Changes You’ll See Coming to Medicare in 2026

The new year brings changes to Medicare that could affect your coverage, costs, and benefits. How much these changes matter to you depends on your health, income, and other personal factors. Here are some key updates to know for 2026:

1. Lower drug prices

Starting January 1, 2026, ten high-cost prescription drugs covered by Medicare will be available at lower prices. These include medicines for arthritis, blood clots, cancer, and diabetes.

Thanks to a law passed in 2022, these lower prices will make medications more affordable and accessible. If you take any of these drugs, you could save money on your prescriptions. Medicare estimates that overall, these changes could reduce out-of-pocket spending by about $1.5 billion in 2026—and the savings will continue every year.

All Medicare Advantage and Part D plans must include these drugs at the lower prices, so you can take advantage of the savings no matter which plan you have.

Here’s a look at the drugs and their new 2026 prices:

The rates below are for a 30-day supply of the prescription.

Drug name	Negotiated price	List price in 2023	Percent discount
Januvia	$113	$527	79%
NovoLog/Fiasp, several pens	$119	$495	76%
Farxiga	$178	$556	68%
Enbrel	$2,355	$7,106	67%
Jardiance	$197	$573	66%
Stelara	$4,695	$13,836	66%
Xarelto	$197	$517	62%
Eliquis	$231	$521	56%
Entresto	$295	$628	53%
Imbruvica	$9,319	$14,934	38%

2. You may get another chance to switch Medicare plans

If you looked at the 2026 Medicare Plan Finder and got ready for open enrollment (Oct. 15–Dec. 7), you may notice something new. CMS now shows which doctors, hospitals, and other health care providers are included in a Medicare Advantage plan’s network right in the plan finder.

Before, you had to visit each plan’s website, call the insurance company, or work with a broker just to see if your doctors were covered. Now it’s easier, though not all plans have complete information yet. CMS will keep updating it as they get new data.

Here’s what you need to know:

• If you choose original Medicare, you can see almost any doctor who accepts Medicare (about 98% of all non-pediatric doctors).

• Medicare Advantage plans have a set list of providers. If you go out-of-network, you may pay more—or the plan might not cover the visit at all.

• If you enroll in a Medicare Advantage plan and later find out your doctors aren’t actually in-network, you may get a special chance to switch plans or go back to original Medicare—but only in 2026.

Tip: As soon as your coverage starts, double-check that the doctors and hospitals you want are actually in your plan’s network. This can save you money and avoid surprises.

3. Part D deductibles and spending limits go up

Starting in 2026, the maximum out-of-pocket limit for Medicare prescription drug plans will rise from $2,000 to $2,100. This limit applies to both stand-alone Part D plans and the drug coverage included with Medicare Advantage plans.

The maximum deductible for Part D plans is also going up, from $590 in 2025 to $615 in 2026. Some plans may still offer lower or no deductibles, so it’s worth checking your options.

What this means for you:

• You may pay slightly more out of pocket for your prescriptions next year.

• Reviewing your plan now can help you find the best coverage and keep your costs manageable.

4. No need to reenroll in Medicare in 2026 for drug payment plans

If you were on a Part D prescription plan or a Medicare Advantage plan with drug coverage in 2025, you may have used the Medicare Prescription Payment Plan to pay out-of-pocket costs in monthly installments instead of all at once. For example, a $2,000 bill could be spread out as $167 per month.

Good news: If you were on the plan in 2025, you’ll be automatically reenrolled in 2026. You don’t have to do anything unless you want to opt out or switch to a new Part D or Medicare Advantage plan. If you change plans and still want a payment plan, just contact your new plan.

This automatic renewal is designed to make things easier for you. If you do decide to opt out, your plan must process it within three days.

5. Original Medicare starts a prior authorization test

Starting Jan. 1, 2026, some original Medicare services may require prior authorization in a six-year pilot program. This means you may need approval before certain medical services, procedures, or devices are covered.

The pilot will involve millions of Medicare beneficiaries in Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington and runs through December 2031. It focuses on 16 types of services and devices that are at higher risk for fraud, waste, or misuse.

The goal is to speed up coverage decisions and reduce unnecessary spending. Some Medicare Advantage plans already use prior authorization, sometimes with AI to help make decisions.

What you need to know:

• If you live in one of these states, you may have to get approval before certain services are covered.

• This could save money for Medicare but may require more paperwork or steps to get care.

• Caregivers should check ahead to make sure services are approved, so there are no delays in care.

6. Medicare in 2026 ends a supplemental benefits pilot

Starting Jan. 1, 2026, some extra benefits you may have received through Medicare Advantage could end. More than 7 million people, including those with chronic illnesses or limited incomes, may no longer get things like help with prescriptions, food assistance, transportation to appointments, or support managing chronic conditions.

This pilot program, called the Medicare Advantage Value-Based Insurance Design Model, began in 2017 to make care easier for people who need it most. It helped low-income beneficiaries, including those on both Medicare and Medicaid or on the Extra Help program.

The program was expensive—costing over $2 billion a year—so CMS decided to end it.

7. Medicare Advantage plans limit non-medical benefits

Medicare Advantage plans can still offer extra benefits for people with chronic conditions, called Special Supplemental Benefits for the Chronically Ill. These don’t have to be medical, but they must reasonably help maintain or improve your health or function.

In 2026, some benefits will no longer be allowed, including:

• Alcohol, cannabis, and tobacco products

• Cosmetic procedures like facelifts or treatments for facial lines

• Funeral planning and expenses

• Life insurance or hospital indemnity insurance

• Unhealthy foods

CMS says this makes the rules clearer for both plans and beneficiaries.

What this means for you:

• If you relied on non-medical extras from your plan, check your coverage for 2026.

• Focus on benefits that directly help your health or manage your chronic conditions.

Final Thoughts

Medicare is changing in 2026. Some drugs will cost less, some benefits may end, and certain services may need prior approval. Review your plan now to make sure your doctors, medications, and benefits are covered.

If you need help, A Circle Of Love Home Care is here for you. Call us today to get guidance and make the most of your Medicare benefits.