Key Medicare changes for 2026

Key Medicare Changes for 2026

1. Part B Premiums & Deductible

• Projected Increase: According to the 2026 Medicare Trustees Report, the standard Part B premium is expected to rise to $206.50/month, up from $185 in 2025 (a roughly 11.6% increase) medicareresources.orgInvestopedia.

• Projected Deductible: Expected to be $288 in 2026, up from $257 in 2025 medicareresources.org.

• These figures are estimates; final amounts will be confirmed by CMS in fall 2025.

2. Part A Premium & Deductible

• Premium (for 1% of enrollees who pay it): Estimated at $310 or $563/month, depending on work history, both increases from 2025 levels medicareresources.org.

• Deductible: Projected to increase, though specific figures not yet finalized medicareresources.org.

3. Part D (Prescription Drug Coverage)

• Out-of-Pocket Cap: Raised to $2,100 (up $100 from $2,000 in 2025) Kiplingermedicareresources.orgUnitedHealthcare.

• Maximum Deductible: Increased to $615, up $25 from $590 Kiplinger.

• Medicare Prescription Payment Plan for Part-D RX Plans Enhancements:

  • Automatic Enrollment: Those enrolled in 2025 will be automatically re-enrolled in 2026 unless they opt out Kiplinger.

  • Opt-Out Processing: Plans must process opt-outs within 3 calendar days, easing administrative requirements Kiplinger.

• Negotiated Drug Prices: Under the Inflation Reduction Act, Medicare will begin negotiating prices for 10 high-cost drugs in 2026, potentially lowering costs Wikipedia+1.

4. Medicare Advantage (Part C)

• Payment to MA Plans: Government payments are expected to grow by about 5.06% from 2025 to 2026 Centers for Medicare & Medicaid Services.

• Appeals Process: The final 2026 Medicare Advantage rule strengthens inpatient provider appeal rights but leaves some policy details uncertain American Physical Therapy Association.

• Out-of-Pocket Maximum: May see a slight decrease to $9,250 in 2026 from $9,350 in 2025 medicareresources.org.

5. Prior Authorization & Service Restrictions

• Traditional Medicare: Starting January 1, 2026, prior authorization will be required for 17 procedures in six pilot states, potentially affecting coverage for those services under Original Medicare MRC.

• WISeR Model Expansion: CMS will roll out the Wasteful and Inappropriate Service Reduction (WISeR) pilot across six states, requiring prior approval for procedures like neurostimulator implants and knee arthroscopies, while exempting urgent or hospitalization services Diario AS.

6. Other Notable Changes

• Vaccine & Insulin Costs:

  • Adult Vaccines is expected to continue being covered without cost-sharing under Part D Federal Register.

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

• Political & Legislative Impact:

  • The One Big Beautiful Bill Act could trigger massive automatic cuts to Medicare (about $500 billion over 8 years starting in 2026) under PAYGO rules unless offsets are enacted KiplingerMarketWatch.

  • However, the status and impact of this are still evolving and may face revisions in Congress.