Posted on Thursday, November 13, 2025
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by Sabrinah Cave
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0 Comments
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Key Takeaways:
✅ Projected Increases for Part A & Part B
✅ Original Medicare uses Prior Authorizations in Select States
✅ Zero Cost-Sharing for Adult Vaccines
2026 Medicare Changes
Medicare is set to undergo important changes in 2026. This affects everything from drug costs to plan participation rules. These updates also directly impact your wallet and healthcare. Staying informed now can help you make smarter choices during the Annual Enrollment Period (which ends December 7th).
Here are six significant Medicare changes in 2026:
1. Projected Part A and B Increases
Although final figures have not been released yet, both Part A and Part B are expected to have increased costs in 2026. CMS usually announces these finalized amounts after the Social Security Cost-of-Living Adjustment (COLA) announcement, but due to the recent Goverment shutdown, it may be delayed.
Now, most people receive Part A premium-free. For individuals without sufficient work history, Part A premiums are projected to increase to $310 or $563 per month.
Other projected increases for Medicare Part A include:
- Inpatient deductible: $1,716 (up from $1,676)
- Daily copay for days 61–90 in hospital: $429/day (up from $419)
- Lifetime reserve day copay: $858/day (up from $838)
- Skilled nursing facility copay (days 21–100): $214.50/day (up from $209.50)
Additionally, the projected standard Part B monthly premium for 2026 is $206.50, up from $185 in 2025. The Part B deductible is expected to increase to $288 next year—a $31 jump from 2025.
2. Prescription Payment Plans Will Auto-Renew
Starting in 2026, the Medicare Prescription Payment Plan (MPPP) will automatically renew for beneficiaries who are already enrolled. This program allows you to spread out your prescription drug costs over the year instead of paying all at once at the pharmacy.
Unless you actively opt out, you’ll be re-enrolled each year. CMS will require plan sponsors to honor opt-out requests within three calendar days. This update reduces paperwork while helping beneficiaries manage healthcare costs more predictably.
3. Drug Costs Rise
In 2026, the out-of-pocket cap for Medicare Part D prescription drugs will rise to $2,100, up from $2,000 in 2025. While a $100 increase may seem modest, it’s part of a broader trend of rising medical expenses that retirees need to prepare for. This change means you’ll pay more before reaching the catastrophic coverage threshold, so it’s wise to review your plan to see how high-cost medications are covered.
Part D plans will see another hike in their maximum deductible, climbing to $615 in 2026—a $25 increase from 2025. Keep in mind that plans can choose to have a lower deductible amount, so be sure to check with your plan provider for updated amounts.
Medicare Advantage plans will face tighter rules around what they can offer under their Special Supplemental Benefits for the Chronically Ill (SSBCI). In 2026, CMS will enforce a list of non-allowable items, including:
- Tobacco, alcohol, and cannabis products
- Cosmetic procedures and unrelated membership discounts
These limits aim to ensure that benefits actually improve or maintain the enrollee’s health, aligning with traditional Medicare standards.
5. Free Vaccines Continue for Medicare Beneficiaries
Medicare Part D will continue to offer zero cost-sharing for adult vaccines recommended by the CDC’s Advisory Committee on Immunization Practices (ACIP). This includes critical vaccines like shingles, pneumonia, and flu shots.
This benefit will remain in effect permanently. However, keep in mind that the list of covered vaccines may change each year, so always double-check before scheduling immunizations.
6. Prior Authorizations Coming to Original Medicare in Select States
For the first time, traditional Medicare will implement prior authorization requirements in six states—Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington—as part of the new WISeR Model beginning January 1, 2026.
This initiative will use technology to speed up authorization for select services. Importantly, final decisions will be made by licensed clinicians, not AI systems. While some may view this as added red tape, the goal is to reduce wasteful or unnecessary procedures while protecting taxpayer dollars.
Review Your Coverage During the Annual Enrollment Period
Each year, you have a chance to review or change your Medicare plan during the Annual Enrollment Period. Medicare benefits and costs change annually—what worked for you last year may not be the best fit in 2026. Whether you’re enrolled in a Medicare Advantage plan, Original Medicare, or a Part D plan, take the time to compare your options. The decisions you make during the Annual Enrollment Period can have a significant impact on both your healthcare and finances.
For help with Medicare plans – or any questions you may have about Medicare – contact AMAC’s Medicare Advisory Service at 1-855-611-4856 or click the button below to request a quote.
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