10 Big Medicare Changes in 2026: Higher Premiums, Drug Price Drops, and Looming Program Cuts
- Craig Jennings
- Aug 29
- 4 min read
Medicare rules, costs, and benefits change every year, but some coming up in 2026 could have a bigger impact on your health and your wallet than usual. Along with having to pay fairly standard price increases, you may be affected by uncertainty across the health insurance market because of changes related to the new presidential administration and the GOP’s “One Big Beautiful Bill Act” (OBBBA) have created.
These ripple effects may make your plan choices and access to care more complicated. Here’s what to know about the major ways Medicare is changing in 2026 and how it might affect your coverage.
Key Takeaways
Medicare Part B and Part D prices are expected to rise, with some increases hitting double digits.
You’ll face slightly higher maximum out-of-pocket drug costs, but new negotiated drug prices could save you on insulin and other expensive drugs.
Medicare Advantage plans are scaling back on extra perks, while Original Medicare is testing new prior-approval requirements, introducing new trade-offs.
Recent Medicaid cutbacks could directly impact people who qualify for both Medicare and Medicaid, and indirectly affect all Medicare users.
Open enrollment starts October 15. Prepare by reviewing these changes, exploring all options, and consulting with a Medicare expert.
1. You’ll Pay More for Medicare Parts B and D
Premiums for Medicare Part B (medical insurance that helps pay for doctor visits and medical equipment) are projected to rise 11.6%, from $185 to $206.50, while Part D (optional prescription drug coverage) base beneficiary premiums are expected to increase by an estimated 6%, from $36.78 to $38.99.1
But the base beneficiary premium is just the starting place for calculating the plan-specific premiums. Part D plans are offered by private companies, which haven’t yet released the actual premiums. Yours could be higher or lower than the base beneficiary premium. Many Part D plans, especially those offered with Medicare Advantage plans, have $0 premiums.
Other costs are getting more expensive, too, with Part B’s deductible expected to rise by 12%, from $257 to $288, and Part D’s deductible slated to go from $590 to $615.
Medicare year-over-year cost increases aren’t new. They typically tie to inflation—specifically, the rising cost of health care. (Last year, the Part B premium increased by $10.30.)2 Still, the cost hikes can strain budgets, particularly for cash-strapped seniors.
“The lower your income, the more fixed your income, the more you’re going to feel it,” said George Huntley, CEO at the Diabetes Patient Advocacy Coalition.
2. Part D’s Catastrophic Threshold Is Going Up
The Inflation Reduction Act (IRA) instituted a cap on out-of-pocket drug costs for people with Medicare Part D. This catastrophic threshold is similar to an out-of-pocket maximum in other health plans, but it just applies to prescription drugs. After you meet it, the plan pays 100% of your costs. The threshold will increase in 2026 from $2,000 to $2,100.3
Even with the increase, “for seniors on fixed income or low income, there’s strong protection against catastrophic drug costs,” said Harry Nelson, health care attorney and managing partner of Nelson Hardiman.
3. It’ll Get Easier to Participate in Prescription Payment Plans
Last year, you had the chance to sign up for the Medicare Prescription Payment Plan (MPPP), which allows you to spread your out-of-pocket drug costs across the calendar year instead of paying everything at once at the pharmacy if you have a Part D plan.
This year, if you sign up for the payment plan, it’s going to be easy to keep the payment plan going in the future without having to think about it. If you enroll in 2026, you’ll automatically stay enrolled in 2027 unless you opt out.4 You’ll get a renewal notice at the end of each election period outlining any new terms and conditions. If you decide to leave, providers must process your request within three calendar days.
4. Your Medicare Advantage Plan Might Have Fewer Supplemental Benefits
Beginning in 2026, Medicare Advantage (MA) Plans, a long-time alternative to Original Medicare, are getting new guardrails on what they can offer under Special Supplemental Benefits for the Chronically Ill (SSBCI). SSBCI are non-medical benefits that are supposed to contribute to the well-being and functioning of people with certain chronic conditions. Now, they must exclude:
Non-healthy food
Alcohol
Tobacco
Life insurance4
The new provisions continue a trend that has seen private insurers pare back MA plan supplemental benefits, including for over-the-counter medications, transportation services, nutrition services, and meals, in recent years.
However, Nelson said these changes don’t represent a fundamental reshaping. “They’re kind of sanding down the edges,” he said. Plus, the scale back could encourage seniors to focus on a plan’s core value.
“For the individual, it does remove the distractions,” said Brandy Thompson, CEO of benefitbay, a platform that helps employers offer their employees money to buy health insurance, including Medicare Supplement plans. In prior years, “they may have just focused on that supplemental thing that was eye-catching … Now they're going to be forced to make the decision on actual network access, drugs, and their needs.”
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