Skip to content

Freitas Wealth Management

Medicare in 2026: What Beneficiaries Should Expect Ahead of AEP

Medicare in 2026: What Beneficiaries Should Expect Ahead of AEP

Introduction

The Medicare Annual Enrollment Period (AEP) runs from October 15 through December 7, 2025. This is the time when beneficiaries can review their coverage and make changes for the 2026 plan year. While Medicare adjusts every year, the upcoming changes for 2026 are especially important due to increases in costs and reductions in plan availability in some areas.

Key Changes for 2026

Part D Out-of-Pocket Cap and Deductibles

  • The annual out-of-pocket spending cap for prescription drugs will rise to $2,100.
  • Plans may set deductibles up to $615.

 

Rising Premiums

  • Many beneficiaries will see higher Part D premiums in 2026.
  • This increase is due in part to subsidy adjustments and plan redesigns.
  • Even if you remain in the same plan, your monthly cost may change.

 

Insulin and Vaccine Cost Protections

  • The $35 monthly cap on insulin continues.
  • ACIP-recommended vaccines covered under Part D will no longer be subject to a deductible, meaning many preventive vaccines will be available at no cost.

 

Medicare Advantage Supplemental Benefits

  • CMS has clarified which supplemental benefits are permitted.
  • Some non-health-related items (such as funeral planning or life insurance) will no longer be allowed.
  • The out-of-pocket maximum for Medicare Advantage plans decreases slightly to $9,250.

 

Service Area Reductions

  • Several carriers are reducing their Medicare Advantage and Part D service areas in 2026.
  • This may result in:
    • Fewer plan choices in some counties.
    • Automatic reassignment if your plan is discontinued.
    • Changes in provider networks or prescription formularies.
  • Reviewing your Annual Notice of Change (ANOC) is essential to confirm that your plan remains available in your area.

 

Original Medicare Premiums and Deductibles (Projected)

  • Part B premium: approximately $206.50/month.
  • Part B deductible: about $288.
  • Part A hospital deductible: projected at $1,716.
  • Skilled nursing copay (days 21–100): about $214.50/day.

 

Prior Authorization in Original Medicare (Pilot Program)

  • Starting January 1, 2026, CMS will launch a prior authorization pilot in six states: Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington.
  • Licensed clinicians will make final determinations, with technology used only to support the process.

 

High-Income Surcharges (IRMAA)

  • Income thresholds for surcharges on Part B and Part D are scheduled to rise.
  • Beneficiaries in higher income brackets may still see larger monthly adjustments.

 

What You Should Do

  1. Review your Annual Notice of Change (ANOC) carefully when it arrives.
  2. Compare costs and coverage for your current plan versus alternatives in your area.
  3. Check prescription coverage against the 2026 formulary.
  4. Confirm provider networks if you are in a Medicare Advantage plan.
  5. Schedule a Medicare review early in the AEP to avoid last-minute surprises.

 

Conclusion

The 2026 Medicare updates bring higher premiums, important drug cost protections, and reduced plan availability in some areas. Taking time to carefully review your options during the Annual Enrollment Period can help ensure your healthcare coverage continues to meet your needs for the coming year.

📌 Next Step: If you have questions or want help reviewing your Medicare options, contact our office to schedule your AEP review.

Freitas Wealth Management