Medicare Changes for 2026 — What You Need to Know

How next year’s updates compare to 2025, and what it means for you
Medicare changes a little bit every year. Deductibles shift, premiums rise (sometimes more than we’d like), and certain protections expand. While the numbers are important, what really matters is how these changes affect your wallet and your peace of mind .
Let’s take a closer look at what’s different in 2026 compared to 2025 — and what you should keep in mind as you review your coverage this fall.
In 2026, the Part A deductible rises to $1,716 , up from $1,676 in 2025. Hospital coinsurance also ticks up slightly — $429 per day for days 61–90, compared to $419 in 2025. Skilled nurs0ing facility costs climb too, moving from $209.50 per day to $214.50 for days 21–100.
What this means for you: These are relatively small increases, but if you experience a hospital stay or need skilled nursing care, they can add up quickly. It’s another reason why having the right supplemental coverage matters.

Part A (Hospital Insurance)

Here’s where the biggest jump happens. The Part B monthly premium is projected to be $206.50 in 2026 , up from $185 in 2025. The annual deductible also rises — from $257 to $288. Coinsurance remains the same at 20% once the deductible is met.
What this means for you: This is one of the largest Part B premium increases we’ve seen in recent years. For retirees on fixed incomes, even $20 more a month can strain the budget. It’s especially important to weigh whether your current plan is still the most cost-effective for your needs.

Part B (Medical Insurance)

Medicare Advantage (Part C)

There’s a small bit of good news here. The maximum out-of-pocket limit (MOOP) for Advantage plans drops slightly , from $9,350 in 2025 to $9,250 in 2026.
What this means for you: While a $100 decrease may not sound like much, it does provide a little extra protection if you have a bad health year. Still, remember

Medicare Part D (Prescription Drug Coverage)

Prescription drug coverage continues to evolve under the Inflation Reduction Act. In 2026:
  • The annual out-of-pocket cap rises to $2,100 up from $2,000 in 2025.
  • The maximum deductible climbs to $615 up from $590.
  • The average monthly premium is projected to decrease — from $38.31 down to $34.50.
  • Insulin stays capped at $35 for a one-month supply, or 25% of its negotiated price (whichever is less).
  • Vaccines recommended by the CDC remain free of cost-sharing.
What this means for you: Even with a slightly higher out-of-pocket cap, the average premium drop is welcome news. Seniors with high medication costs should still see significant protection compared to years past.

Higher-Income Premium Adjustments (IRMAA)

For those with higher incomes, Medicare’s income-related monthly adjustment amounts (IRMAA) are also increasing. In 2026, the surcharge applies to individuals with incomes above $109,000 (up from $103,000 in 2025), or $218,000 for couples.
What this means for you: If your income is near these thresholds, tax planning becomes even more important. The monthly surcharges range from $82.60 up to $495.60 on top of your standard premium.

Pulling It All Together

So, what’s the big picture?
  • Hospital and doctor costs are inching upward.
  • Part B premiums are taking a sharp jump.
  • Medicare Advantage offers a little more protection with a lower MOOP.
  • Prescription coverage continues to improve, especially for those on expensive medications.
  • High-income retirees will see steeper surcharges.

Key Takeaway

2026 brings a mix of challenges and opportunities. Costs are rising in some areas, but drug coverage protections are stronger, and Advantage plans offer a bit more out-of-pocket relief.
The smartest move? Review your coverage during AEP. Make sure your doctors, prescriptions, and budget are all still aligned with the plan you’re in. And remember — you don’t have to sort through all these details alone. Schedule time with your broker to review your options carefully, so you head into 2026 with clarity and confidence.

Choosing the Right Medicare Coverage

Selecting the best Medicare coverage depends on factors like your healthcare needs, budget, and preferred providers. You can choose between:
  • Original Medicare (Parts A & B): Allows you to see any doctor or
    hospital that accepts Medicare but does not include prescription drug
    coverage (Part D) or additional benefits.
  • Medicare Advantage (Part C): Offers bundled coverage with
    potential extra benefits but may require using a network of providers.
  • Medigap (Medicare Supplement Insurance): Helps cover
    out-of-pocket costs not covered by Original Medicare, such as
    copayments and deductibles.

Key Medicare Enrollment Periods

It is crucial to enroll in Medicare at the right time to avoid penalties and ensure continuous coverage:
  • Initial Enrollment Period (IEP): A seven-month window starting
    three months before your 65th birthday month.
  • General Enrollment Period (GEP): From January 1 to March 31
    each year for those who missed their IEP.
  • Annual Election Period (AEP): From October 15 to December 7,
    allowing you to switch or enroll in Medicare Advantage and Part D
    plans.
  • Open Enrollment Period(OEP): From January 1 to March 31 for
    those who missed AEP and want to make certain changes.
  • Special Enrollment Period(SEP): Can be used anytime during the
    calendar year for those that meet certain criteria such as moving to a
    new service area.

Finding Help with Medicare

Understanding Medicare can be complex, but you don’t have to do it alone. Licensed Insurance Brokers, Medicare.gov, and state health assistance programs can provide guidance tailored to your specific needs.
By taking the time to explore your Medicare options, you can make informed decisions that ensure you receive the healthcare coverage that best suits your lifestyle and budget.
Do I have to sign up for Medicare?
It depends upon your current coverage. If you are employed and your employer has over 20 employees then you can delay signing up for Medicare and avoid penalties.
No, You will have to enroll in a stand alone Part D plan or a Medicare Advantage Plan(Part C) to get coverage.
There are no networks with Medicare and most doctors and hospitals accept it. However, Medicare does not cover 100% of services so a Medicare Supplement or Medicare Advantage plans is advisable.

Mike Miligi- Owner

For over 10 years, Mike has been assisting Seniors and other Medicare-eligible individuals in understanding the ins and outs of Medicare and Medicare Health Insurance options, including Medicare Advantage Plans(Part C), Medicare Supplement Plans(Medigap), Prescription Drug Plans(PartD), and Dental and Vision programs.
Mike is Licensed in seven States and Certified with 11 Insurance Carriers. He has helped thousands of individuals decide on the best course of action for their particular Health Insurance needs. Because Mike is an Independent Medicare Health Insurance Broker, he works for the client, not the Insurance Carriers, and is able to provide his clients with accurate and unbiased Health Insurance options.
Mike recertifies with CMS(The Centers for Medicare and Medicaid Services) annually, regularly completes Continuing Education Courses required by individual State Insurance Departments, and keeps abreast of industry trends and standards to offer his clients the most up-to-date information.
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