Medicare Changes for 2026 That You Need To Know

[Last updated September 19, 2025]

Choosing a Medicare plan can be complicated and stressful, especially with new changes each year. Open enrollment for making changes to your Medicare plan runs from October 15 to December 7, with updates taking effect on January 1. Some new developments will come in 2026, and understanding the changes can help you make informed choices. Here’s a look at what’s changing in original Medicare, Medicare Advantage, and Medigap, and what it all means for you.

Note: The Centers for Medicare and Medicaid Services (CMS) issues many of Medicare’s pricing changes. They traditionally publish them in October or November of each year, which is already within the open enrollment period. This report presents any already-published prices as of the time of publication as well as pricing projected by credible industry sources.

Here’s a breakdown of the key changes coming in 2026 for both original Medicare and Medicare Advantage.

Changes to original Medicare (Part A and Part B)

If you have chosen to receive your Medicare coverage through original Medicare, you can expect the following changes in 2026:

• Part A (hospital insurance) cost adjustments: Rates, most of which are still awaiting CMS publication, include:
  • Hospital deductible: Projected at $1,716 per benefit period in 2026, up from $1,676 in 2025.
  • Inpatient-stay coinsurance: Projected at $429 in 2026 for days 61 to 90 and $858 for lifetime reserve days, up from $419 and $838, respectively, in 2025. There is no coinsurance for the first 60 days after paying the deductible.
  • Part A monthly premium: If you don’t qualify for the $0 premium, rates are projected at $310 and $563 in 2026, up from $285 and $518 in 2025.
  • Skilled nursing facility coinsurance: Projected at $214.50 in 2026 for days 21 to 100, up from $209.50 in 2025. The first 20 days cost $0, and after day 100, you pay all costs.

• Part B (medical insurance) cost adjustments: Rates include:
  • Part B monthly premium: Projected to increase to about $206.50 in 2026, up from $185.00 in 2025. This significant jump of over 11% could consume a large portion of the Social Security cost-of-living adjustment (COLA) increase for many beneficiaries on a fixed income.
  • High-income premiums: Projected as high as $702.10 in 2026 (up from $628.90 in 2025) for high-income beneficiaries who must include the income-related monthly adjustment amount (IRMAA).
  • Part B annual deductible: Projected to be $288 in 2026, up from $257 in 2025.
• Proposed prior authorization pilot program: Anticipated to start in 2026, a pilot program in six states (Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington) may require prior authorization for 17 specific medical services under original Medicare. According to CMS, the purpose is to reduce unnecessary procedures and combat fraud. In practice, this may lead to increased paperwork and potential delays for beneficiaries in those states. In fact, an amendment has been passed by the House of Representatives to block funding for the pilot program, so its implementation will be monitored.

Changes to stand-alone Part D (prescription drug coverage) plans

If you have original Medicare, you have likely purchased a private insurer’s Part D prescription drug plan. Here’s how those plans will change for 2026:

• Part D cost adjustments: Adjustments will depend on which plan you select.
  • Part D annual deductible: The maximum deductible is increasing to $615 in 2026 from $590 in 2025.
  • Part D out-of-pocket cap: The annual cap (“catastrophic threshold”) on prescription drug costs will be $2,100 in 2026, adjusting for inflation from $2,000 in 2025. Once you hit the cap, you pay nothing for covered drugs for the rest of the year.
  • High-income premiums: Projected as high as $91 above your plan premium in 2026 (up from $85.80 in 2025) for high-income beneficiaries who must include the income-related monthly adjustment amount (IRMAA).
  • The national base beneficiary premium (which serves as a baseline for how much people might pay for Part D): $38.99 in 2026, up from $36.78 in 2025.
• Insulin costs: Starting in 2026, the maximum monthly cost of insulin will be the lesser of $35 or 25% of other federally negotiated pricing, not subject to any deductible.
• Free vaccines: Free vaccines are now a permanent feature of Part D plans, with deductibles and cost sharing being waived for the adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP).
• Drug price negotiation: A landmark provision of the Inflation Reduction Act takes effect in 2026. The negotiated prices for the first 10 drugs covered under Medicare Part D will go into effect, which should lower costs for both beneficiaries and the government. Drugs include Eliquis, Enbrel, Entresto, Farxiga, Imbruvica, Januvia, Jardiance, Fiasp/NovoLog, Stelara, and Xarelto.
• Medicare Prescription Payment Plan: The Medicare Prescription Payment Plan spreads the costs of prescription drugs over the calendar year instead of paying in full at the pharmacy counter. Beginning in 2026, if you have opted in, your plan participation will be automatically renewed each year until you opt out.

Changes to Medigap, an optional add-on to original Medicare

Many original Medicare beneficiaries choose to supplement their coverage with a Medigap plan, which “fills the gaps” in Medicare coverage to cover things like copayments, coinsurance, and deductibles. These plans are also called Medicare supplement insurance. 

Here’s what to be aware of for 2026:

• Medigap cost adjustments: Medigap plans themselves don’t change structurally from year to year, but their premiums are directly affected by higher Part B costs, medical inflation, and insurer loss rates. An increase in those costs directly translates to higher premiums for Medigap policyholders.
  • Monthly premiums: Premiums that ranged from $100 to $300 in 2025 are projected to increase, on average, by 8% to 12% in 2026. 

Changes to Medicare Advantage

Medicare Advantage (also called Medicare Part C) plans are private insurance alternatives to original Medicare. While they can be appealing due to their low premiums and extra benefits, several changes are worth noting for 2026.

• Part C cost adjustments: Adjustments will depend on which plan you select.
  • Part C monthly premiums: Premiums are expected to increase, as “payments from the government to MA plans are expected to increase on average by 5.06% from 2025 to 2026.”
  • Part C out-of-pocket cap: CMS has not yet published the annual out-of-pocket maximums for in-network and out-of-network services. In 2025, they were $9,350 for in-network services and $14,000 for combined in- and out-of-network services.
• List of non-allowable special supplemental benefits for the chronically ill (SSBCI) on Medicare Advantage: SSBCI are benefits that aim to address nonmedical factors that impact a person’s management of chronic conditions by offering benefits related to nonmedical items and services. These items and services “must have a reasonable expectation of improving or maintaining the health or overall function of the chronically ill enrollee.” In 2026, new provisions will formalize excluding benefits for things like non-healthy food, alcohol, tobacco, life insurance, and more. 
• Aforementioned proposed prior authorization pilot program: As we mentioned above, the pilot program anticipated to start in six states in 2026 (Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington) could require prior authorization for 17 specific medical services, which would also impact Medicare Advantage plan enrollees. Already, 99% of Medicare Advantage enrollees are required to get prior authorization for some services, mostly high-cost services. CMS is justifying the pilot program to reduce unnecessary procedures and combat fraud. 
• Streamlined appeals process: Starting in 2026, Medicare Advantage plans must follow new rules that make it easier for enrollees to appeal denied services. The changes require plans to clearly notify enrollees of denials, treat more coverage decisions as appealable, and limit when approvals can be taken back.

2026 Medicare: What’s changing

Coverage area	2025 cost	2026 cost (actual or projected)
Part A (hospital care)	$1,676 hospital deductible	$1,716 hospital deductible
	$419/day coinsurance after 60 days	$429/day coinsurance after 60 days
	$838/day after 90 days (lifetime reserve)	$858/day after 90 days (lifetime reserve)
	$0–$518 monthly premium	$0–$563 monthly premium
	$209.50/day in skilled nursing (days 21–100)	$214.50/day in skilled nursing (days 21–100)
Part B (medical care)	$185 monthly premium	$206.50 monthly premium
	$628.90 max monthly premium for high-income earners	$702.10 max monthly premium for high-income earners
	$257 annual deductible	$288 annual deductible
Part D (prescription drugs)	$590 deductible	$615 deductible
	+$85.80/month monthly premium max for high-income enrollees	+$91/month max monthly premium for high-income enrollees
	$36.76 base premium	$38.99 base premium
	$2,000 yearly cap on drug costs	$2,100 yearly cap on drug costs
Medigap (supplement plans)	$100–$300 monthly premium (average)	Premiums expected to rise 8–12% on average
Medicare Advantage (Part C)	Max out-of-pocket: $9,350 in-network, $14,000 combo in- and out-of-network	2026 limits not yet set

By understanding the changes to Medicare for 2026, you can feel more confident in your decision and choose the best plan for your needs and budget, whether it’s during the upcoming open enrollment period or any change period in the future.