Medicare changes every year, and 2026 brought some of the biggest prescription drug changes in the program's history. Here's what changed for 2026 and what it means if you have Medicare Advantage or a Part D plan.
1. Part D Out-of-Pocket Cap Rises to $2,100
Once your out-of-pocket spending on covered Part D drugs reaches $2,100 in 2026 (up from $2,000 in 2025), you pay $0 for covered drugs for the rest of the year. The cap applies to standalone Part D plans and to Medicare Advantage plans that include drug coverage. The coverage gap, or "donut hole," is gone.
2. The First Negotiated Drug Prices Take Effect
On January 1, 2026, Medicare's first negotiated prices took effect for 10 widely used drugs, including Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, and NovoLog/Fiasp insulin. What you actually pay still depends on your plan's formulary and cost-sharing, so check your own drugs.
3. Spread Drug Costs Across the Year
The Medicare Prescription Payment Plan lets you pay your out-of-pocket Part D costs in monthly installments instead of all at once at the pharmacy. It's voluntary, free to join, and available through any Part D or Medicare Advantage drug plan. It can help if you fill expensive prescriptions early in the year.
4. Insulin Stays Capped at $35
Covered insulin costs no more than $35 for a month's supply, and the Part D deductible doesn't apply.
5. New Part A and Part B Costs
| 2026 Medicare cost | Amount |
|---|
| Part B standard monthly premium | $202.90 |
| Part B annual deductible | $283 |
| Part A inpatient deductible (per benefit period) | $1,736 |
| Part D deductible (maximum a plan can charge) | Up to $615 |
| Part D out-of-pocket cap on covered drugs | $2,100 per year |
| Covered insulin | $35 per month supply, no deductible |
| Higher-income surcharge (IRMAA) starts above | $109,000 single / $218,000 joint (2024 tax return) |
Source: CMS, "2026 Medicare Costs" and "Medicare & You 2026."
6. New Covered Services
- Advanced Primary Care Management: a monthly care-coordination service from participating primary care practices, with 24/7 access to your care team.
- CT colonography is now covered as a colorectal cancer screening option.
What Medicare Advantage Members Should Check
Medicare Advantage plans set their own premiums, copays, networks, drug lists, and extra benefits each year within Medicare's rules, so changes are plan-specific. Plans must also send members a mid-year notice of any unused supplemental benefits, such as dental or vision, so you can use what you're paying for. Before AEP (October 15 – December 7), review:
- Your Annual Notice of Change, which arrives by September 30
- Whether your doctors and hospitals are still in-network
- Where your prescriptions fall on the plan's drug list
- Changes to extra benefits such as dental, vision, hearing, or fitness
- Your plan's maximum out-of-pocket limit for medical care
For step-by-step help, see our Medicare AEP guide.
Talk It Through With a Local Agent
Triangle Life and Health is an independent agency in Raleigh, licensed since 2013. Our help is free to you. We compare plans from several carriers against your doctors, prescriptions, and budget. Book a free review or call 919-689-6565.
Michael Cubell : Sep 3, 2023, 11:03:17 AM
