Cat DeFazio Smith
December 2, 2025
As we look ahead to 2026, Medicare will experience some important updates. These changes can affect healthcare costs and coverage, so staying informed helps beneficiaries make confident decisions about their care. The Centers for Medicare & Medicaid Services (CMS) review and adjust Medicare every year to keep it aligned with healthcare needs and trends across the country. Below is a clear and friendly breakdown of what beneficiaries can expect in 2026.
Most beneficiaries will continue to pay no monthly premium for Medicare Part A. This part of Medicare covers inpatient hospital stays, skilled nursing facility care, hospice services and some home healthcare. The main change in 2026 is a slight increase in the inpatient hospital deductible, rising from $1,676 in 2025 to $1,736 in 2026. While any cost increase can feel concerning, many people will still access this vital coverage without paying a monthly premium.
Part B covers essential services like doctor appointments, outpatient care, preventive screenings and durable medical equipment. In 2026, the standard monthly premium will rise from $185 to $202.90, and the annual deductible will increase from $257 to $283. These updates ensure Medicare can continue supporting access to routine and preventive care. Having this information early allows beneficiaries to plan ahead and avoid budgeting surprises.
One of the most meaningful improvements in recent Medicare updates has been the effort to reduce prescription expenses through Part D. These protections will continue into 2026.
The old coverage gap known as the “donut hole” is no longer part of the Medicare drug program. Instead of moving through multiple confusing phases with different cost-sharing rules, beneficiaries now have a simpler, more consistent coverage experience throughout the year.
Beginning in 2025 and continuing in 2026, beneficiaries will not pay more than $2,100 per year for covered prescription medications. This cap offers peace of mind for those who rely on multiple or high-cost prescriptions.
In 2026, Medicare Part D will continue with this straightforward structure:
Beneficiaries pay a deductible of up to $615 before their plan begins covering medication costs. After that, copays or coinsurance apply until their total out-of-pocket spending reaches $2,100.Once that limit is reached, covered prescriptions will be 100% covered by your Part D plan throughout the rest of the year. New for 2026, participation in the Medicare Part D Prescription Plan will automatically renew from year to year until you opt out.
Additionally, insulin remains capped at $35 per month, helping keep this life-saving medication accessible for those who need it most.
Medicare Advantage plans will also see updates in 2026 that may influence coverage choices for millions of beneficiaries.
Medicare Advantage plans are an alternative to Original Medicare and are offered through private insurers. These plans often include Part D coverage, plus additional benefits such as dental, vision and hearing. Enrollment in these plans continues to grow as more people seek bundled benefits and predictable costs.
Premiums and costs may shift in 2026. The average monthly Medicare Advantage premium is expected to adjust slightly from $16.40 to $14 in 2026, but the amount will vary depending on the plan. Some plans may introduce drug deductibles or update cost-sharing structures, which is important to keep an eye on.
Changes in coverage may include adjustments to supplemental benefits and provider networks. While most plans will keep popular perks like dental, vision and hearing coverage, other extras such as over-the-counter allowances or telehealth features may differ from plan to plan. It is also possible that some plans may be discontinued or consolidated, meaning a portion of enrollees will need to select new coverage.
These updates are part of an ongoing effort to balance affordability, access and value across Medicare Advantage offerings.
The federal government continues to work on making prescription drugs more affordable and accessible. Through policies like those in the Inflation Reduction Act, the government can negotiate some drug prices with pharmaceutical companies, aiming to reduce costs over time for Medicare beneficiaries. These reforms are designed to improve affordability and expand access to needed treatments.
Beneficiaries can stay ahead of these changes by reviewing their Medicare options during the Annual Election Period, which runs October 15 through December 7 each year. This is the perfect time to make sure your current plan still fits your medical needs, especially if prescriptions, doctors or pharmacy preferences have changed.
It’s always okay to ask for help. Licensed insurance agents and resources like Medicare.gov can provide guidance tailored to your personal situation. A quick review now can help avoid unexpected costs later.
Medicare is continuing its mission to make healthcare easier to navigate, more affordable and better aligned with the needs of the people it serves. While change can feel overwhelming, understanding your benefits and keeping up with updates helps ensure you get the most out of your coverage in 2026. Your health and peace of mind matter and staying informed empowers you to take control of your healthcare journey.
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