Medicare Changes for 2026

Changes for Medicare in 2026 focus is on rising costs for Parts A (Hospital) & Part B (Medical), Part D (Drug Prescriptions)drug benefits lower out-of-pocket cap, new Medicare Advantage rules (especially for extra benefits like food/utilities), and efforts to lower drug prices, including a higher Part B deductible, lower drug copays, and continued drug negotiation.

Medicare.gov

Original Medicare (Parts A & B)

Part A Deductible: Increases to $1,736 (up $60).

Immunosuppressive Drugs: Standard premium for continued Part B coverage after kidney transplant is $121.60.

Part B Premium: Standard premium increases to $202.90/month (up from $185 in 2025).
Part B Deductible: Rises to $283 (up $26 from 2025).

Medicare Part D (Prescription Drugs)

Out-of-Pocket Cap: The annual limit on out-of-pocket drug costs is set at $2,100.

Drug Price Negotiation: More drugs will have negotiated lower prices.

Payment Plan: Automatic renewal for those in the Medicare Prescription Payment Plan.

Medicare Advantage (Part C) & Other Changes

Cost-Sharing: Updates for behavioral health services.

Extra Benefits: Stricter rules for some chronic illness extras (like food/utilities), requiring qualification for chronic conditions.

Prior Authorization: A pilot program tests prior authorization for some Part B services in six states.

Telehealth: More telehealth services, including developmental/psychological testing, become permanent.

Preventive Care: Expanded coverage for mental health check-ups and heart screenings.

NOTE - Reviewing with your agent is beneficial and worth your time. Medicare costs, benefits, and providers can change each year. Comparing options help to ensure your doctors, specialist, and hospital have not changes. If you need assistance, working with an un-biased Medicare Agent or calling your locate SHIP program (State Health Insurance Assistance Program). They can help you sift through the Medicare Advantage plans available in your area to find the one with coverage that matches your needs.