Medicare changes for 2026 are critical for new enrollees as well as existing enrollees to understand. It’s quite common for Medicare changes to happen each year, and being prepared for them allows you to stay ahead of the process and manage your finances more effectively.
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What’s New for 2026 in Medicare?
Below, you’ll read the details of the projected and final changes to Medicare for 2026. Here’s a quick summary of what you will see:
- Medicare Part D Out-of-Pocket Cap increases to $2,100 (final amount). (Source)
- Medicare Part D Deductible maximum increases to $615 (final amount). (Source)
- Medicare Part B Standard Premium is projected to increase to $206.50 (estimate). (Source)
- Medicare Part B Annual Deductible is projected to increase to $288 (estimate). (Source)
- Insulin copays remain capped at $35 per month. (Source)
- The first set of Medicare-negotiated drug prices will take effect for certain high-cost medications. (Source)
Other Key Policy Updates In 2026
- Prior Authorization Expands to Original Medicare (Pilot Program): Starting January 1, 2026, Original Medicare will launch a pilot program called the WISeR Model in six states (AZ, NJ, OH, OK, TX, and WA) that requires prior authorization for certain high-risk outpatient procedures. This is the first significant expansion of prior authorization into Traditional Medicare. (Source: CMS Final Rule, WISeR Model)
- New Guardrails on MA Prior Authorization: Medicare Advantage plans face stricter federal requirements starting in 2026 to make prior authorization faster (e.g., 7-day maximum for standard decisions) and ensure approvals remain valid for the entire approved course of treatment. (Source: CMS Interoperability Final Rule)
- Stricter Rules for Supplemental Benefits (SSBCI): New regulations for Medicare Advantage Special Supplemental Benefits for the Chronically Ill (SSBCI) will place more restrictive definitions on which members can access certain non-medical benefits (like food or utility allowances), linking the benefit more directly to a qualifying chronic condition. (Source: CMS Contract Year 2026 Policy Final Rule)
Medicare Part A Changes 2025
As one of the two components that make up Original Medicare, Medicare Part A offers coverage for inpatient care, such as having to stay in the hospital or a skilled nursing facility, it can include home health care in some situations as well.
Most people – about 99% – do not pay a Part A premium if they have 40 quarters of work contributions. The Part A inpatient hospital deductible paid when admitted to the hospital is $1676 for 2025. That is an increase of $44 from 2024. This deductible covers costs for the first 60 days of covered inpatient hospital care for that benefit period.
Beneficiaries must pay coinsurance of the amount of $419 per day for the 61st5 day of care through the 90th day of hospitalization. And $838 per day for lifetime reserve days. These are also increases from the 2024 figures. Those in a skilled nursing facility pay a daily coinsurance rate for days 21 to 100 of extended care services at a rate of $209.50 for 2025. These 2025 Medicare premiums changes were announced in November of 2024.
| Medicare Part A Deductible and Coinsurance Amounts For 2024 and 2025 by Type of Cost Sharing | ||
| 2024 | 2025 | |
| Inpatient hospital deductible | $1,632 | $1,676 |
| Daily coinsurance for hospital stay days 61-90 | $408 | $419 |
| Daily hospital coinsurance for lifetime reserve days | $816 | $838 |
| Skilled nursing facility daily coinsurance for days 21-100 | $204 | $209.50 |
Medicare Part B Changes 2025
Medicare Part B insurance covers outpatient hospital services, physician care, durable medical equipment, and other health services not provided under Part A.
The standard monthly premium for enrollees in 2026 is estimated to be $206.50. That is an increase of $21.50 from the previous year. The annual deductible for Medicare Part B beneficiaries is a projected $288. (source)
2026 Medicare Part B premium is based on a person’s income. However, the exact numbers have not been released. Below are the Medicare premiums in 2025:
| Income-Related Monthly Adjustment Amounts for Medicare Part B Based on Modified Adjusted Gross Income | ||
| Beneficiaries who file individual tax returns | Beneficiaries who file joint tax returns | Income-related adjustment amount |
| Less than or equal to $106,000 | Less than or equal to $212,000 | $0 |
| Greater than $106,000 and less than or equal to $133,000 | Greater than $212,000 and less than or equal to $266,000 | $14 |
| Greater than $133,000 and less than or equal to $167,000 | Greater than $266,000 and less than or equal to $334,000 | $35 |
| Greater than $167,000 and less than or equal to $200,000 | Greater than $334,000 and less than or equal to $400,000 | $57.00 |
| Greater than $200,000 and less than $500,000 | Greater than $400,000 and less than $750,000 | $78.60 |
| Greater than or equal to $500,000 | Greater than or equal to $750,000 | $85.80 |
Medicare Part B Immunosuppressive Drug Coverage Only
Some people who have a high income only have immunosuppressive drug coverage. However, the amount has not been released as of the publishing date. Below are the Medicare Part B premiums in 2025:
| Medicare Part B Immunosuppressive Drug Coverage Based on Modified Adjusted Gross Income | ||
| Beneficiaries who are married and lived with their spouses at any time during the year but who file separate tax returns from their spouses | Income-Related Monthly Adjustment Amount | Total Monthly Premium |
| Less than or equal to $106,000 | $0 | $185 |
| Greater than $106,000 and less than $394,000 | $406.90 | $592 |
| Greater than or equal to $394,000 | $443.90 | $628.90 |
Medicare Part D Prescription Drug Coverage Changes
The biggest structural changes come from the Inflation Reduction Act (IRA).
Weight Loss Drug Coverage
Medicare Part D coverage is excluded for drugs used solely for weight loss. However, Part D plans will continue to cover drugs like Mounjaro and Ozempic when they are prescribed for their FDA-approved, non-excluded indications, such as the treatment of Type 2 Diabetes or cardiovascular risk reduction. Coverage still depends on the plan’s formulary and prior authorization rules.
Medicare Advantage Costs 2026 Changes
Medicare Advantage is an alternative to Original Medicare. It enables many people to see a more all-in-one solution for their care needs, and it may allow you to tailor your coverage a bit more to your situation. The 2026 cost landscape shows a mix of decreases in average premiums but adherence to maximum limits set by the federal government.
- Average Premiums Projected to Decrease: The average monthly premium across all Medicare Advantage plans (including those with drug coverage, MA-PDs) is projected to decrease from $16.40 in 2025 to $14.00 in 2026.
- Note: This is an average. Many plans will continue to offer a $0 premium, but you must still pay your separate Part B premium. (Source: CMS Press Release, Sept 2025)
- Part D Drug Cap: Since most MA plans include drug coverage, they are subject to the same cost limits as stand-alone Part D plans. The out-of-pocket cap for prescription drugs will increase to $2,100 for 2026. (source)
While the average premium is down, beneficiaries should carefully compare their plan’s specific copayments, deductibles, and network changes to ensure their overall out-of-pocket costs remain favorable.
FAQ
What are Social Security Medicare premiums for 2026?
The amounts have not been released as of publication due to the government shutdown.
Who does the Part D prescription drug cap apply to?
In 2025, Medicare introduced a $2000 cap on the costs you have to pay under Medicare Part D coverage for prescription medications. This cap covers all people who are enrolled in Medicare Part D plans. It limits the amount that you have to pay for prescription drugs out of pocket.
It applies to all people. That includes those who have out-of-pocket medication costs that are very high but who do not qualify for the federal Extra Help program. After 2025, expect to see the Part D cap increase annually to account for inflation.
Get the Medicare Coverage You Need Now
Medicare changes can be frustrating and confusing. Yet, these services are critical to Medicare beneficiaries and ensure they get the care they need. If you have questions, the Medicare Medicaid Services CMS resources in your community can help you. You can also get help from a Medicare insurance agent.
Note the importance of applying for Medicare during the required enrollment periods. Medicare’s 2026 Open Enrollment Period runs from October 15 to December 7 each year.
Note that there are other times when you may qualify to enroll in Medicare coverage, including the 3 months before and three months after you reach the age of 65. It is critical to act quickly during this time to ensure you have the time you need to choose the right Medicare plans for your needs. Compare your Medicare options now and learn more about plans that may fit your needs.
How to Get Help Now
Schedule a consultation with a licensed insurance provider or use the tools on this page to get updated details about the Medicare changes that are applicable to you and what plans may fit your needs.
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