Quick Answer
The biggest Medicare changes for 2026 are: Part B premium increased to $202.90/month, Part D out-of-pocket cap is $2,000 (from the IRA), 10 drugs have negotiated prices, IRMAA brackets adjusted upward, and Medicare Advantage plans reduced some extra benefits. The Part D redesign is the most impactful change for beneficiaries with high drug costs.
Coverage Comparison by Plan Type
| Plan Type | Coverage | Notes |
|---|---|---|
| Part B Premium | Increased to $202.90/month | Up from $185/month in 2025 - $17.90/month increase |
| Part D OOP Cap | $2,000 maximum (2025+) | IRA change: no more catastrophic phase; plan pays 60% after cap |
| Negotiated Drug Prices | 10 drugs in 2026 | First 10 CMS-negotiated prices take effect Jan 1, 2026 |
| Medicare Advantage | Reduced extra benefits | CMS tightened rules; some plans cut dental/vision/hearing benefits |
Understanding Your Coverage Options
Part B Premium and Deductible Changes
The standard Part B premium for 2026 is $202.90/month, up from $185/month in 2025 - an increase of $17.90/month ($214.80/year). Higher-income beneficiaries pay more due to IRMAA surcharges, which range from $81.20 to $487.00/month on top of the standard premium.
The Part B annual deductible increased to $257 in 2026 (up from $240 in 2025). After meeting the deductible, Original Medicare pays 80% of approved costs and you pay 20% coinsurance - unless you have Medigap or Medicare Advantage.
What It Covers
- Part B covers all medically necessary outpatient services, doctor visits, preventive care
- After $257 deductible: Medicare pays 80%, you pay 20% coinsurance
- Preventive services (Annual Wellness Visit, screenings) at $0 cost-sharing
- IRMAA surcharges apply to incomes above $109,000 (single) / $218,000 (joint)
What It Doesn't Cover
- Part B does not cover routine dental, vision, or hearing
- Part B does not cap your out-of-pocket costs - no annual OOP maximum without Medigap or MA
- Part B does not cover most prescription drugs (Part D covers those)
Part D: The $2,000 Out-of-Pocket Cap
The most impactful Medicare change in recent years is the Part D out-of-pocket cap of $2,000, which took effect in 2025 and continues in 2026. Before this change, beneficiaries with high drug costs could face unlimited out-of-pocket expenses in the catastrophic phase.
In 2026, once you spend $2,000 on covered Part D drugs, the plan pays 100% for the rest of the year. This is especially significant for beneficiaries on expensive specialty medications, biologics, or cancer drugs. The Medicare Prescription Payment Plan (M3P) also allows you to spread costs across monthly installments.
What It Covers
- $2,000 annual OOP cap on all covered Part D drugs
- Plan pays 100% after the $2,000 cap is reached
- Medicare Prescription Payment Plan (M3P): spread costs across 12 monthly payments
- Manufacturer discounts now count toward the OOP cap (unlike before 2025)
What It Doesn't Cover
- OOP cap does not apply to Part D premiums
- OOP cap does not cover drugs not on the plan's formulary
- OOP cap does not apply to Part A or Part B cost-sharing
Big Win for High-Cost Drug Users
The $2,000 Part D OOP cap is the biggest improvement to Medicare drug coverage in 20 years. If you take specialty medications, biologics, or cancer drugs, you could save thousands of dollars per year.
Medicare Drug Price Negotiation: 10 Drugs in 2026
Under the Inflation Reduction Act, CMS negotiated prices for 10 high-cost drugs that take effect January 1, 2026. These include drugs for blood thinners (Eliquis, Xarelto), diabetes (Jardiance, Farxiga), heart failure (Entresto), and others. Negotiated prices are significantly lower than list prices.
For example, Eliquis (apixaban) - one of the most widely used blood thinners - has a negotiated price of $231 for a 30-day supply, down from over $500 at list price. These prices apply at all Part D pharmacies, including mail order.
What It Covers
- 10 negotiated drugs: Eliquis, Xarelto, Jardiance, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, Fiasp/NovoLog, Januvia
- Negotiated prices apply at all Part D pharmacies including mail order
- Prices are significantly lower than previous list prices
- Savings count toward the $2,000 OOP cap
What It Doesn't Cover
- Negotiated prices only apply to the 10 selected drugs - other drugs are not affected
- Does not apply to drugs not covered by Part D
- Does not reduce Part D premiums directly
Medicare Advantage Changes in 2026
Medicare Advantage enrollment reached approximately 33 million in 2026 (about 54% of Medicare beneficiaries). However, CMS tightened rules on extra benefits, and many plans reduced or eliminated some supplemental benefits (dental, vision, hearing, OTC allowances) to manage costs.
The MA in-network OOP maximum remains $9,350 in 2026. CMS also increased oversight of MA marketing practices, following concerns about misleading advertising. The 5-star Special Enrollment Period continues to allow beneficiaries to switch to 5-star plans year-round.
What It Covers
- All Original Medicare services (Parts A and B) plus usually Part D
- Annual OOP maximum: $9,350 in-network (2026)
- Extra benefits vary by plan: dental, vision, hearing, fitness, transportation
- 5-star SEP: switch to a 5-star MA plan any time of year
What It Doesn't Cover
- Some plans reduced dental/vision/hearing benefits in 2026 - verify before enrolling
- MA cannot be used alongside Medigap
- Out-of-network care costs more or may not be covered (HMO plans)
IRMAA Brackets Updated for 2026
Income-Related Monthly Adjustment Amount (IRMAA) brackets were adjusted upward for 2026. The income threshold for the first IRMAA bracket increased to $109,000 (single) / $218,000 (joint), up from $106,000/$212,000 in 2025. This means some beneficiaries who previously paid IRMAA may no longer owe it.
IRMAA is based on your income from 2 years prior (2024 income determines 2026 IRMAA). If your income has decreased due to a qualifying life event (retirement, divorce, death of spouse), you can appeal using Form SSA-44.
What It Covers
- IRMAA brackets adjusted upward - some beneficiaries pay less or no IRMAA in 2026
- Part B IRMAA surcharges: $81.20–$487.00/month (on top of $202.90 standard premium)
- Part D IRMAA surcharges: $13.70–$85.80/month
- Appeal available via Form SSA-44 for qualifying life events
What It Doesn't Cover
- IRMAA surcharges are in addition to standard premiums - not waived without appeal
- IRMAA is based on 2-year-old income - recent income drops require an appeal
- IRMAA applies to both Part B and Part D premiums
Key Medicare Cost Changes: 2025 vs. 2026
| Cost Item | 2025 | 2026 | Change |
|---|---|---|---|
| Part B Standard Premium | $185.00/month | $202.90/month | +$17.90/month (+9.7%) |
| Part B Deductible | $240/year | $257/year | +$17/year |
| Part A Deductible | $1,676/benefit period | $1,732/benefit period | +$56/benefit period |
| Part D OOP Cap | $2,000 | $2,000 | No change (new in 2025) |
| Part D Base Premium | $34.70/month | $36.78/month | +$2.08/month |
| IRMAA Threshold (Single) | $106,000 | $109,000 | +$3,000 (favorable) |
| MA OOP Maximum | $9,350 | $9,350 | No change |
✦ What Did not Change in 2026
Part a Premium (Most Beneficiaries)
Most beneficiaries (40+ work quarters) pay $0 for Part A. This did not change in 2026.
Part D $2,000 OOP Cap
The $2,000 cap was introduced in 2025 and continues in 2026 - no change.
MA OOP Maximum
The Medicare Advantage in-network OOP maximum remains $9,350 in 2026.
$35 Insulin Cap
The $35/month insulin cap for Part D continues in 2026 - no change.
✦ Legislative Updates Driving 2026 Changes
Inflation Reduction Act - Part D Redesign
PassedThe IRA's $2,000 OOP cap, drug price negotiation, and $35 insulin cap are all now in effect. The M3P payment plan is also available.
10 Negotiated Drug Prices (Jan 1, 2026)
PassedCMS negotiated prices for Eliquis, Xarelto, Jardiance, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, Fiasp/NovoLog, and Januvia take effect.
H.R. 1 - Medicaid Work Requirements
ProposedProposed legislation would add work requirements for Medicaid, potentially affecting dual-eligible beneficiaries. Not yet passed.
What to do in Response to 2026 Medicare Changes
The Part B premium increase is automatic - there is nothing you can do to avoid it unless you qualify for a Medicare Savings Program (which pays your Part B premium). If your income is near the IRMAA threshold, consider tax planning strategies to stay below the bracket.
For Part D, the $2,000 OOP cap is a major improvement. Review your current plan to ensure your medications are covered at the best tier. If you take any of the 10 negotiated drugs, verify your plan's formulary reflects the new negotiated prices.
2026 Medicare Changes Action Checklist
- Review your Part B premium - check if you qualify for a Medicare Savings Program to have it paid
- If you pay IRMAA, verify your 2024 income and appeal if it has decreased (Form SSA-44)
- Review your Part D plan's formulary for the 10 negotiated drugs - ensure you're getting the lower price
- If you take specialty or high-cost drugs, calculate your new OOP costs under the $2,000 cap
- Enroll in the Medicare Prescription Payment Plan (M3P) if you want to spread Part D costs monthly
- Review your MA plan's Annual Notice of Change (ANOC) for benefit changes in 2026
- Compare MA plans during AEP (Oct 15–Dec 7) if your current plan reduced dental/vision/hearing benefits
✦ Frequently Asked Questions
David Haass
AuthorDavid Haass is a licensed Medicare expert who has been helping beneficiaries navigate their Medicare options for over a decade.
Ashlee Zareczny
ReviewerAshlee Zareczny is a licensed Medicare agent dedicated to helping those eligible for Medicare find the best coverage options.