Important Medicare Changes for 2026: What You Need to Know
Each year from October 15 to December 7, Medicare beneficiaries can make changes to their coverage. This year, it is especially important to review your options. Significant updates take effect January 1, 2026, impacting Prescription Drug Plans (PDPs) and Medicare Advantage (MA) plans.
Key Prescription Drug Changes
• The “donut hole” coverage gap was eliminated in 2025, but new drug cost rules apply in 2026.
• Out-of-pocket drug costs will be capped at $2,100.
• Maximum drug deductible: $615.
• Many Advantage plans will shift from fixed copayments to coinsurance (a percentage of the drug cost).
Example: In 2025, a Tier 3 drug like Eliquis or Ozempic may have cost $47 after the deductible.
In 2026, you may pay 20 percent of $600 = $120 — it all depends on your plan’s pricing structure.
This shift could mean substantially higher initial costs for Tier 3–6 medications. It is essential to check your projected 2026 prescription costs.
2025 was the first year that the Medicare Prescription Payment Plan (MPPP) enabled those with Medicare prescription drug coverage to spread the costs of their prescription drugs over the calendar year rather than paying in full at the pharmacy counter each time they fill a prescription. Keeping this arrangement just got easier.
Automatic renewal of plan participation. Beginning in 2026, if you participate in the MPPP, you will be automatically re-enrolled in 2026. You may want to consider this if you will reach the $2,100 quickly.
Advantage Plan Adjustments
To offset rising drug expenses, many Advantage plans will:
• Increase deductibles and coinsurance.
• Reduce or eliminate extra benefits like dental, vision, hearing, or over-the-counter allowances.
• Raise premiums, maximum out-of-pocket limits, or copays.
What You Should Do
• Review the Annual Notice of Change (sent by your current plan). This side-by-side comparison outlines how your 2025 plan benefits and costs will change in 2026.
• Pay close attention to prescription coverage and any reductions in extra benefits.
Supplement (Medigap) Plans
• No benefit changes are scheduled for 2026.
• However, higher drug costs may encourage some beneficiaries to try a Medicare Advantage plan.
• Medicare offers a one-time “trial right”: You can try an Advantage plan for up to 12 months and still return to your original Supplement plan with guaranteed acceptance.
Final Thoughts
The good news: You have time to evaluate your options and avoid surprises. As a licensed Medicare agent, I believe informed decisions lead to the best outcomes.
If you’d like a no-cost, no-obligation plan review, I can walk you through your 2026 options — by phone or in person.
Kathy Olejniczak, Licensed Medicare Agent, 561.212.7640. I speak Medicare.
