What's New

Medicare is rolling out several important changes in 2026 that affect drug costs, plan flexibility, and supplemental benefits. Here’s a streamlined look at what beneficiaries should know.

Lower Drug Prices Begin

Starting January 1, 2026, Medicare will introduce its first negotiated prices on 10 high-cost prescription drugs used to treat conditions like cancer, diabetes, and arthritis. These changes are designed to reduce out-of-pocket costs for many enrollees.

Possible Extra Chance to Change Plans

Some beneficiaries may qualify for a special opportunity to switch plans in early 2026 if Medicare Plan Finder errors caused inaccurate provider listings. This helps ensure access to covered doctors and hospitals.

Part D Costs Increase

Despite lower prices for certain drugs, overall Part D costs are rising. The annual out-of-pocket cap increases to $2,100 in 2026 (up from $2,000), and deductibles and premiums may also go up.

Automatic Renewal for Drug Payment Plan

Anyone enrolled in the Medicare Prescription Payment Plan in 2025 will be automatically reenrolled for 2026 unless they opt out.

Changes to Supplemental Benefits

Medicare is ending or scaling back some supplemental benefit pilot programs. Medicare Advantage plans are also tightening access to nonmedical benefits like meals, transportation, and wellness services.

Bottom Line

While lower drug prices may help some beneficiaries, higher Part D costs and fewer supplemental benefits make reviewing your Medicare plan for 2026 more important than ever.

Medicare costs for 2026 include several notable increases that beneficiaries should understand as they plan for the year ahead. The standard Medicare Part B premium for doctor visits and outpatient services will rise to $202.90 per month, up from $185.00 in 2025, and the Part B annual deductible will increase to $283 from $257. The Medicare Part A deductible — the amount you pay before Original Medicare begins covering in-patient hospital stays — is increasing to $1,736 in 2026, up slightly from $1,676 in 2025, and daily coinsurance amounts for extended hospital and skilled nursing stays are also rising. Most Medicare beneficiaries who have sufficient work history will continue to have a $0 Part A premium, but those who do not will see modest increases in Part A premium rates. These cost changes reflect the latest actuarial estimates and care utilization patterns released by the Centers for Medicare & Medicaid Services (CMS).

It’s important to note that higher‑income beneficiaries will see additional adjustments through the Income‑Related Monthly Adjustment Amount (IRMAA), which adds a surcharge to both Part B and Part D premiums based on reported income from two years prior. For 2026, IRMAA can raise total monthly Part B premiums significantly for individuals and couples above key income thresholds, with multiple tiers that increase with income. Medicare Part D (prescription drug) plans also include income‑related adjustments for those in higher brackets. Understanding these updates can help you anticipate changes to your monthly costs and tailor your coverage choices accordingly. Reviewing your options with a licensed broker, and planning ahead for potential income‑related adjustments, can help reduce the impact of rising costs in 2026. Reach out to us today for guidance!

In 2026, Original Medicare (Parts A & B) will begin testing prior authorization for certain medical services, marking a significant change for traditional Medicare. This update is part of broader Medicare changes outlined by AARP and reflects efforts by the Centers for Medicare & Medicaid Services (CMS) to reduce unnecessary care and protect Medicare funds.

Prior authorization means Medicare must approve some services before they are performed. While this process has long been common in Medicare Advantage plans, it has rarely applied to Original Medicare. Under the new pilot program—known as the WISeR Model—CMS will require approval for about 17 outpatient services that have been identified as vulnerable to overuse, fraud, or inappropriate billing.

The pilot will apply only in six states: Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington. CMS says the goal is to ensure services are medically appropriate while maintaining access to necessary care. The program will be evaluated before any decision is made to expand it nationwide.

For beneficiaries in the affected states, some treatments may take longer to schedule if prior authorization is required. Healthcare providers will handle the approval process, but beneficiaries are encouraged to ask in advance whether a service needs authorization. For now, Medicare enrollees outside the pilot states will see no change.