What’s New with Medicare in 2026 (And What You Need to Know)

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.

Key Changes in 2026

1. Bigger increases in costs for Part B and Part D
   • The standard Part B premium is projected to jump by around 11.6%, from $185 to about $206.50.
   • The annual Part B deductible is also rising, by roughly 12%.
   • For Part D (prescription drug plans), the maximum deductible limit will increase to $615. Kiplinger+1
   • The new out-of-pocket cap for drug costs will be $2,100 (up from $2,000) under the Part D redesign.
2. Medicare Advantage (MA) payment boost & plan shakeups
   • The government will increase payments to MA plans by about 5.06% for 2026.
   • Some insurers are scaling back or exiting certain MA or Part D markets, which could reduce plan choices in some areas.
   • The allowable network out-of-pocket maximum for Medicare Advantage (for in-network services) will decrease slightly to $9,250 (from $9,350).
3. Changes to the Medicare Prescription Payment Plan (MPPP)
   • If you use the MPPP to spread out your drug costs over the year, starting in 2026 it will be automatically renewed unless you opt-out. Kiplinger+1
4. New prior authorization requirement in pilot states
   • Beginning Jan 1, 2026, “Traditional Medicare” (Part A and B, or Original Medicare) will require prior authorization for 17 medical procedures in six pilot states: New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington. That means providers must get Medicare’s approval ahead of time for those services — otherwise, coverage may be denied. Many people, who selected original Medicare over Medicare Advantage because there was no prior authorization required, are upset by what this test might bring.
5. Negotiated drug prices & Part D program refinements
   • The government has negotiated prices on the first set of high-cost prescription drugs, which will go into effect in January 2026. The 10 prescription drugs are: Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, and NovoLog/Fiasp.The $35 monthly insulin cap continues. Free ACIP-recommended vaccines remain covered.

Don’t Forget: Open Enrollment Starts October 15

Each year, Medicare’s Open Enrollment Period (also called the Annual Election Period) lets you review and change your Medicare coverage. In 2025, the enrollment window runs from October 15 to December 7 — and the changes you make then take effect January 1, 2026.

During that time, you can:

• Switch between Original Medicare (Part A & B) and Medicare Advantage (Part C)
• Change or join a Medicare Part D (prescription drug) plan
• Change your Medicare Advantage plan
• Drop your Medicare Advantage plan and go back to Original Medicare

If you miss that window, your options are more limited.

What You Should Do Now

• Mark your calendar for October 15 – December 7
• Review your current plan’s 2026 “Annual Notice of Change” (you should receive it by late September) to see what’s changing (premiums, networks, drug coverage)
• Shop around — plan offerings, formularies, and networks change each year
• Consult unbiased help — for example, your State Health Insurance Assistance Program (SHIP) or the Medicare.gov Plan Finder
• Budget ahead — with expected cost increases, knowing your likely out-of-pocket expenses is more important than ever.

Comments? Are you considering changing your Medicare plan for next year? We know people have different views about Original Medicare vs. Medicare Advantage. Each plan has its fans and detractors.

Need more help?

1-800-MEDICARE or Medicare.gov.  
This Manual from Medicare is very helpful describing the program along with what is new for 2026.