Be Ready for Changes to Medicare in 2026
Major updates to Medicare are coming in 2026, and with the Main Open Enrollment Period beginning October 15th, it’s crucial to understand how these changes could impact your coverage. This includes potential shifts in premiums, out-of-pocket costs, plan options, and overall availability for beneficiaries.
Here’s a breakdown of the key updates stemming from the Inflation Reduction Act of 2022, along with guidance to help you prepare and make informed decisions. Understanding these changes now can help you choose the Medicare plan which best fits your healthcare needs and financial situation.
Prescription Drugs: Stable Out-of-Pocket Caps
Probably the most significant and welcomed change will be the very small increase in the cap for out-of-pocket costs for prescription drugs under Medicare Part D. Currently at $2,000, the cap will only increase to $2,100 for 2026. While still a 5% increase, considering there were no cap limits in the past, this limited increase represents major relief, especially for those who spend much more on medication each year.
In addition, Medicare (particularly the Centers for Medicare and Medicaid Services) is stepping up efforts to negotiate prices on high-cost drugs, which could mean further cost savings for those requiring these types of expensive, yet critical, medications.
Lastly, under the Medicare Prescription Payment Plan (where enrollees can spread their drug costs over the year instead of paying all up front each time at the pharmacy), if you opt in to this program in 2026, you won’t be required to opt in again for 2027; you’ll be automatically re-enrolled unless you opt out within the new required three-day window.
Medicare Part B & D Deductibles Are Rising
While the deductibles for Medicare Parts A & B usually garner more attention, your Part D plan may also have a deductible which must be paid as well. Part D plans vary, but if so, in 2026 this deductible will increase from $590 in 2025 to $615. The Part B deductible is expected to increase from $257 to $288.
You pay all out-of-pocket costs until you meet your plan’s full deductible, then 25% coinsurance on Part D expenses until you reach the above cap of $2,100 in 2026.
Vaccines and Insulin Could Be More Affordable
Vaccine discussions are prominent in the media today, but what may not be discussed enough is the savings recipients will enjoy for vaccines and insulin. Starting in 2026, all vaccines on the current CDC-recommended vaccines will be free under Part D with zero cost-sharing through 2026, despite changes occurring under the current CDC administration.
If you require regular insulin, monthly costs will be hard-capped at $35 or 25% of the negotiated or “maximum fair price” (set by the Price Negotiated Program), whichever is lower.
Increasing Premiums for Part B and Part D
On the downside, Medicare recipients will see a substantial 11% increase to their Part B base premiums in 2026. Part B base premiums will rise from $185 in 2025 to $206.50 per month, while the Part D initial base premium is expected to increase by 6% from $36.78 to just about $39 per month.
It’s important to note Part D plans are offered by private companies who may not have set next year’s premiums yet, so your actual Plan D premium could be higher or lower. Some Part D plans have $0 premiums, so it may pay to shop around.
Medicare Advantage Plans May Have Less Extras
For those who opted for Medicare Part C (also known as Medicare Advantage) instead of Traditional Medicare, the Special Supplemental Benefits (or SSBCI) they may have enjoyed are expected to be curtailed. These are the non-medical features which are intended to promote well-being and functioning for those with chronic conditions. Now-excluded benefits will include designated “non-healthy” food, alcohol, tobacco, cannabis products, and cosmetic procedures.
This is a growing trend among private insurers to curtail supplemental benefits such as nutritional supplements, transportation, and others.
Steps to Take Now
Given all of these changes and more, here are some action steps to take to prepare:
- Don’t blindly re-enroll in your Medicare plan: It may be more comfortable to just re-enroll, but this could cost you coverage and money. Check to see if your healthcare provider network has not shrunk and your doctor(s) are no longer included. Shop around to confirm your coverage is still the best for your area and your particular healthcare needs.
- Review your Part D plan list of covered drugs: These lists, called “formularies,” include the covered medications under your plan. Many times pharmacy benefit managers review and change these lists and pricing strategies. Therefore, it’s important your Part D coverage includes your needed medications each upcoming year.
- Get assistance if you need it: Oftentimes, a Medicare insurance consultant, broker, or a financial planner knowledgeable in Medicare can be very helpful in guiding you through these changes, considerations, and decisions so you can make informed choices that are right for you.
Get Guidance for Medicare and Retirement Planning Today
At The Rosamond Financial Group, we guide you through the complexities of Medicare and retirement planning, creating strategies tailored to your needs. Our goal is to help make your finances simpler and your retirement more enjoyable, so you can focus on the life you’ve earned.
Ready to get in touch? Contact us today at 830-798-9400 or email solutions@rosamondfinancialgroup.com to start the conversation.
About Preston
Preston Rosamond is a financial advisor and the founder of The Rosamond Financial Group Wealth Management, LLC with over two decades of industry experience. He provides comprehensive wealth management and financial services to successful business owners, corporate executives, and affluent retirees who enjoy simplicity and seek a professional to help them pursue their goals. Preston personally serves his clients with an individual touch, a sincere heart, and his servant’s attitude is evident from the moment you meet him. Learn more about Preston or start the conversation about your finances with him by emailing solutions@rosamondfinancialgroup.com or schedule a call on his online calendar.