Key Changes for Medicare in 2026

 

Key changes for Medicare in 2026 include a $2,100 cap on yearly out-of-pocket prescription drug costs, the first year of Medicare negotiating prices for some high-cost drugs, free recommended adult vaccines with no cost-sharing, and a $35 monthly cap for insulin. However, Part B premiums are projected to increase, and the Part D deductible and out-of-pocket cap are rising to $615 and $2,100, respectively.

 

Prescription Drugs (Part D) 

• Out-of-Pocket Cap: The yearly out-of-pocket cost for covered Part D drugs will be capped at $2,100.

• Drug Price Negotiation: Medicare will begin negotiating prices for certain high-cost drugs under the Inflation Reduction Act, potentially leading to lower costs.

• Part D Deductible: The Part D deductible will increase to $615.

• Insulin Cost Cap: Monthly costs for insulin will be capped at $35 or 25% of the negotiated price, whichever is lower.

• Free Vaccines: All recommended adult vaccines will be covered with no deductible or copay.

 

Medicare Part B 

• Premium Increase: The standard Part B premium is projected to increase to approximately $206.50 per month.

• Deductible Increase: The Part B annual deductible is also expected to increase to around $288.

 

Medicare Advantage Plans 

• Prior Authorization: Plans must honor prior authorization decisions and appeal outcomes.

• Fewer Supplemental Benefits: Some MA plans may offer fewer supplemental benefits for the chronically ill.

 

Other Changes

• Traditional Medicare Prior Authorization: A pilot initiative will require prior authorization for certain services under Traditional Medicare in six states.