What’s New with Medicare in 2026 (And What You Need to Know)
Category: Medicare
Oct. 13, 2025 – f you’re on Medicare (or will be soon), 2026 brings a number of changes you’ll want to watch — especially as you head into the annual Open Enrollment season that starts Oct. 15. Below is a quick rundown of the highlights and what you should keep in mind. Premiums and deductibles are generally going up next year. But the good news is that negotiated drug prices on 10 very expensive drugs go into effect in 2026.
Comments on "What’s New with Medicare in 2026 (And What You Need to Know)"
Mike says:
For the first time Medicare is offering a tool to see if your Advantage providers are in network, unfortunately the tool is giving incorrect information. If someone uses the provider tool and finds out their provider is not in network Medicare will allow them to switch coverage but only for the first three months the policy is in effect. It seems you would be on the hook for the cost of using an out of network provider even though the finder tool said the provider is in network. If you find four months into coverage a listed provider is not in network you wont be able to switch plans. Insurance have faced criticism in the past for having ghost networks, directories that don't accurately show what providers are in their networks so contacting the insurance company directly may not be helpful. Just what seniors need, making an already difficult decision harder. Buyer beware. Plans have until January 1, 2026, to upload their network information to the Medicare directory which is strange since Medicare enrollment ends December 15.
https://www.aarp.org/medicare/medicare-plan-finder-glitches/
Admin says:
In addition to changes in Medicare Part A, B, and C (Medicare Advantage Plans), Part D plans should be reexamined as well. Premiums are generally going up, depending on the company. It pays to shop around, so check the Annual Notice of Change document that recently came in the mail. Use the Medicare Plan Finder to compare plans and benefits, paying attention to what tiers different drugs are in. Their "Star Ratings" can be useful too. Check out this helpful primer from the NY Times, Fall Enrollment Is Time to Check on Drug Plans.
Mike says:
The Congressional Budget Office announced that changes in the One Big Beautiful Bill Act will cost taxpayers $8.8 billion over ten years by removing some orphan drugs from the Medicare price negotiation plan. Orphan drugs are supposed to be for treating a rare single disease that affects fewer than 200,000 people but after approval are often used to treat more common conditions. In 2017 seven of the top ten selling drugs were orphan drugs prescribed for non orphan uses. The $8.8 billion will reduce the cost expected cost savings from Medicare’s price negotiation plan by nearly 10%.
Companies receive substantial tax incentives to create orphan drugs and can claim 25% of their clinical testing as tax credits while getting seven years of market exclusivity that prevents competitors from developing a generic version and expedited approval process and a waiver on application fees valued at $3 million.
President Trump recently claimed he had cut drug prices, saying “You know, we’ve cut drug prices by 1,200, 1,300 and 1,400, 1,500%,” “I don’t mean 50%. I mean 14- 1,500%.” That is mathematically impossible unless the drug companies are paying us to use their products.
The pharmaceutical lobby has spent $300 million on lobbying since 2024, just saying.