What to Expect from Medicare in 2026
By Sandra Kahlon
Medicare is something that touches nearly every family in our community, and each year it brings a few changes. The Centers for Medicare & Medicaid Services has just shared projections for 2026, giving us a sneak peek at what’s ahead. These updates aren’t tied to any specific plan, but they do help us start preparing—and I’m here to walk with you through what the numbers mean in everyday life.
What to Expect in 2026
Cost & Premium Changes
• Medicare Part B Premium & Deductible
The standard Part B premium is projected to rise to $206.50/month, marking an 11.6% increase from 2025 (when it was about $185) The Part B deductible is expected to increase by around 12%, from $257 to $288
• Medicare Part D (Prescription Drug Plans)
◦ Premiums: A base premium projected to rise 6% to $38.99
◦ Deductible: Increasing to $615, up from $590 .
◦ Out-of-Pocket Cap: Will increase to $2,100, up $100 from 2025
• Impact on Social Security Cost-of-Living (COLA)
Although retirees may receive a 2.7% COLA in 2026, much of it may be absorbed by rising Part B costs—a growing concern for retirees on fixed incomes
Prescription Drug Reforms & Savings
• Medicare Drug Price Negotiations
Under the Inflation Reduction Act, Medicare will begin negotiating prices for select high-cost drugs in 2026. These price cuts—estimated to be at least 38% per drug on ten common medications—are expected to save beneficiaries significant out-of-pocket costs
• Insulin Cost Cap
The $35 monthly cap on insulin costs (introduced earlier) will now offer even more savings. The cost to beneficiaries will be the lesser of $35, 25% of the maximum fair price, or 25% of the negotiated price under their plan.
• Vaccines Remain Free
Cost-sharing for adult vaccines recommended by the ACIP (e.g., COVID-19, RSV, shingles) remains permanently eliminated under Part D. However, changes in administration or supply could affect availability.
Administrative & Structural Updates
• Medicare Prescription Payment Plan (MPPP)
Beneficiaries enrolled in the plan—allowing prescription costs to be spread over the year—in 2025 will be automatically re-enrolled in 2026, unless they opt out. Opt-out requests must be processed within three calendar days.
• Medicare Advantage (MA) & Part D Policy Changes
CMS finalized a range of changes affecting MA and Part D covering prescription payment plans, drug price negotiations, Star Ratings, dual-eligible special needs (D‑SNPs), and other programmatic areas effective for coverage starting January 1, 2026.
• Medicare Advantage Plan Payments
CMS will increase payments to MA plans by approximately 5.06% in 2026, helping stabilize program funding.
What Beneficiaries Should Know & Consider
1. Cost Increases Are Real
With Part B and D premiums, deductibles, and drug caps rising, beneficiaries should evaluate their coverage options—during open enrollment (October 15 to December 7)—to potentially lower expenses.
2. Maximize Savings Through Negotiated Drug Price Programs
Beneficiaries should stay informed about which drugs are included in negotiation programs and how those savings apply to their plans and if their drugs will continue to be in their plans formulary for 2026.
3. Opt-Out Decisions for Payment Plans
Automatic re-enrollment in the prescription payment plan requires awareness—those who want to opt out must act and do so promptly.
4. Keep an Eye on MA Plan Changes
If enrolled in MA, look for plan communications detailing benefit shifts, especially regarding coverage and nonmedical supplemental benefits. Your ANOC (Annual Notice of Change) will arrive no later than October 1st. Many plans will be discontinued for 2026 so it’s important to read all communications sent to you by your plan.
This year, it’s more important than ever to work with a trusted advisor or do your own research at medicare.gov to ensure you make the best choice for 2026. If you have questions about how these numbers might affect you—or if you’d simply like to talk through your Medicare choices — I’d love to help. Please feel free to reach out, or join me at one of our upcoming educational meetings at the co-op.
Sandra Kahlon has been in the healthcare industry for over 30 years. She specializes in helping you understand when and how to enroll in Medicare. She will answer your questions and clarify the insurance options you have. Her clients are located all across the United States, giving her a deep knowledge for the insurance landscape. www.SandraKahlonServices.com
View all the Coop Scoop Blog posts here.