2026 Changes to Medicare

Mara Woloshin

 

Nothing is as constant as change, and Medicare is no exception. There are multiple changes coming to Advantage and prescription drug plans in 2026.

Following are some of the ways these may affect your wallet.

 

Rx Changes

Having a prescription denied by your plan is frustrating. Beginning in 2026, however, the Centers for Medicare and Medicaid Services (CMS) is requiring plans to provide specific reasons for such denials, including the coverage rule used for the denial. This also applies to denials of procedures.

 

High medication prices challenge many, even those with insurance. Luckily, the Inflation Reduction Act reduced prescription drug costs in 2025. This legislation also placed a ceiling of $2,000 on out-of-pocket costs for all prescriptions. While the cap will rise to $2,100 in 2026, Medicare now has the right to negotiate DOWN high-price Part D drugs.

 

More good news: all adult vaccines are covered, including Shingles. Insulin will remain capped at $35 for a one-month supply. Additionally, the program known as Extra Help will be expanded to 150% of the federal poverty level. That makes more beneficiaries eligible, dramatically reducing costs at the pharmacy. Learn more or apply for Extra Help at www.ssa.gov.

 

As you can see, there are both positive and negative changes that could impact your Medicare plan and your finances in 2026.

 

Plans

For changes specific to your Medicare plan, look for the Annual Notice of Change (ANOC), arriving in mailboxes by Sept 30. This details your plan changes for the coming year. If you don’t receive this letter, call your plan for a copy.

 

Enrollment

While health plans offer printed materials, virtually all now offer digital copies. It is easier to change plans by enrolling online.

 

 

 

Mara Woloshin owns Woloshin Communications and is a Certified Retirement Coach, Medicare Consultant, and Health Educator. Learn more at woloshin.com.