Medicare Changes in 2026 You Need to Know Before Enrolling
If you’re preparing to enroll in Medicare for 2026—or simply reviewing your current coverage—it’s crucial to understand the key updates that will take effect next year.
Medicare’s annual adjustments reflect new policies, healthcare costs, and evolving priorities to better serve seniors and individuals with disabilities.
This article breaks down the most relevant 2026 Medicare changes in clear, practical terms, helping you prepare for a smooth enrollment experience.
Why These Changes Matter
The upcoming Medicare changes for 2026 are significant because they directly impact what beneficiaries pay for coverage, medications, and healthcare services.
These adjustments stem from the Centers for Medicare & Medicaid Services (CMS) rules for the 2026 contract year and ongoing reforms introduced by the Inflation Reduction Act. The primary goals are to improve affordability, increase transparency, and simplify access to necessary medications and care.
However, some of these updates may also require careful review to avoid unexpected costs or changes in plan benefits.
The Most Important Medicare 2026 Changes
Part B Premium and Deductible Increases
Medicare Part B premiums and deductibles will rise again in 2026.
The standard monthly premium is expected to increase to $206.50, representing an 11.6% increase from 2025. The annual Part B deductible will also rise to $288, about 12% higher than last year.
These increases mean you’ll need to pay more before Medicare begins covering your healthcare expenses. It’s important to budget for these changes and evaluate whether a Medicare Advantage plan might help offset some costs.
New Out-of-Pocket Cap for Part D
In 2026, Medicare will introduce a new $2,100 annual out-of-pocket maximum for prescription drug coverage under Part D.
Once you reach that spending limit, you won’t pay any additional copays or coinsurance for covered medications for the rest of the year.
The maximum deductible for Part D plans will also rise from $590 to $615, reflecting inflation and higher drug costs.
This change aims to make medication expenses more predictable and protect beneficiaries from catastrophic drug spending.
Drug Price Negotiations Begin
Starting in 2026, Medicare will begin negotiating prices for select high-cost prescription drugs.
This long-awaited reform is designed to make medications more affordable and limit steep price increases.
Initially, only a small group of the most expensive drugs will be included in the negotiation process, but this program will expand in future years.
This is one of the most transformative Medicare changes in decades, aiming to provide real savings for millions of seniors.
Automatic Renewal of the Medicare Prescription Payment Plan (MPPP)
The Medicare Prescription Payment Plan (MPPP) allows enrollees to spread out their medication payments over 12 months instead of paying large sums upfront at the pharmacy.
Beginning in 2026, participation in this program will automatically renew for beneficiaries who used it in 2025. You’ll still have the option to opt out if you prefer to pay in full each time you fill a prescription.
This program helps beneficiaries better manage their budgets and avoid financial strain from high-cost drugs.
Adjustments to Supplemental Benefits in Medicare Advantage
For those enrolled in Medicare Advantage plans, new rules will redefine certain supplemental benefits offered under the Special Supplemental Benefits for the Chronically Ill (SSBCI) program.
Some non-medical services—like home modifications or meal deliveries—may face tighter eligibility criteria or documentation requirements.
These adjustments are designed to ensure that benefits remain directly related to improving health outcomes and reducing hospitalizations.
Additionally, plan networks, provider availability, and prior authorization rules may change, so reviewing your Annual Notice of Change (ANOC) this fall is essential.
New Prior Authorization Rules in Certain States
CMS is introducing new prior authorization requirements in Original Medicare (Parts A and B) for specific procedures in six states: New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington.
These requirements apply to certain non-emergency surgeries and treatments and aim to reduce unnecessary procedures and costs.
While the goal is to improve efficiency and control wasteful spending, it’s possible some patients could experience delays if authorizations are not processed promptly.
Beneficiaries in these states should pay close attention to communication from their healthcare providers regarding pre-approval processes.
What to Do Before and During Open Enrollment
The open enrollment period is the best time to review your coverage, compare plans, and take advantage of any new benefits available in 2026.
Here’s how to prepare:
Key Enrollment Dates
Medicare Open Enrollment: October 15 – December 7, 2025
(Any changes you make take effect on January 1, 2026.)Medicare Advantage Open Enrollment: January 1 – March 31, 2026
Mark these dates on your calendar and plan time to review your options.
Review Your Annual Notice of Change (ANOC)
Each fall, you’ll receive an Annual Notice of Change (ANOC) from your current plan provider. This document outlines how your plan’s premiums, copays, and benefits will change in 2026.
Read it carefully—these details can have a big impact on your total yearly costs.
Compare Plans Thoroughly
Don’t assume your current plan is still the best choice. Compare total yearly costs—including premiums, deductibles, and out-of-pocket spending—across different plans.
If you take prescription medications, check that your drugs are still covered and confirm your preferred pharmacy remains in-network.
Consider Special Situations
Higher-income beneficiaries: You may pay extra monthly premiums (IRMAA adjustments) for Parts B and D based on your income.
Dual-eligible individuals: If you have both Medicare and Medicaid, make sure your plan coordinates benefits efficiently.
Relocation: Moving to a different state or ZIP code may require enrolling in a new plan. Always verify availability before you move.
