Medicare 2026 Updates: Medicare users will see some major changes in 2026 that will affect their healthcare costs and options. These updates include new premium rates, changes to drug coverage, and modified enrollment rules. Ongoing worries about the federal shutdown may also cause issues in benefits and claim processing, making things uncertain for many older adults who depend on Medicare.
Medicare 2026 Changes: Here’s What you Need to Know
Medicare Coverage
The Medicare is a government health insurance program for adults aged 65 and older. Every year, there is an open enrollment period from October 15 to December 7. During this time, people can sign up, change their plans, or update their existing coverage.
- Medicare has four parts. Part A covers hospital stays, skilled nursing, and some home healthcare.
- Part B pays for doctor visits, outpatient services, and preventive care.
- Part C called Medicare Advantage, combines Parts A and B and sometimes includes Part D.
- Part D is for prescription drugs.
In 2026, Medicare Advantage and Part D plans will get several updates. Around 51% of people have additional coverage like Medicare Advantage, and about 81% use Part D for their prescriptions. The Centers for Medicare & Medicaid Services (CMS) expects there will be about 5,600 Medicare Advantage plans nationwide in 2026, nearly the same as in 2025. The number of plans and benefits can vary depending on where a person lives.
Effects of Federal Shutdown
Because of the ongoing federal shutdown issues, some programs that expired on October 1 have not been renewed. This might delay claim processing and payments to healthcare providers. It could also limit access to telehealth, especially for people living in rural areas or those who have trouble traveling.
“Beneficiaries should be proactive,” said Whitney Stidom, eHealth vice president. “As comparing plans from multiple insurers can help people save money and find the right option for them.”
Part D Premiums
Medicare Advantage plans that include prescription drug coverage will see a small drop in monthly premiums from $16 in 2025 to $14 in 2026. Stand-alone Part D plans will also fall slightly from $38 to $34 a month. However, some insurers may raise their Part D premiums up to $50 monthly, especially for plans covering expensive specialty medicines.
Medicare Open Enrollment 2026 Starts This Week: Dates and Details
Dr. Kanwar Kelley, an otolaryngology specialist, warned, “Any cost increase to medical premiums will be significant as prices are rising for other goods and services. In the end, it means less money in consumers’ pockets.”
The in-network out-of-pocket limit for Medicare Advantage plans will slightly decrease from $9,350 to $9,250. For Part D drugs, the out-of-pocket maximum will rise from $2,000 to $2,100. Insulin prices will stay capped at $35 per month.
Some of the 2026 changes could help people manage their coverage better. Medicare’s Plan Finder tool will continue to help users compare plans and check which doctors and hospitals are covered.
Special Enrollment Periods
People who experience major life events or turn 65 in 2026 may qualify for special enrollment periods. These windows allow them to change or start plans outside the normal October-to-December time. Extra enrollment chances will also be open between January 1 and March 31, and again from December 8 to February 28.
