan, preferring to pay for medications all at once, you have to opt out.

3. Part B Premiums Are Increasing

As with prescription drug costs, the price of Medicare Part B (the part that covers physician, outpatient, and durable equipment costs) is expected to rise in 2026.

The official Part B premium won’t be announced until the fall. But the Medicare Trustees Report anticipates that the standard deductible for low- and moderate-income recipients will climb to $206.50 per month. That represents an increase of $21.50 a month over the current deductible. In addition, the annual deductible is expected to increase from $257 to $288.

4. Fewer Supplemental Benefits Through Medicare Advantage

Part C, better known as Medicare Advantage, plans are administered by private insurers that contract with Medicare. Some of these plans provide reimbursement for extra, non-medical expenses that help chronically ill patients manage their health and wellbeing. However, that list is getting shorter in 2026.

Under a recently finalized rule, Special Supplemental Benefits for the Chronically Ill “must have a reasonable expectation of improving or maintaining the health or overall function of the chronically ill.”

Therefore, starting in 2026, Medicare Advantage plans may not cover:

• Non-healthy food
• Alcohol
• Tobacco
• Life insurance

5. Insulin Costs Are Capped

There’s some good news if you’re a Medicare recipient who requires insulin. Beginning next year, the program is making permanent price caps that were first implemented as part of the Inflation Reduction Act of 2022. That limit is the lesser of $35 for a 30-day supply of insulin or 25% of the negotiated price. There’s no deductible for insulin expenses under Medicare, further reducing your out-of-pocket costs.

6. Adult Vaccines Offered at No Cost

Some vaccines have been free to Medicare recipients going back to 2023. But in the coming year, any vaccines recommended by the Advisory Committee on Immunization Practices will be fully covered. These include shots for shingles, diphtheria, pertussis, tetanus, and respiratory syncytial virus.

What if the vaccine you’re hoping to get isn’t on your plan’s approved list? You can still ask your plan for an exception or request reimbursement if you had to pay a provider with your own funds.

7. Some States to Require Prior Authorization

In the past, you typically only had to worry about getting prior authorization for medical expenses if you enrolled in Medicare Advantage. But the Centers for Medicare & Medicaid Services (CMS) is launching a pilot program in six states (Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington) that will require upfront approval for specific services, even if you have traditional Medicare.

The Wasteful and Inappropriate Service Reduction model uses AI to “expedite the prior authorization processes” for expenses that are subject to waste and abuse. However, CMS has clarified that technicians will make the final determination about coverage, not software algorithms.

So far, the list of services that require prior authorization in these states includes skin and tissue substitutes, electrical nerve stimulator implants, and knee arthroscopy.

Review Your Medicare Options

Few things are certain in life, including what you can expect out of Medicare from one year to the next. By staying up to date on what’s happening, you’re in a position to make the right choice for coverage for your unique circumstances once open enrollment rolls around.

And remember, you can use the Medicare comparison tool to see which Medicare Advantage or Part D option will bring you lower costs or more generous benefits.

Colonial Penn Is Here for You

Colonial Penn has specialized in making life insurance simple and accessible by offering it directly to consumers since 1957. Click here to learn more.

Colonial Penn is an insurance company and is not affiliated with or endorsed by the U.S. government or Medicare. Colonial Penn does not offer Medicare plans. The information provided relates to general insurance matters. Insurers and their representatives cannot give tax or legal advice. This article is for general educational purposes related to insurance. Seek personalized advice from qualified tax or legal advisors.

This information is for educational purposes only and is not a substitute for professional medical, legal, or financial advice. For specific Medicare questions, visit www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048). We strive for accuracy but make no guarantees. Policies and regulations can change. Verify information with authoritative sources and consult professionals where necessary.