Key Medicare Changes in 2026: What You Need to Know

Medicare is introducing several important changes in 2026 that could impact your healthcare coverage and expenses.

 

Premiums and Deductibles: The average premium for stand-alone Medicare Part D prescription drug plans is projected to decrease by approximately 10%, from $38.31 in 2025 to $34.50 in 2026. ([cms.gov](https://www.cms.gov/newsroom/press-releases/medicare-advantage-medicare-prescription-drug-programs-expected-remain-stable-2026?utm_source=openai)) However, the maximum Part D deductible will increase from $590 in 2025 to $615 in 2026. ([medicareadvocacy.org](https://medicareadvocacy.org/wp-content/uploads/2025/09/Issue-Brief-89-9-16-2025.pdf?utm_source=openai)) Additionally, the annual out-of-pocket cap for prescription drugs will rise slightly to $2,100, up from $2,000 in 2025. ([cms.gov](https://www.cms.gov/newsroom/press-releases/cms-releases-proposed-2026-payment-policy-updates-medicare-advantage-and-part-d-programs?utm_source=openai))

 

Prescription Drug Pricing: Starting January 1, 2026, Medicare will implement negotiated prices for ten high-expenditure Part D drugs, including Eliquis, Jardiance, and Xarelto. These negotiations are expected to result in discounts ranging from 38% to 79% off the 2023 list prices, potentially saving beneficiaries an estimated $1.5 billion in out-of-pocket costs. ([medicarerights.org](https://www.medicarerights.org/medicare-watch/2025/10/09/negotiated-prices-take-effect-for-ten-drugs-in-2026?utm_source=openai))

 

Insulin Costs: The cost for a month's supply of covered Part D insulin will be capped at the lesser of $35, 25% of the Medicare-negotiated Maximum Fair Price, or 25% of your plan’s negotiated price. Notably, no deductible will apply to covered insulin products. ([kiplinger.com](https://www.kiplinger.com/retirement/medicare/medicare-changes-coming-in-2026?utm_source=openai))

 

Medicare Advantage and Part D Plan Availability: Some major insurers are scaling back their Medicare Advantage and Part D plan offerings due to financial pressures. This reduction may lead to fewer plan options in certain regions, potentially affecting beneficiaries' choices. ([kiplinger.com](https://www.kiplinger.com/retirement/medicare/insurers-scale-back-medicare-advantage-and-part-d-plans-for-2026?utm_source=openai))

 

Open Enrollment Period: Medicare Open Enrollment runs from October 15, 2025, to December 7, 2025. During this period, it's crucial to review your plan's Annual Notice of Change to understand any adjustments to benefits, provider networks, or coverage areas. Even if you're satisfied with your current plan, comparing options could lead to savings or better coverage. ([cms.gov](https://www.cms.gov/newsroom/press-releases/medicare-advantage-medicare-prescription-drug-programs-expected-remain-stable-2026?utm_source=openai))

 

Staying informed about these changes will help you make the best decisions for your healthcare needs in 2026. 

Beneficiaries should cross-check personalized details on Medicare.gov or with 1-800-MEDICARE, as regional variations apply.

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