As Medicare evolves to meet the needs of millions of beneficiaries, 2026 brings major updates that will affect costs, coverage, and access to care. From rising premiums and deductibles to historic drug price negotiations, these changes aim to balance rising healthcare costs with greater affordability for seniors.
The Annual Enrollment Period (AEP), running from October 15 to December 7, 2025, is your chance to review and adjust your Medicare coverage. This article highlights the seven most impactful Medicare changes for 2026, including higher Part B and Part D costs, the end of Medicare-Medicaid Plans, and new prior authorization requirements in select states. Whether managing chronic conditions or planning, understanding these changes will help you make informed decisions to protect your health and finances.
Medicare Part B premiums are rising significantly in 2026, reaching $202.90 per month for individuals. This increase is driven in part by the cost of new treatments, including Alzheimer’s medications, and will impact millions of beneficiaries.
Medicare beneficiaries should expect to pay more for coverage in 2026. According to the Centers for Medicare & Medicaid Services (CMS), Part B premiums are increasing by about 9.7%, reaching $202.90 per month for an individual and $405.80 per couple. That is the highest premium increase since 2022, nearly double that of 2025’s 6% premium increase. Expect to pay roughly $17.90 more monthly ($214.80 annually) or $35.80 more monthly as a couple ($429.60 annually).
One factor contributing to higher Part B premiums is the cost of new treatments, including Alzheimer’s medications such as Leqembi (lecanemab). In August 2025, the FDA approved a subcutaneous shot, Lequmbi Iqlik, that can be given through an autoinjector once a week at home. Patients who have completed the initial 18-month IV therapy are eligible.
Medicare continues to cover these drugs for eligible patients under strict criteria, such as confirmation of beta-amyloid plaques and enrollment in a CMS-approved registry. While this coverage is crucial for patients and families, it also adds financial pressure to the Medicare program, which is reflected in rising premiums.
With Medicare Part B premiums rising to $202.90 in 2026, now is the time to review your options. Call (623) 223-8884 and speak with a local licensed insurance agent today. Explore Medicare Advantage, Medicare Supplement, and Part D plans that could help manage your costs.
The Part D out-of-pocket cap and deductible for Part D prescription drug plans are increasing in 2026, which may raise upfront and overall prescription costs. These changes are designed to account for inflation while maintaining protections for seniors with high medication expenses.
The Part D annual out-of-pocket spending cap, introduced in 2025 at $2,000, will rise by 5% to $2,100 in 2026, according to the Centers for Medicare & Medicaid Services (CMS). Once you spend $2,100 on covered prescription drugs in a calendar year, your plan covers the rest. The $100 increase is significant for seniors on a fixed budget.
In addition, the maximum Part D deductible will rise by 4.2%, increasing from $590 in 2025 to $615 in 2026. This means beneficiaries will pay slightly more upfront before drug coverage begins.
Review your Part D options during the Annual Enrollment Period to protect your wallet from rising prescription costs. Call (623) 223-8884 to speak with a local licensed Medicare insurance agent before December 7, 2025.
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Local, licensed insurance agents with 25+ years of experiencePart D prescription drug plan premiums are expected to rise about 6% in 2026, reflecting higher spending on specialty drugs. Reviewing and comparing plans during AEP can help beneficiaries manage these rising costs.
According to the Centers for Medicare & Medicaid Services (CMS), the base premium for Part D prescription drug plans is expected to rise around 6% to $38.99 monthly. This is the base premium for a standalone prescription drug plan without Income-Related Monthly Adjustment Amounts (IRMAA). Part D costs vary by plan and county.
Diabetes is the leading cause of Medicare Part D premium increases. GLP-1s are prescribed for diabetes or cardiovascular disease, and weight loss is a side effect. According to the Kaiser Family Foundation, spending on GLP-1 medications rose from $56.8 million in 2018 to $5.7 billion in 2022, and spending is climbing. According to JAMA, in the next 10 years, 30 million Medicare beneficiaries will be eligible for GLP-1RAs for obesity treatment, reaching $8 billion in Medicare spending.
The Annual Enrollment Period is the best time to review your Medicare Part D coverage. Call (623) 223-8884 and speak with a local licensed insurance agent to compare plans and manage rising prescription costs in 2026.
Agent tip:
“Medicare costs are rising in 2026, with higher Part B and Part D premiums and deductibles. These increases can quickly add up, but you may be able to manage expenses by comparing Medicare Advantage, Medicare Supplement, and Part D plans during the Annual Enrollment Period. Reviewing your coverage before December 7 can help you find a plan that better fits your health needs and budget.“
For the first time in Medicare history, government-negotiated prices will allow beneficiaries to pay significantly less for some of the costliest drugs.
One of the most historic Medicare changes in 2026 will be launching the first-ever negotiated drug prices under the Inflation Reduction Act. Beginning January 1, 2026, Medicare beneficiaries will see lower costs for 10 high-expense medications—used to treat diabetes, heart failure, blood cancers, and osteoporosis—with discounts ranging from 38% to 79%.
Since most of these drugs have no generic alternatives, the negotiated prices are expected to deliver substantial savings for millions of seniors while marking the start of a new era in Medicare’s ability to make prescription drugs more affordable.
These negotiated prices offer substantial savings for Medicare beneficiaries:
If you take any of these popular medications, you may see significantly lower out-of-pocket costs.
These price reductions for seniors managing chronic conditions can lead to significant out-of-pocket savings, making essential medications more affordable and accessible. During the Annual Enrollment Period, check if your current medications are on this list to maximize your savings. Call (623) 223-8884 to speak with a local licensed insurance agent today.
The Medicare Prescription Payment Plan will automatically re-enroll participants in 2026 unless they opt out. This ensures continued financial relief for those managing high drug costs.
The Medicare Prescription Payment Plan (MPPP), introduced in 2025 to help spread out high drug costs, will automatically re-enroll participants in 2026. According to CMS, your enrollment will continue unless you actively opt out. Plans must process opt-out requests within three business days, and they must send renewal notices after the close of AEP.
The MPPP can provide crucial financial relief for beneficiaries with high upfront prescription costs. But if your circumstances change or you prefer to pay costs all at once, it is vital to respond promptly to opt-out communications to avoid unwanted charges.
If you are enrolled in a plan with Connie Health, we can help you with your MPPP enrollment or opt-out requests. We’re here to support you throughout your Medicare journey. Call (623) 223-8884 to speak with a local licensed insurance agent today.
Free, unbiased serviceCompare all major plans and carriers Local, licensed insurance agents with 25+ years of experienceMedicare–Medicaid Plans (MMPs) will end in 2025, and dual-eligible beneficiaries will transition to new Medicare Advantage D-SNP plans. States and insurers are working to ensure coverage continues without interruption, but a plan review is recommended.
The demonstration program that combined Medicare and Medicaid benefits for dual-eligible beneficiaries will close on December 31, 2025. These Medicare–Medicaid Plans (MMPs) served about 235,000 people nationwide, and starting in 2026, enrollees will need to transition to new Medicare Advantage Dual-Eligible Special Needs Plans (D-SNPs). According to CMS, individuals in these states may be enrolled in an MMP.
| California | Ohio |
| Illinois | Rhode Island |
| Massachusetts | South Carolina |
| Michigan | Texas |
| New York (FIDA-IDD Model) |
Some beneficiaries will be automatically moved to new coverage, while others must make an active selection. States and insurers are working to ensure that no one loses coverage. Still, dual-eligible individuals and their caregivers should pay close attention to transition notices and enrollment instructions to avoid disruptions in care.
If you’re enrolled in an MMP or are unsure, schedule a time to review your Medicare plan during the Annual Enrollment Period. Call (623) 223-8884 early so you do not have an interruption in care or coverage.
Starting in 2026, certain services under Original Medicare will require prior authorization in six states through the WISeR program. This change aims to reduce unnecessary spending while ensuring appropriate patient care.
Original Medicare will require prior authorization for certain services under the WISeR (Well-Integrated System for Enhanced Review) model for the first time. Beginning January 1, 2026, this requirement will apply in six states: Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington.
Seventeen services will require pre-approval. Review the services below, grouped by treatment type, to see if your care may be impacted where you live.
| Deep Brain Stimulation for Essential Tremor and Parkinson's Disease | Sacral Nerve Stimulation for Urinary Incontinence |
| Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea | Vagus Nerve Stimulation |
| Phrenic Nerve Stimulator |
| Arthroscopic Lavage and Arthroscopic Debridement for the Osteoarthritic Knee | Percutaneous Image-Guided Lumbar Decompression for Spinal Stenosis |
| Cervical Fusion | Percutaneous Vertebral Augmentation for Vertebral Compression Fracture |
| Epidural Steroid Injections for Pain Management (excluding facet joint injections) | Spinal Fusions |
| Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds | Skin and Tissue Substitutes |
| Diagnosis and Treatment of Impotence | Incontinence Control Devices |
| Electrical Nerve Stimulators |
Artificial intelligence will help process requests quickly, but clinicians will still make the final decisions. The goal is to reduce unnecessary spending without interfering with appropriate patient care.
If you live in Arizona, New Jersey, Ohio, Oklahoma, Texas, or Washington, review your Medicare coverage during the Annual Enrollment Period. Call (623) 223-8884 to speak with a local licensed insurance agent to understand WISeR prior authorization requirements and ensure your plan meets your needs for 2026.
The 2026 Medicare changes bring a mix of higher costs and critical new protections. Part B and Part D premiums are rising, deductibles are increasing, and prior authorizations are on the rise. Still, beneficiaries will benefit from negotiated drug prices and a cap on out-of-pocket prescription costs. Reviewing your plan options during the Annual Enrollment Period is essential to ensure your coverage, costs, and preferred providers meet your healthcare needs.
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Yes. Medicare covers all recommended adult vaccines at no cost under either Part B or Part D.
No. If enrolled in 2025, you will automatically re-enroll in 2026 unless you opt out.
No. States and insurers will transition beneficiaries to new plans so your coverage continues without interruption. However, reviewing your new plan to ensure it meets your healthcare needs is still important.
Starting January 1, 2026, Medicare’s negotiated prices will reduce out-of-pocket costs for 10 high-cost Part D drugs, benefiting millions of beneficiaries. These include Eliquis and Xarelto for preventing blood clots and strokes; Jardiance and Farxiga for managing diabetes, heart failure, and kidney disease; Januvia and Fiasp/NovoLog for diabetes control; Entresto for heart failure; Enbrel for rheumatoid arthritis and psoriasis; Imbruvica for blood cancers such as leukemia; and Stelara for psoriasis, Crohn’s disease, and ulcerative colitis.
Yes. Comparing plans during AEP can help manage prescription costs and avoid surprises.
Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington. Beneficiaries in these states should check coverage requirements.
Read more by Renee van Staveren
Since 2009, I've been writing about complicated, technical issues, with the goal of making topics like Medicare and healthcare easier to understand. I've been writing about Medicare since 2021 and healthcare since 2019. I am an AmeriCorps alumni. I enjoy gardening, reading, and DIYing.
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