Medicare in 2026: What's Changed and What You Need to Know

Every year, Medicare makes changes. Some are small. Some are significant. And if you're on Medicare or about to enroll, it's worth spending ten minutes understanding what's different this year — because the wrong plan choice can cost you thousands of dollars you didn't need to spend.

I've been helping people navigate Medicare for years, first alongside my mother Lynn, and now on my own. Here's my honest take on what matters in 2026 and what you should actually do about it.

Part B Premiums: Yes, They Went Up Again

The standard Part B monthly premium for 2026 is $185.00, up from $174.70 in 2025. That's about a 6% increase. Not a surprise — Part B premiums have gone up nearly every year for as long as anyone can remember — but it still adds up. That's an extra $123.60 per year coming out of your Social Security check or your bank account.

The Part B annual deductible also increased to $257, up from $240 in 2025. This is the amount you pay out of pocket before Medicare starts covering 80% of your outpatient services.

If your income is higher, you'll pay more. Medicare uses something called IRMAA (Income-Related Monthly Adjustment Amount) to add surcharges based on your tax return from two years ago. For 2026, if your modified adjusted gross income was above $106,000 as an individual or $212,000 as a couple (based on your 2024 tax return), you'll pay a higher Part B premium — and the surcharges get steep quickly at higher income levels. If you've had a life-changing event like retirement, you can appeal to Social Security using Form SSA-44.

Medicare Advantage: More Choices, More Fine Print

Medicare Advantage (Part C) plans continue to grow. In most markets, you'll have more options than ever — many of them with $0 premiums beyond your standard Part B cost. Plans are increasingly bundling extras like dental, vision, hearing, over-the-counter allowances, and even meal delivery after hospital stays.

That said, 2026 is also a year where some plans are exiting certain counties or reducing benefits. Star ratings — Medicare's quality scoring system — have been updated, and plans with lower ratings may lose bonus funding, which means they may cut benefits or raise costs. If you're already on an Advantage plan, don't just assume everything stays the same.

The appeal of Advantage plans is real: lower upfront costs, bundled benefits, and maximum out-of-pocket limits that Original Medicare doesn't have. But you're trading flexibility for structure. If that trade-off works for your situation, great. If it doesn't, it can be expensive to find out the hard way.

Part D: The $2,000 Cap Changes Everything

This is the biggest change for 2026, and it's genuinely good news. Thanks to the Inflation Reduction Act, there is now a hard cap of $2,000 per year on out-of-pocket spending for prescription drugs under Part D. This applies to all Part D plans, including drug coverage built into Medicare Advantage plans.

For years, seniors on expensive medications faced the dreaded “donut hole” — a coverage gap where you suddenly had to pay a much larger share of your drug costs. That gap has been fully eliminated. Once you hit $2,000 in out-of-pocket drug spending for the year, you pay nothing more.

There's also a new option to spread your out-of-pocket costs evenly across the year through the Medicare Prescription Payment Plan, rather than facing large bills early in the year when you fill expensive prescriptions. Think of it like an interest-free payment plan for your drug costs.

If you're someone who takes several brand-name medications, this is a meaningful financial protection that didn't exist before. It's worth reviewing your Part D plan to make sure your specific drugs are still on the formulary at the tier you expect — but the overall cost exposure is now capped in a way that provides real peace of mind.

Medigap vs. Advantage: How to Think About It

This is the question I get more than any other: “Should I go with a Medicare Supplement plan or a Medicare Advantage plan?” The honest answer is that it depends entirely on your situation. There's no universal right answer, but there is a right answer for you.

A Medigap (Supplement) plan might be the better fit if you:

• Travel frequently or split time between states — Medigap works with any provider that accepts Medicare, nationwide
• Have specific doctors or specialists you won't compromise on, regardless of network
• Want predictable costs with minimal surprises — Plan G, for example, covers nearly everything after the Part B deductible
• Are willing to pay a higher monthly premium in exchange for lower out-of-pocket risk
• Want to keep Original Medicare as your primary coverage

A Medicare Advantage plan might be the better fit if you:

• Primarily see doctors within a local network and don't need nationwide flexibility
• Want lower monthly premiums — many Advantage plans have $0 premiums beyond Part B
• Value bundled extras like dental, vision, hearing, and fitness programs
• Are comfortable with copays and a maximum out-of-pocket limit rather than paying a flat monthly premium for near-zero cost sharing
• Want drug coverage and medical coverage in one plan

Key Enrollment Periods You Need to Know

Medicare enrollment isn't like shopping for health insurance on the marketplace. There are specific windows, and if you miss them, you could face penalties or gaps in coverage. Here's the quick version:

Initial Enrollment Period (IEP) — This is your first chance to enroll, and it's a 7-month window centered around your 65th birthday: the 3 months before, your birthday month, and the 3 months after. If you're still working and have employer coverage, you may be able to delay enrollment without penalty — but the rules are specific, so it's worth getting guidance.

Annual Election Period (AEP) — October 15 through December 7, every year. This is when you can switch Medicare Advantage plans, switch from Advantage to Original Medicare, change your Part D drug plan, or add/drop coverage. Changes take effect January 1.

Medicare Advantage Open Enrollment Period (OEP) — January 1 through March 31. If you're already in an Advantage plan, you can switch to a different Advantage plan or drop back to Original Medicare (and pick up a Part D plan). You get one change during this window.

Special Enrollment Periods (SEPs) — These apply when you have a qualifying life event: you move to a new area, lose employer coverage, qualify for Extra Help (low-income subsidy), or other specific circumstances. The rules and timeframes vary, so don't assume — ask.

What You Should Do Right Now

Here's my advice, and it's the same thing I tell my own family members:

Review your plan every year. I know it's tempting to set it and forget it. But plans change their formularies, their networks, their costs, and their benefits annually. The plan that was perfect for you last year might not be the best fit this year. This is especially true for Part D — drug formularies can shift significantly from year to year.

Don't assume the lowest premium is the best deal. A $0 premium Advantage plan with high copays and a narrow network might cost you more than a $150/month Medigap plan with predictable costs. Look at the total picture: premiums, deductibles, copays, drug costs, and whether your doctors and hospitals are covered.

Get help from someone who doesn't work for a single carrier. As an independent broker, I work with multiple carriers and have no incentive to push you toward any specific plan. My job is to help you find the plan that actually fits your situation — your doctors, your medications, your budget, your travel patterns. That's it.

If you're turning 65, already on Medicare, or helping a parent navigate their options, I'm happy to sit down and walk through it with you. No cost, no pressure, no sales pitch. Just a straightforward look at what's available and what makes sense.