11 Medicare Changes in 2026 Everyone Over 65 Should Know About

Medicare isn't a "set it and forget it" program.

Coverage that worked well one year may not be so great in others. Changes to premiums, plan rules, and out-of-pocket costs can stealthily chip away at retirement funds.

In 2026, several updates could affect how much you pay, which doctors you can see, and how prescription drug costs are handled. Below, we break down the biggest Medicare changes on the horizon — and what you can do now to avoid surprises and maximize your senior benefits.

Part B premiums change

Medicare Part B premiums are reviewed and adjusted annually, and they don't always move in lockstep with Social Security cost-of-living increases.

Premiums can rise due to higher health care costs, policy changes, or shifts in enrollment.

Guardrails exist, however, to cushion the blow. Under the "hold-harmless provision," Social Security and Medicare must work together to prevent Medicare Part B premium increases from reducing your Social Security benefit. Most people will pay the higher premium because their cost-of-living adjustment (COLA) covers the increase.

For retirees on fixed incomes, even modest increases can hamper monthly cash flow. Review annual notices and factor Part B premiums into your annual budget planning.

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Medicare Advantage plan rules (can) change each year

Medicare Advantage plans can change benefits, costs, and rules every year. This includes premiums, copayments, drug formularies, and extra benefits like dental or vision coverage.

A plan that fits well one year may look very different the next. This makes the Annual Enrollment Period critical for reviewing plan updates and comparing alternatives before automatic coverage renewal.

Your provider may no longer be in your network

Medicare Advantage networks are not guaranteed to stay the same each year. Doctors, hospitals, and specialists can leave a plan's network, potentially forcing you to switch providers or pay higher out-of-network costs.

Even if your health needs haven't changed, confirm that your providers are still covered — or be prepared to pay a hefty, out-of-network bill.

Protections expand for behavior health

Starting in 2026, Medicare Advantage plans will be required to match or improve upon Original Medicare's cost-sharing model for behavioral health services.

This means you generally won't pay more for mental health or substance use disorder treatment than you would under traditional Medicare.

Cost-sharing caps include 20% coinsurance for many outpatient behavioral health services and zero cost sharing for opioid treatment programs.

Insulin costs become more predictable

In 2026, insulin costs under Medicare will be capped annually at the lowest of three thresholds: $35 per month, 25% of the maximum fair price, or 25% of the plan's negotiated price.

Importantly, no deductible will apply to insulin purchases in order to reduce financial strain for those who rely on daily diabetes medications.

Prescription payment plans automatically renew

If you're enrolled in the Medicare Prescription Payment Plan (MPPP), you'll be automatically re-enrolled each year unless you opt out.

This program allows beneficiaries to spread prescription drug costs across monthly payments to help with budgeting.

Automatic renewal reduces paperwork, but also makes it important to review whether the program still fits your financial situation each year.

Out-of-pocket limits go down

For 2026, the federal maximum out-of-pocket limit for in-network services under Medicare Advantage plans will decrease slightly from last year, dropping from $9,350 to $9,250.

While many plans already set lower limits, the cap helps protect beneficiaries from catastrophic medical expenses.

Prior authorization pilot launches in select states

A new prior authorization program will roll out in six states ( Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington) for certain services under Original Medicare.

Known as the WISeR model, the pilot uses enhanced technology and clinical review to reduce wasteful spending or inappropriate care. The program applies only to Original Medicare and will not affect Medicare Advantage enrollees.

Prescription drug spending cap goes up

In 2026, Medicare Part D beneficiaries will have an annual out-of-pocket cap of $2,100 on covered prescription drugs, up from $2,000 in 2025. Once you reach that limit, you won't pay anything more for covered medications for the rest of the year.

Colorectal cancer screening options expand

Medicare will continue expanding coverage for colorectal cancer screenings, including CT colonography.

Coverage includes multiple screening options at different intervals, often with no cost sharing if providers accept the assignment.

Improved accessibility should improve outcomes and help beneficiaries afford preventive care.

New digital tools aim to simplify Medicare management

CMS is investing in digital tools and technology-enabled care models to help beneficiaries manage chronic conditions more effectively.

Programs like the ACCESS model can improve coordination, expand digital health options, and support better outcomes for conditions affecting many Medicare enrollees, including diabetes, hypertension, and depression.

Bottom line

Medicare changes every year, but 2026 brings some especially meaningful updates around prescription drug costs, behavioral health coverage, and broader cost protections. Staying informed is your best defense against retirement budget surprises.

If rising premiums or medical expenses are stressing your finances, now's the time to compare options or seek help. Assistance from Medicare counselors or SHIP programs (at shiphelp.org) can make a real difference.

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