For me (and other Medicare agents), this is the busiest time of the year.
Not just because of Medicare open enrollment from October 15 – December 7. I also need to learn about the changes coming up for Medicare for next year.
If you’re on Medicare (or about to be), some big changes are coming up for 2026, including:
- Higher premiums and deductibles
- New rules for prescription drugs
- Increased use of artificial intelligence
So, before 2025 open enrollment starts, let’s take a look at the upcoming changes to Medicare and how they might affect your coverage.
Higher Costs for Part A and Part B
Your out-of-pocket costs for Part A and Part B (a.k.a. “original Medicare”) will go up in2026:
- Part B premiums will increase to $206.50/month (an 11% increase from 2025)
- The Part B deductible will climb from $257 to $288 per year
- The Part A deductible will go up by $40/year (from $1676 to $1716)
- If you have to pay a Part A premium (meaning you didn’t have 40 quarters of work history to qualify for free Part A), your monthly Part A premium will increase to either $310 or $563 depending on your work history.
What’s the impact on you? Although the cost increases may not seem large in terms of dollars, most people on Medicare are on fixed incomes. Even a small increase in costs can have a significant effect on your monthly budget.
Prescription Drug Costs: New Caps and Negotiated Prices
Medicare Part D, which provides prescription drug benefits, will see some changes in 2026.
- Medicare introduced a $2000 cap on annual drug costs in 2025. For 2026, this will increase to $2100.Although this cap has gone up slightly, it still protects seniors from unlimited out-of-pocket drug costs.
- The maximum deductible Part D plans can charge is also going up, from $590 in 2025 to $615 in 2026.
- In 2026, Medicare will negotiate with drug companies to implement reduced prices for some expensive medication
- Starting next year, you can enroll in the Prescription Payment Program. This lets you spread your prescription costs out over the year. If you enroll in this program, you’ll be automatically re-enrolled in following years unless you opt out.
These changes mean drug coverage will be a little more predictable and, hopefully, more affordable for people with high medication needs.
What About Medicare Advantage?
Medicare Advantage (Part C) plans, which deliver Medicare benefits through private insurance providers, will also see some changes in 2026.
Government payments to these plans are expected to rise by just over 5%. That could mean more plan options and extra benefits for enrollees, but it may also lead to premium adjustments depending on the plan you choose.
Prior Authorization Comes to Traditional Medicare
Prior authorization for some procedures has been limited to Medicare Advantage plans…until now.
In 2026, Medicare will begin a pilot program to require prior authorization for some outpatient services. The pilot program will be limited to six states: Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington.
In addition, artificial intelligence (AI) will be used to help review requests. A licensed clinician will, however, make the final decision.
Medicare’s stated intent is to cut down on unnecessary procedures and costs. But there are concerns that the new system could increase delays or denials for some procedures.
What You Need to Do Now
If you’re on Medicare (or will be), these changes mean you’ll want to:
- Budget for higher premiums and deductibles
- Review your drug coverage carefully during open enrollment to make sure your plan still works for you.
- If you’re in one of the pilot states for prior authorization, your experience with Original Medicare may be different in 2026.
- Schedule a meeting with your Medicare advisor before Open Enrollment. He or she should have the most up-to-date information about the impact of the new Medicare rules on your coverage.
The bottom line: 2026 will bring some Medicare cost increases but also additional protections…especially when it comes to prescription drug spending.
Be proactive and stay informed to make sure you get the most from your Medicare coverage in 2026.
Want to learn more about the upcoming changes for Medicare in 2026? I’m here to help you sort through the noise and make sure you get the most from your Medicare coverage
Give me a call at (832) 773-7981, email me at scott.goodell@ghstx.com, or go to https://goodellhealthsolutions.com and use my contact form if you want to make an appointment or ask me a question.
Remember…at Goodell Health Solutions, we put the “Care” in Medicare.
Scott Goodell
Goodell Health Solutions
We Put the “Care” in Medicare