2026 Medicare Changes: What Retirees Must Know
Major Changes Coming in 2026
Medicare changes are happening once again in 2026. These new changes may save you money or affect your coverage. Whether you’re turning 65 soon or already on Medicare, here’s what you need to know before the next enrollment period.
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1. Your Drug Costs Are Now Capped at $2,100
The Big Change: If you have Medicare drug coverage (Part D), your yearly out-of-pocket Part D drugs will be capped at $2,100 in 2026. Once you reach this cap, you won’t have to pay a Copayment or Coinsurance for covered Part D drugs for the rest of the calendar year.
What This Means for You:
- No more surprise bills after you hit the limit
- You’ll know your maximum drug spending upfront
- Especially helpful if you take expensive medications
2. Insulin Costs Stay Low at $35 Per Month
Plans can’t charge you more than $35 for a one-month supply of each Part D-covered insulin you take, and you don’t have to pay a Deductible for insulin.
What This Means for You:
- Predictable costs if you use insulin
- No deductible to meet first
- Similar caps on costs apply for traditional insulin used in Part B-covered insulin pumps.
3. New Advanced Primary Care Benefits
The Big Change: Medicare now pays for Advanced Primary Care Management services each month where your doctor or other Health care provider coordinates and tailors care to your needs. Providers that offer these services must give you 24/7 access to your care team or provider and more.
What This Means for You:
- Better coordination between your doctors
- Round-the-clock access to your care team
- More personalized care planning
Action Step: Ask your Primary care doctor if they offer Advanced Primary Care Management services.
4. More Colorectal Cancer Screening Options
Medicare covers a wide range of colorectal cancer screenings, including computed tomography (CT) colonography.
What This Means for You:
- Medicare covers this screening test once every 24 months if you’re 45 or older and at high risk for colorectal cancer. If you aren’t at high risk, Medicare covers the test once every 60 months, or 48 months after a previous sigmoidoscopy or colonoscopy.
- You pay nothing if your provider accepts Assignment
- Less invasive option than traditional colonoscopy
5. Negotiated Drug Prices Take Effect
The Big Change: Prices for the initial 10 drugs that Medicare negotiated with participating drug companies will take effect on January 1, 2026.
What This Means for You:
- Lower costs on certain high-price medications
- Savings will vary by drug and your plan
Action Step: Contact your plan for details on how these negotiated prices will affect you.
Standard Costs for 2026 (Not Yet Final)
Important Note: The 2026 Premium amounts, drug costs, and income limits weren’t available at the time of printing.
For comparison, here are 2025 costs:
Part B Premium
The standard Part B premium for 2025 is $185.
Part A Costs (if you have to buy it)
If you buy Part A, you’ll pay a premium of either $285 or $518 each month in 2025 depending on how long you or your spouse worked and paid Medicare taxes.
Higher-Income Adjustments (IRMAA)
If you’re single and your income is above $106,000, or married with an income above $212,000, you are considered to be a higher-income beneficiary. You’ll pay more for both Part B and Part D.
Action Step: Visit Medicare.gov for final 2026 amounts when they’re released.
Important Enrollment Dates for 2026
Annual Election Period (AEP)
October 15 – December 7, 2025
Change your Medicare health or drug coverage for 2026, if you decide to. You can join, switch or drop a Medicare Advantage Plan or Part D drug plan, or switch to Original Medicare during this Open Enrollment Period each year.
What you can do:
- Add, change or drop Part D drug plan coverage
- Switch from Medicare Advantage to Original Medicare (or vice versa)
- Change Medicare Advantage Plans
- Coverage starts January 1, 2026
- Switching Medigap plans can happen year round, but may be subject to Underwriting
Medicare Advantage Open Enrollment Period
January 1 – March 31, 2026
New Payment Option: Medicare Prescription Payment Plan
The Big Change: This payment option works with your current drug coverage to help you manage your out-of-pocket costs for drugs covered by your plan by spreading them across the calendar year (January–December).
What This Means for You:
- Spread drug costs over 12 months instead of paying all at once
- No cost to participate
- This payment option might help you manage your expenses, but it doesn’t save you money or lower your drug costs.
Who it’s NOT for: This payment option may not be the best choice for you if you get or are eligible for Extra Help from Medicare, including if you get coverage from a Medicare Savings Program.
Action Step: Contact your plan to see if this payment option fits your budget.
How to Prepare for 2026
Review Your Current Coverage
Mark your calendar with these key dates! October 1, 2025: Start comparing your current Medicare health or drug coverage with options for 2026. You may be able to save money or get extra benefits.
Check Your Drug List
- Make a list of all prescriptions you take
- Check to find out if the plan you’re enrolled in covers the drugs you use and if you can go to the pharmacies you want.
- See if your drugs are affected by the new $2,100 cap or negotiated prices
Compare Plan Options
Different plans can have very different costs. Compare:
- Monthly premiums
- Drug coverage and costs
- Doctor networks
- Extra benefits (dental, vision, hearing)
Watch Out for These Common Mistakes
1. Missing the Enrollment Deadline
If you don’t enroll in Part B when you’re first eligible for it, you may have to pay a late enrollment Penalty for as long as you have Part B coverage. Also, you may have to wait to enroll, which will delay this coverage.
The penalty: Your monthly premium will go up 10% for each 12-month period you were eligible for Part B, but didn’t sign up for it.
2. Not Understanding How Medicare Works with Employer Coverage
If you’re 65 or older and covered under a Group health plan, either from your own or your spouse’s current employment, you may sign up for Medicare Part B during your Special Enrollment Period (SEP). This means that you may delay enrolling in Medicare Part B without having to wait for a General Enrollment Period (GEP) and paying the penalty for late enrollment.
Important: COBRA and retiree health coverage don’t count as current employer coverage.
3. Contributing to an HSA After Medicare Starts
You can’t contribute to your Health Savings Account (HSA) once Medicare Part A or Part B coverage begins.
To avoid a tax penalty, you should stop contributing to your HSA at least 6 months before you apply for Medicare.
Who Gets Help Paying Medicare Costs?
Extra Help with Drug Costs
You may qualify for Extra Help if you have limited resources and income (tied to the federal poverty level).
2025 income limits:
- Single person: less than $23,475 yearly income, less than $17,600 resources
- Married couple living together: less than $31,725 yearly income, less than $35,130 resources
Automatic qualification: You automatically qualify and don’t need to apply for Extra Help if you have Medicare and meet 1 of the following conditions: Have full Medicaid coverage, Have Supplemental Security Income (SSI), Take part in a state program that pays your Medicare premiums.
Medicare Savings Programs (MSP)
If you can’t afford to pay your Medicare premiums and other medical costs, you may be able to get help from your state. States offer Medicare Savings Programs for people entitled to Medicare who have limited income.
What they cover:
- Qualified Medicare Beneficiary (QMB): Covers Part A premiums and Part B premiums. Medicare providers aren’t allowed to bill you for services and items Medicare covers, including deductibles, coinsurance, and copayments.
- Specified Low-Income Medicare Beneficiary (SLMB): Covers Part B premium only.
- Qualifying Individual (QI): Covers Part B premium only.
Action Step: Contact your state Medicaid office to apply. These programs vary by state.
Questions to Ask Before Changing Plans
- Are my prescriptions covered?
- All plans must cover a wide range of prescription drugs that people with Medicare take, including most drugs in certain “protected classes,” like drugs to treat cancer, HIV/AIDS, depression, psychosis, seizures, or to prevent organ transplant rejection.
- What are my total costs?
- Add up premiums + deductibles + copays + coinsurance
- Plans have a yearly limit on what you pay for covered Medicare services (which may include different limits for in-network and out-of-network services).
- Do I need referrals to see specialists?
- Requirements vary by plan type
Getting Help: Your Free Resources
Medicare.gov
Your Personal Medicare Account
Log into (or create) your secure Medicare account at Medicare.gov to switch to the electronic handbook.
Red Flags: Protect Yourself from Fraud
Warning Signs
Medicare, or your Medicare plan representative, will only call you in limited situations:
- A Medicare plan can call you if you’re already a member of the plan.
- A customer service representative from 1-800-MEDICARE can call you if you’ve left a message.
- If you filed a report of suspected fraud, you may get a call from someone representing Medicare to follow up.
Never Share Your Medicare Number With:
- Unsolicited phone callers
- Door-to-door salespeople
- Unsolicited emails
- Anyone promising “free” medical equipment
Report Fraud
If you think your Medicare Number has been used fraudulently, call 1-800-MEDICARE (1-800-633-4227).
Special Situations
Turning 65 Soon?
If you’re approaching age 65 and not receiving benefits, you should contact us about 3 months before your 65th birthday to sign up for Medicare. You should sign up for Medicare even if you don’t plan to retire at age 65.
Your Initial Enrollment Period: You can sign up for Part A and Part B during the 7-month period that begins 3 months before the month you turn 65. This period includes the month you turn 65 and ends 3 months after the month you turn 65.
👉 Find your Medicare enrollment dates fast—check yours now with our quick tool.
Already Collecting Social Security?
If you’re already getting benefits from Social Security or the Railroad Retirement Board (RRB), you’ll automatically be enrolled in both Part A and Part B starting the 1st day of the month you turn 65.
Still Working?
If you’re 65 or older and covered under a group health plan, either from your own or your spouse’s current employment, you may sign up for Medicare Part B during your Special Enrollment Period (SEP).
Key deadline: The SEP rules allow you to enroll in Medicare Part B during the 8-month period that begins the month after the employment ends or the group health coverage ends, whichever happens first.
Have End-Stage Renal Disease (ESRD)?
If you have ESRD, you can choose either Original Medicare or a Medicare Advantage Plan when deciding how to get Medicare coverage.
After transplant: If you’re only eligible for Medicare because you have ESRD and you get a kidney transplant, your Medicare benefits will end 36 months after the transplant.
Next Steps: Your Action Plan
Before October 1, 2025
- [ ] List all your current medications and costs
- [ ] Check if your doctors accept Medicare assignment
- [ ] Calculate last year’s out-of-pocket medical expenses
- [ ] Gather insurance documents (current plan details)
October 1 – December 7, 2025
- [ ] Compare plans and Get Your Free Medicare Quote Now
- [ ] Review the “Annual Notice of Change” from your current plan
- [ ] Make your Part D plan decision by December 7
January 1, 2026
- [ ] New coverage begins
- [ ] Verify your new plan card arrived
- [ ] Update pharmacy with new plan information
Don’t Go It Alone: Schedule Your Free Medicare Review
Medicare changes every year, and so do your health needs. The 2026 changes could save you hundreds or even thousands of dollars—but only if you choose the right plan.
Our free consultation includes:
- Personalized plan comparison based on YOUR medications and doctors
- Clear explanation of the $2,100 drug cap and how it affects you
- Review of new benefits you may qualify for
- Help understanding if you’re eligible for Extra Help or MSPs
- Answers to all your Medicare questions
No obligation. No pressure. Just honest guidance.
👉 Schedule Your Free Annual Medicare Review
Additional Resources
- Medicare & You Handbook: Medicare.gov/publications
- Social Security: SSA.gov or 1-800-772-1213
This guide is for educational purposes only and is based on official Medicare publications. Medicare rules and costs can change. Always verify current information at Medicare.gov or by calling 1-800-MEDICARE. This is not insurance advice.
Michael Quinn is a seasoned Medicare insurance expert and licensed agent dedicated to simplifying the complexities of healthcare coverage. With over a decade of experience, he is a trusted advisor known for his compassionate guidance and commitment to empowering individuals. As the Cofounder of REMEDIGAP in 2013, Michael offers unbiased resources and personalized support to assist clients in making informed decisions.
His expertise has been recognized on reputable platforms such as USA Today and Nerdwallet, solidifying his reputation as a reliable and knowledgeable industry leader. With a Master's Degree in Communicative Disorders, Michael combines strong communication skills with a genuine passion for positively impacting lives through tailored insurance solutions.
Written by Michael Quinn
Licensed Broker, REMEDIGAP Founder
Fact Checked by Joann Quinn
Chief Compliance Officer
As a licensed insurance broker, REMEDIGAP upholds the principles of integrity in our editorial standards and ensures transparency in how we receive compensation from our insurance partners.
