- Medicare is the federal health insurance program for Americans age 65 and older.
- Open enrollment for Medicare plans for 2026, also known as Annual Enrollment Period (AEP), runs from October 15 to December 7.
- Some of the changes for 2026 include increased monthly premiums and out-of-pocket costs for prescription drugs.
There are a few changes coming January 1st that consumers should take note of. medicareThe federal health insurance program for adults 65 years of age and older in the United States.
Every year, seniors celebrate from October 15th to December 7th. cheap Sign up for Medicare or change plans.
- Part A helps cover inpatient care in hospitals, skilled nursing facilities, and home health care.
- Part B is for outpatient coverage, including diagnosis and treatment of illnesses in a hospital, as well as preventive services such as vaccines and wellness visits.
- Part CAlso known as Medicare Advantage plans, are bundled coverage that includes Parts A, B, and sometimes Parts A. d.
- Part D provides coverage for prescription drugs.
There are several changes to Medicare Advantage and Part D coverage plans in 2026. This article aims to explain what these changes will look like.
The Centers for Medicare and Medicaid Services (CMS) estimates: 5,600 By 2026, Medicare Advantage plans will be available nationwide. This is similar to the 2025 figure. number of options It decreased compared to the previous year.
The number of plans available to individual Medicare beneficiaries varies by state.
Additionally, some Medicare Advantage providers, including UnitedHealthcare, presentation plan to reduce Service area and/or coverage options.
The average monthly premium for a Medicare Advantage plan with prescription drug coverage is expected to be: decrease It will increase from $16 in 2025 to $14 in 2026.
It is roughly estimated as follows. 81% of Medicare beneficiaries are enrolled. Part DCovers prescription drug costs.
CMS estimate The monthly premium for a standalone Part D plan will decrease from $38 in 2025 to $34 in 2026. Premiums for Part D, part of Medicare Advantage plans, will be reduced slightly from $13 to $11 per month.
However, insurance companies Increase allowed Part D premiums will be up to $50 per month, up from the current maximum of $35 per month.
Medicare officials will continue to price negotiation For drugs covered under Part D.
Experts say it could be so. result The regular prices of 10 widely used prescription drugs, including blood thinners Eliquis and Xarelto, and diabetes drugs Januvia, Jardiance, and Farxiga, are discounted by 38% to 79%.
People with Part D plans will continue to Automatic Prescription Payment Plan This spreads the cost of the drug over the year. People who currently have this plan will automatically re-enroll in 2026 unless they opt out.
Medicare beneficiaries may feel the impact of increased premiums.
“The increased cost of health insurance premiums will be significant as prices for other goods and services rise, which means less money in consumers’ pockets.”
— Kanwar KellyMD, an expert in ENT, head and neck surgery, obesity medicine, and lifestyle medicine, is the co-founder and CEO of Side Health in Orinda, California.
Despite these price cuts, experts say some Medicare beneficiaries could still end up paying more for their prescription drugs.
“While prices for Part D (drug benefits) may be lower overall, fewer options and changes to covered drugs may result in higher costs for consumers of certain specialty drugs,” Kelley said.
The annual out-of-pocket limits for in-network services for Medicare Advantage beneficiaries are as follows: slightly decreased It increases from $9,350 in 2025 to $9,250 in 2026.
Annual out-of-pocket limit for Part D drugs will increase from $2,000 in 2025 $2,100 In 2026.
The out-of-pocket maximum for insulin will remain the same. $35 every month, and most of the time vaccine continuously Subject to Part D.
However, earlier this year the Trump administration decide against Medicare covers the cost of GLP-1 weight loss drugs like Ozempic. However, this class of drugs is still covered when prescribed for other reasons, such as type 2 diabetes and certain heart conditions.
There are several changes to Medical Advantage plan services that may benefit consumers.
that Find a health plan A tool provided by Medicare to help enrollees determine whether doctors and hospitals are in a Medical Advantage plan network.
The first runs from January 1 to March 31. registration desk Participants can switch Medicare Advantage plans if they discover that their health care providers are not in the network covered by their current plan.
The second begins on December 8 and lasts until February 28. Registrant wishing to register For a new Medical Advantage plan if your current coverage ends.
“Beneficiaries should be proactive during their Medicare annual enrollment period, as comparing plans from multiple insurers can help people save money and find the right option for them.”
— whitney stadVice President of eHealth Consumer Activation
Enrollees may also be able to sign up for a new Medicare Advantage plan between January 1 and December 1 if they discover they were given inaccurate information about whether a health care professional was in their network.
Elderly people can also use it Special registration period You have a qualifying life-changing event or you turn age 65 in 2026.
There may also be uncertainty If the federal government shutdown lasts for an extended period of time..
One is that there may be delays in processing beneficiary claims and payments to health care providers.
Another thing is that telehealth services may decline. This may impact patients with mobility issues, those living in rural areas, or individuals with caregiver limitations. Some telehealth programs that had been offered in previous years expired on Oct. 1, and Congress has taken no action to renew them.
