Medicare Plans 2026

What’s new in Medicare plans in 2026?

Key updates include possible premium changes for Medicare Advantage and Medicare Part D, automatic re-enrollment for Medicare Part D prescription drug plans, an insulin cap at $35/month, and ongoing free vaccines. Discover all you need to know to maximize your benefits for Medicare Advantage plans in 2026.

Key Takeaways

• In 2026, average monthly premiums for Medicare Advantage and Medicare Part D plans are expected to decrease, alongside the introduction of automatic re-enrollment for Medicare Part D beneficiaries.

• The out-of-pocket maximum for Medicare Part D will rise to $2,100, and essential benefits like the $35 insulin cap and zero cost-sharing for ACIP-recommended vaccines will continue, improving access to necessary medications and preventive care.

• Beneficiaries are encouraged to annually review their Medicare plans during the Open Enrollment Period from October 15 to December 7 to ensure coverage aligns with their healthcare needs due to potential changes in costs and benefits.

Medicare Plans – What’s new for 2026?

Exciting changes are on the horizon for Medicare in 2026, as the Centers for Medicare & Medicaid Services (CMS) announces updates to improve care and reduce costs. Notably, average monthly premiums for Medicare Advantage and Part D plans are expected to decrease. This aligns with CMS’s strategy to maintain stable premiums and benefit options for beneficiaries.

Additionally, the introduction of automatic re-enrollment for Medicare Part D, an increase in the out-of-pocket maximum for Part D, and enhanced benefits for managing chronic illnesses in Medicare Advantage plans are set to make a significant impact. Notably, the $35 monthly insulin cap and zero cost-sharing for ACIP-recommended vaccines will continue, ensuring that essential medications and preventive care remain accessible to all beneficiaries.

Medicare Part D Prescription Payments are Automatic

In 2026, Medicare Part D will implement automatic re-enrollment for beneficiaries, ensuring uninterrupted prescription drug coverage. This means those already enrolled will remain in their current plans without manual re-enrollment, reducing administrative burdens and providing a seamless experience.

Additionally, Medicare Part D prescription payments will be automatically deducted from Social Security payments, ensuring consistent and convenient coverage without manual claims filing. Simplifying the payment process allows beneficiaries to focus more on their health.

Medicare Part D out-of-pocket maximum

In 2026, the out-of-pocket maximum for Medicare Part D will rise to $2,100. Beneficiaries will not pay more than this amount annually for covered medications. This cap adjusts each year based on the previous year’s average expenditure increases for Part D drugs.

After reaching the $2,100 out-of-pocket maximum, beneficiaries will not incur additional cost-sharing for covered drugs for the rest of the year. This change provides financial relief and predictability for those who rely heavily on prescription medications.

Medicare Advantage chronic illness benefits

Medicare Advantage plans in 2026 will offer enhanced support for managing chronic illnesses, providing improved resources and services aimed at better care for enrollees. One of the key features is the Chronic Special Needs Plans (C-SNPs), which are tailored for individuals with specific chronic conditions such as diabetes and chronic heart failure. These plans offer a range of benefits, including:

• $0 copays for essential services like dental, vision, and hearing care

• Financial credits for purchasing over-the-counter products

• Financial credits for purchasing healthy food

Eligibility for C-SNPs requires a doctor’s confirmation of a qualified chronic condition within a specified timeframe before enrollment. This ensures that benefits are tailored to the needs of patients with chronic health issues, improving overall health and functionality.

The new regulations also set clear limitations on the types of special supplemental benefits that can be provided, specifically excluding non-healthy food and substances like alcohol and tobacco. Plans are required to demonstrate a reasonable expectation that the offered supplemental benefits will enhance the health or functional capabilities of enrollees with chronic illnesses, as outlined in the final rule.

Furthermore, updates for 2026 aim to enhance care coordination for dually eligible individuals, with integrated health assessments to streamline their health management across Medicare and Medicaid.

$35 Monthly insulin cap continuation

Starting in 2026, the cost of insulin for Medicare beneficiaries will continue to be capped at $35 per month. This cap ensures that beneficiaries pay no more than this amount for a one-month supply of covered insulin, providing significant financial relief for those managing diabetes.

Maintaining this cap ensures essential medications remain affordable and accessible, helping beneficiaries manage their health conditions effectively.

Free ACIP-recommended vaccine continuation

In 2026, Medicare Part D will maintain zero cost-sharing for adult vaccines. These vaccines are recommended by the Advisory Committee on Immunization Practices (ACIP). This means that beneficiaries will not have to pay out-of-pocket for these vaccines, ensuring that preventive care remains accessible and affordable.

Covering all ACIP-recommended immunizations without cost-sharing promotes public health and prevents the spread of vaccine-preventable diseases.

Original Medicare Explained

Original Medicare consists of two main parts: Part A, which covers hospital insurance, and Part B, which deals with outpatient medical services. Understanding these components is crucial for beneficiaries to make informed decisions about their healthcare coverage.

While Part A generally includes coverage for:

• inpatient hospital stays
• skilled nursing facility care
• Hospice care Part B covers:
• outpatient care
• preventive services
• some necessary medical equipment.

Parts of Original Medicare

Part A of Original Medicare generally covers:

• Inpatient hospital stays
• Skilled nursing facilities
• Hospice care
• Some home health care services

Most beneficiaries do not pay a monthly premium for Part A if they have paid Medicare taxes while working. However, there are deductibles and coinsurance costs associated with the services covered under Part A.

Part B of Original Medicare typically includes coverage for physician services, outpatient hospital care, durable medical equipment, and preventive services like vaccinations and screenings. Unlike Part A, Part B requires a monthly premium, which can vary based on the beneficiary’s income. Understanding these parts helps beneficiaries navigate their healthcare options and make informed choices.

Medicare Coverage and Costs

Beneficiaries of Original Medicare usually pay a monthly premium for Part B, as well as deductibles and coinsurance for services received. In 2026, the Part A deductible is set to be $1,676, while the Part B deductible will be $257. These costs are essential for beneficiaries to consider when planning their healthcare expenses.

The average monthly premium for Medicare Advantage plans is expected to decrease from $16.40 in 2025 to $14.00 in 2026. Additionally, the average total premium for standalone Part D plans is projected to drop from $38.31 in 2025 to $34.50 in 2026. These changes reflect CMS’s efforts to control Medicare prescription drug coverage costs and provide affordable options for beneficiaries.

Original Medicare and Medigap

Medigap plans are designed to fill the gaps in coverage by Original Medicare, helping cover costs such as copayments, coinsurance, and deductibles. These plans are purchased from private insurance companies and offer varying levels of coverage. Medigap policies do not include coverage for prescription drugs; separate Medicare Part D plans are needed for that.

There are ten standardized Medigap plans available, with Plan F and Plan G being the most popular options for beneficiaries. Medigap insurance policies can help cover out-of-pocket costs not fully paid by Original Medicare, providing financial relief and predictability for beneficiaries.

Comparing Medigap plans is crucial because premiums can vary significantly between insurance companies for the same coverage.

Original Medicare or Medicare Advantage in 2026?

Deciding between Original Medicare and Medicare Advantage in 2026 involves considering various factors such as healthcare needs, preferred providers, and additional benefits. Original Medicare provides extensive coverage for necessary medical services, but does not include many routine care services.

On the other hand, Medicare Advantage plans must cover all services offered by Original Medicare and often include additional benefits such as dental, vision, and hearing care. Cost is another crucial factor. While Original Medicare has no cap on out-of-pocket expenses unless supplemented by additional coverage, Medicare Advantage plans often include prescription drug coverage and have an out-of-pocket maximum, providing financial predictability.

Beneficiaries who prefer flexibility in choosing healthcare providers may opt for Original Medicare, which allows them to see any doctor or hospital that accepts Medicare. In contrast, Medicare Advantage plans typically require the use of a network of providers.

How to enroll in Original Medicare

Enrollment in Original Medicare typically begins during the Initial Enrollment Period, which lasts seven months around an individual’s 65th birthday. This period starts three months before the 65th birthday and ends three months after.

Individuals can also enroll during the General Enrollment Period from January 1 to March 31 each year, with coverage starting on July 1. To enroll, individuals need both Medicare Part A and Part B and must reside in the plan’s service area.

Verifying that the chosen plan choices cover necessary prescriptions and include approved preferred healthcare providers is crucial, as you expect to have the right mail coverage to request.

Medicare Advantage Plans in 2026

Medicare Advantage plans in 2026 are set to see several updates and enhancements aimed at improving coverage and benefits for participants:

• The average monthly premium for Medicare Advantage plans is projected to drop from $16.40 in 2025 to $14.00 in 2026, making these plans more affordable for beneficiaries.

• Enrollment in Medicare Advantage is expected to be around 34 million in 2026, slightly down from 34.9 million in 2025.

• Over 99% of Medicare beneficiaries will have access to at least one Medicare Advantage plan.

Additionally, the number of available Medicare Advantage plans is anticipated to decrease slightly from 5,633 in 2025 to about 5,600 in 2026. CMS aims to provide beneficiaries with improved tools to compare Medicare plans during the Open Enrollment period. This includes enhancements to the Medicare Plan Finder, which will help beneficiaries evaluate their options and select the best plan for their needs.

Medicare Advantage PPO Plans 2026

Medicare Advantage PPO plans for 2026 include:

• Updates to prescription drug coverage and medical costs, which can affect copays and coinsurance.
• The requirement for members to review their Annual Notice of Changes (ANOC) to understand any benefit alterations for the upcoming year.
• Expanded provider networks, allowing members to receive care from both in-network and out-of-network providers, though at different cost levels.

PPO plans provide flexibility, as members are generally not required to select a primary care doctor, giving them more freedom to access specialists directly. Many PPO plans also feature additional benefits such as vision and dental coverage, which are not typically included in Original Medicare.

In 2026, certain PPO plans may offer wellness programs to promote preventive health services and enhance overall health management through a health plan.

Medicare Advantage HMO Plans 2026

Medicare Advantage HMO plans in 2026 will continue to emphasize coordinated care, which can lead to improved health outcomes for enrollees. Key features include:

• Access to a network of healthcare providers
• Requirement of referrals from primary care physicians for specialist services
• Automatic renewal is available for members who choose to remain in their current plan.

HMO plans are expected to offer:

• More tailored supplemental benefits based on individual medical needs.

• Maximum out-of-pocket limits for Medicare Advantage plans, including HMO options, will be subject to annual adjustments reflecting rising healthcare costs starting in 2026.

• A wider range of telehealth services to enhance access to care.

Medicare Supplement Plans for 2026 (Medigap)

Medigap plans, also known as Medicare Supplement plans, are designed to cover out-of-pocket expenses not covered by Original Medicare. These plans are purchased from private insurance companies and offer varying levels of coverage to help beneficiaries manage their medical costs.

What is Medigap?

Medigap is an additional insurance policy purchased from private insurers to cover out-of-pocket expenses associated with Original Medicare. These costs can include:

• Copayments
• Coinsurance
• Deductibles provide financial relief and predictability for beneficiaries. There are 10 standardized Medigap plans available, labeled from A to N, each offering varying levels of coverage.

Medigap policies do not include coverage for prescription drugs, so beneficiaries need to enroll in separate Medicare Part D plans for that purpose. To purchase a Medigap policy, individuals generally need to have both Medicare Part A and Part B.

The ideal time to enroll in a Medigap policy is during the 6-month Medigap Open Enrollment Period, which begins when one turns 65.

Medicare Supplement Plan G 2026

Medicare Supplement Plan G is known for its comprehensive coverage, making it one of the most sought-after Medigap options. It includes:

• Coverage of 100% of Part A coinsurance
• Additional days in the hospital beyond Medicare benefits
• Payment for the Part A deductible
• Essential services without upfront costs for doctor visits

Plan G coverage details include:

• 100% coverage of Part B copayments or coinsurance, beneficial for managing outpatient services.
• Does not cover the Part B deductible, which must be paid before benefits begin.
• Offers foreign travel emergency coverage, reimbursing 80% of costs after a deductible is met, up to a certain limit.

Medicare Supplement Plan N 2026

Medicare Supplement Plan N provides a cost-effective option with the following features:

• Lower premiums but requires copayments for certain office visits
• Covers most out-of-pocket costs not included in Original Medicare, except for the Part B deductible and certain excess charges
• Provides full coverage for Part A hospital expenses
• Covers 100% of Medicare Part B coinsurance, with specific copays for some office and emergency visits

Monthly premiums for Plan N are typically lower than those for Plan F and Plan G, making it a more economical option while still offering substantial coverage. Insurance companies may set monthly premiums for Plan N based on factors like age, health, and geographic location.

Beneficiaries can obtain a separate Medicare Prescription Drug plan for prescription medications as Plan N does not include prescription drug coverage.

Medicare Plan G vs Plan N

Comparing Medicare Supplement Plan G and Plan N:

• Plan G generally offers more comprehensive coverage but comes with higher premiums.
• Plan G covers all Medicare Part A and B coinsurance costs.
• Plan N requires some copayments for office and emergency room visits.
• Plan G covers Part B excess charges, which Plan N does not.

Medigap Plan N, on the other hand, has lower premiums but requires beneficiaries to pay $20 for office visits and up to $50 for emergency visits. Choosing between Plan G and Plan N may depend on anticipated healthcare usage, especially the frequency of medical visits.

For example, Plan G’s premium could be $38 higher annually than Plan N, balancing potential out-of-pocket costs against paying premium savings.

Medicare Part D Plans 2026

Medicare Part D plans in 2026 will see several updates aimed at managing prescription drug costs for beneficiaries. The maximum deductible for Medicare drug plans will increase to $615, and out-of-pocket spending limits will rise to $2,100.

These other changes reflect efforts to keep prescription drug coverage affordable and accessible for Medicare beneficiaries.

Increased Medicare Part D Costs

In 2026, the Medicare Part D costs are as follows:

• The deductible may reach $615.
• After meeting the deductible, beneficiaries will pay 25% coinsurance.
• This coinsurance continues until out-of-pocket costs reach the $2,100 limit.
• The out-of-pocket spending limit will be $2,100.

These changes aim to balance the need for affordable prescription drug coverage with rising medical costs.

Insulin Cost Cap for Medicare Beneficiaries

Starting in 2026, Medicare beneficiaries will benefit from the following regarding insulin costs:

• They will pay no more than $35 for a month’s supply of insulin.
• This cap ensures that essential medications for managing diabetes remain affordable and accessible.
• There will be no deductible applied to insulin costs, providing significant financial relief for beneficiaries.

Zero Cost-Sharing for Adult Vaccines

Medicare Part D will maintain zero cost-sharing for adult vaccines. This applies to vaccines recommended by the Advisory Committee on Immunization Practices (ACIP). This means that beneficiaries will not face any out-of-pocket costs for these vaccines, ensuring that preventive care remains accessible and affordable.

The cost-sharing removal for adult vaccinations is a permanent change under Medicare Part D.

Introduction of Medicare Prior Authorizations in Select States

Starting January 1, 2026, six states will implement prior authorization for certain Medicare services under the WISeR Model to address issues of fraud and waste. The services requiring prior authorization include 17 specific procedures identified as prone to abuse and inefficiency.

This change aims to enhance the efficiency of service approvals and reduce unnecessary healthcare expenditures.

While AI will assist in the review of prior authorizations, final decisions will be made by licensed human clinicians, ensuring that technology does not solely dictate outcomes.

The WISeR Model will not change existing coverage or payment rules of Medicare but aims to streamline the prior authorization process.

Annual Review of Your Medicare Plan

Allowing us to help you review your Medicare plan annually is crucial because:

• Medicare costs, benefits, and providers can change each year.
• Evaluating your healthcare needs ensures that your Medicare plan still meets those needs.
• It helps prevent overspending.

It’s advisable for Medicare beneficiaries to check their Medicare plans every fall, especially during the Open Enrollment Period, to make necessary adjustments.

During the annual election period, beneficiaries who do not opt out will be automatically re-enrolled in their current Medicare drug plan. Beneficiaries have the option to:

• Join a plan
• Switch plans
• Drop a plan
• Switch to Original Medicare
• Keep current coverage during their review.

The process of reviewing a Medicare plan can typically be completed in about 10 to 15 minutes. Call us today for help!  1-833-641-4938

Medicare Annual Enrollment Period 2026

The Medicare Open Enrollment Period for 2026 will run from October 15, 2025, to December 7, 2025. During this period, beneficiaries can utilize Medicare.gov and the Medicare Plan Finder to compare their health and drug coverage options.

CMS plans to introduce new features to assist beneficiaries in evaluating ma plans, including comparisons of provider availability and supplemental benefits, and options to change plans.

Initial enrollment period (IEP)

The Initial Enrollment Period (IEP) for Medicare:

• Starts three months prior to eligibility for Part A and/or Part B
• Concludes three months afterward
• Allows individuals to enroll in any Medicare plan during their IEP if they have both Part A and Part B.

If someone requests to join a plan before their Medicare coverage starts, the plan becomes effective on the same day as Medicare Part A and/or Part B.

Annual Enrollment Period (AEP)

The Annual Enrollment Period for Medicare in 2026 is scheduled from October 15 to December 7. During the AEP, eligible individuals can evaluate and select their Medicare coverage options for the upcoming year.

New features for the 2026 AEP include enhancements to the Medicare Plan Finder, such as provider compatibility and additional supplemental benefits.

Medicare Advantage Open Enrollment

The Medicare Advantage Open Enrollment Period occurs annually from January 1 to March 31, allowing beneficiaries to make changes to their coverage. During this period, individuals can switch to a different Medicare Advantage plan or revert to Original Medicare.

Beneficiaries are also eligible to enroll in a separate Medicare drug plan if they return to Original Medicare.

Special Enrollment Periods (SEPs)

Special Enrollment Periods allow individuals to adjust their Medicare coverage following significant life events, such as moving or losing other insurance. When moving outside a plan’s service area, beneficiaries can switch to a new special enrollment period Medicare Advantage Plan or revert to Original Medicare.

If a beneficiary loses creditable drug coverage, they have two months to enroll in a Medicare Advantage Plan that includes drug coverage.