The Annual Enrollment Period (AEP) from October 15 to December 7 is your window to review or change your Medicare plan for 2026. But, before you dive into comparisons, it pays to know what’s changing in the landscape itself. Below are key updates for Medicare in 2026–What’s new, what to watch, and how to use these changes to your advantage.

Prescription Drug (Part D) Limits & Payment Plans

• • In 2026, the maximum out out-of-pocket cap for Part D drug expenses rises to $2,100 as part of the Inflation Reduction Act rollout (Kiplinger, 2025).
  • The deductible for Part D plans (if your plan has one) may increase.
  • The Medicare Prescription Payment Plan (MPPP) will see enhanced auto-renewal: if you enroll, you’ll stay enrolled for the next year unless you opt out (CMS, 2025B). 

Premiums, Deductibles & Cost Sharing

• • Part B premiums are projected to increase (MedicareResources.org, 2025)
  • Part B deductible is estimated to increase
  • Part A deductible and some cost sharing amount are also expected to rise slightly for 2026 (Investopedia, 2025).

Changes in Medicare Advantage & Plan Benefits

• • CMS finalized a 2026 rule that adds changes in benefits, coverage limits, and prescription rules in Medicare Advantage and Part D programs 
  • Payment rates from CMS to Medicare Advantage plans are rising about 5% from 2025 to 2026 (CMS, 2025b).
  • More transparency in provider directory data: plans will be required to make provider network information more accessible (so you can better check if your doctors are in network) (Federal Register, 2025).
  • Changes in eligibility for Dual Eligible Special Needs Plans (D-SNPs) may cause some enrollees to reassess their options (Healthfirst, 2025).

Prior Authorization in Some States under Original Medicare

• • In select pilot states, Traditional Medicare (Original Medicare) may require prior authorization for certain procedures (17 services starting in 2026) (ResourceMedicare.com [MRC], 2025). 
  • If you’re in one of these states, your provider may need Medicare’s approval in advance for some services, otherwise coverage could be denied (MRC, 2025). 

Fewer Plan Options / Market Shifts

• • Several insurers are pulling back or exiting certain markets, meaning few Medicare Advantage or Part D plan choices for some people (MedicareResources.org, 2025) 
  • Even if your plan name continues, benefits, networks or extras (like food or transportation perks) may be trimmed or revised (CMS, 2025b; The Senior Citizens League, 2025; MedicareResources.org, 2025). 

What You Should Do Now

• • Annual Enrollment is Open! Let us guide you through the changes for 2026.
  • Pay special attention to drug costs, especially if you take specialty or high-cost medications. 
  • Compare alternative plans: networks and benefits may shift more than you expect.
  • If you’re in a state with prior authorization rules, ask your provider if your scheduled procedures are affected.
  • Don’t wait until the last minute. Plan changes and high call volumes make late enrollment riskier. 

Let Harbor Health Insurance Services Guide You:

We’ll help you understand these changes and find the plan that makes sense for you, with zero sales pressure and clear guidance. 

Schedule your 2026 Medicare review now: Schedule Your Consult Here! 

References:

American Hospital Association (AHA). CMS issues final rule for CY 2026 policy and technical changes to Medicare Programs. Retrieved from https://www.aha.org

Centers for Medicare and Medicaid Services (CMS). (2025a). Contract Year 2026 policy and technical changes to Medicare Advantage & Part D. Retrieved from https://www.cms.gov

Centers for Medicare & Medicaid Services (CMS). (2025b). CMS finalizes 2026 payment policy updates for Medicare Advantage & Part D. Retrieved from http://www.cms.gov

Healthfirst. (2025). Changes to Medicare in 2026. Retrieved https://healthfirst.org

Investopedia. (2025). 10 Big Medicare Changes in 2026. Retrieved from https://investopedia.com

Kiplinger. (2025). Seven Medicare Changes Coming in 2026. Retrieved from https://www.kiplinger.com

MedicareResources.org. (2025). How are Medicare costs and benefits changing for 2026? Retrieved from https://www.medicareresources.org

ResourcesMedicare.com (MRC). (2025). New Medicare changes in 2026: Prior approval required for these services. Retrieved from https://www.resourcesmedicare.com

The Senior Citizens League. (2025). Medicare changes for 2026. Retrieved https://seniorsleague.org

Medicare Disclaimer: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.