Medicare 2026 Changes: What You Need to Know
Big updates are coming to Medicare starting in 2026. If you’re enrolled—or helping someone who is—it’s important to understand how these changes may impact your health coverage and monthly budget.
Open enrollment is October 15 through December 7, 2025. Use that time to make sure your plan still fits your needs.
Key Changes to Medicare in 2026
1. Lower Prescription Drug Prices
Medicare will now negotiate prices on high-cost medications starting January 1, 2026.
- Drugs for arthritis, diabetes, cancer, and blood clots are included.
- This means lower out-of-pocket costs at the pharmacy for many beneficiaries.
2. Higher Part B Monthly Premiums
The standard monthly premium for Part B is rising.
- 2025 standard Part B premium: $185.00/month
- 2026 standard Part B premium: $202.90/month — not $206
- 2026 Part B annual deductible: $283 (up from $257 in 2025)
3. $2,100 Annual Cap on Part D Spending
Once you’ve spent $2,100 out-of-pocket on covered Part D drugs, you’ll pay nothing more for those covered drugs for the rest of the year. This is the 2026 Part D out-of-pocket threshold.
This cap applies to all plans starting in 2026.
4. Monthly Prescription Payment Program
The Medicare Prescription Payment Plan is a voluntary option. It is not automatic, and you are not enrolled unless you opt in.
- If you join, it spreads covered Part D out-of-pocket costs across monthly bills instead of asking for a large amount at the pharmacy.
- It does not reduce the total drug price by itself. Participation is voluntary for people with a Medicare drug plan.
5. New Prior Authorization System (Pilot Program)
The WISeR model (Wasteful and Inappropriate Service Reduction) tests prior authorization for selected Original Medicare items and services only. It does not apply to Medicare Advantage, and it does not apply to every service or every state.
- States in the model: Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington.
- It covers a limited set of Original Medicare items/services that CMS selected for review — not all care.
If you have Original Medicare in one of those six states, ask your provider whether a listed service is in the model. Medicare Advantage is not part of WISeR.
6. Extra Help for Low-Income Beneficiaries
The Extra Help (Low-Income Subsidy) expansion began in 2024. It is not a new 2026 expansion. Extra Help can still reduce:
- Premiums
- Deductibles
- Prescription co-pays
What to Do Next
- Review your current Medicare plan.
- Compare new options between October 15 – December 7, 2025.
- Factor in both premium changes and drug savings.
- Ask your provider or licensed advisor for support.
Reviewed August 23, 2026. Cost figures and program rules on this page are from CMS and Medicare.gov. eHealth20 is not a government website. This is educational information, not a personal coverage recommendation.
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