The rules for Medicare are changing in a major way, and you need to know exactly how it impacts your wallet. Two monumental shifts are happening: the $2,100 cap on prescription drug costs and a significant hike in the Medicare Part B premium.
For the over 33 million Americans enrolled in Medicare Advantage (MA) plans, these changes to Medicare in 2026 aren’t just technical adjustments; they directly hit your pocketbook costs, access to prescription drugs, and the value of supplemental benefits.
You need to know the reality of the medicare advantage plans changes 2026 to make the best choice during the Annual Enrollment Period (AEP). We’ve gathered the comprehensive, critical updates for you, including the often-overlooked changes to Original Medicare (Parts A and B) that directly impact your budget.
Core Cost Updates: The Rise of Original Medicare (Parts A & B) Costs
While Medicare Advantage (Part C) plans replace the cost-sharing structure of Original Medicare, all MA enrollees must still pay the Medicare Part B premium. Furthermore, the increases in both Part A and Part B costs signal a broader trend in rising healthcare expenditures that impacts all beneficiaries.
A. The Significant Jump in Medicare Part B Costs (Medical Insurance)
Medicare Part B covers outpatient services, doctor visits, preventive care, and durable medical equipment. The 2026 cost adjustments here are particularly notable and affect every Medicare beneficiary.
- Standard Monthly Premium: The standard monthly premium for Part B is increasing by nearly 10%, rising from $185.00 in 2025 to $202.90 in 2026. This $17.90 per month increase will be deducted directly from the Social Security checks of most retirees.
- Annual Deductible: The annual deductible you must pay before Part B begins to cover services will increase from $257 in 2025 to $283 in 2026.
Impact of the Part B Hike and the COLA
The nearly 10% premium increase is significant. Although Social Security recipients will receive a Cost-of-Living Adjustment (COLA) of 2.8% in 2026 (an average increase of about $56 per month), the Part B premium increase will consume a substantial portion of that raise for the average retiree.
Hold Harmless Protection: The “Hold Harmless” provision prevents the Part B premium increase from reducing a beneficiary’s Social Security check below the previous year’s amount. However, for most people whose COLA is larger than the premium hike, the full $202.90 premium will be paid, meaning a smaller net Social Security benefit increase.
B. Income-Related Monthly Adjustment Amount (IRMAA)
For higher-income beneficiaries, the increase is even steeper due to the Income-Related Monthly Adjustment Amount (IRMAA). This surcharge is paid in addition to the standard Part B premium and also applies to Part D coverage.
| Filing Status | Modified Adjusted Gross Income (MAGI) Threshold | Total Monthly Part B Premium (2026) |
| Individual | Less than or equal to $109,000 | $202.90 |
| Individual | Greater than $109,000 up to $137,000 | $284.10 |
| Couple (Joint Filers) | Less than or equal to $218,000 | $202.90 |
| Couple (Joint Filers) | Greater than $218,000 up to $274,000 | $284.10 |
Note: Premiums continue to increase across higher income tiers, reaching up to $689.90 for the highest earners.
C. Medicare Part A Cost Increases (Hospital Insurance)
While roughly 99% of beneficiaries do not pay a Part A premium, the cost-sharing amounts for hospital and skilled nursing facility (SNF) stays are increasing.
| Part A Cost Component (Per benefit period) | 2025 Cost | 2026 Cost |
| Inpatient Hospital Deductible | $1,676 | $1,736 |
| Hospital Coinsurance (Days 61-90) (Per day) | $419 | $434 |
| Skilled Nursing Facility (SNF) Coinsurance (Days 21-100) (Per day) | $209.50 | $217.00 |
If you are in a Medicare Advantage plan, your plan’s co-pays and deductibles replace these figures, but they are a good indicator of the rising healthcare costs that MA plans must manage.
The Prescription Drug Revolution: The $2,100 Out-of-Pocket Cap
The single most transformative shift in the medicare advantage plan changes for 2026 is the hard cap on out-of-pocket spending for Part D prescription drugs. This provision offers unprecedented financial protection for beneficiaries with high medication costs.
A. The Elimination of Catastrophic Costs
Prior to 2026, even after reaching the Catastrophic Coverage phase of Part D, beneficiaries were still responsible for 5% of their drug costs—a share that had no dollar limit.
- The 2026 Cap: Starting January 1, 2026, the maximum amount you will pay out-of-pocket for covered Part D prescription drugs, including those covered under your MA-PD plan, is $2,100.
- 100% Coverage After the Cap: Once your cumulative out-of-pocket spending (known as True Out-of-Pocket or TrOOP) hits $2,100, you will enter the Catastrophic phase, and your plan will cover 100% of the cost of your covered Part D medications for the remainder of the calendar year. You will have a $0 copayment or coinsurance for these drugs.
- Part D Deductible Adjustment: The Part D deductible, which can apply before your coverage kicks in, is also increasing slightly. In 2026, no Part D plan may have a deductible greater than $615.
B. The Medicare Prescription Payment Plan (MPPP)
To further ease the financial burden, especially early in the year, all Part D plans (including MA-PDs) are required to offer the MPPP.
- Payment Flexibility: This program allows you to choose to pay your out-of-pocket prescription drug costs (co-pays, co-insurance, and deductible) in monthly installments rather than paying the full amount at the pharmacy counter.
- Automatic Renewal: If you choose to enroll in the MPPP for 2026, you will be automatically re-enrolled for 2027 unless you actively opt out, ensuring continuous access to this budgeting tool.
C. The First Wave of Negotiated Drug Prices
Another major IRA provision taking effect in 2026 is the implementation of the Medicare Drug Price Negotiation Program. CMS has negotiated the Maximum Fair Price (MFP) for a first group of 10 high-cost drugs.
- Direct Cost Savings: The negotiated lower prices for these selected drugs will take effect, which should translate to lower costs for both beneficiaries and the Medicare program. This is expected to lower the overall costs in the Initial Coverage Phase for affected drugs.
- Insulin Cost-Sharing Refined: The popular $35 cap on a month’s supply of covered insulin will continue, with the cost-sharing refined to be the lesser of: $35, 25% of the negotiated plan price, or 25% of the Maximum Fair Price.
The Scrutiny of Supplemental Benefits: SSBCI Changes
One of the main selling points of MA plans are the supplemental benefits. CMS is tightening regulations, particularly around Special Supplemental Benefits for the Chronically Ill (SSBCI), to ensure they are genuinely contributing to health outcomes. These are the key medicare advantage supplemental benefits 2026 changes.
A. Refocusing Special Supplemental Benefits (SSBCI)
SSBCI are flexible benefits offered to MA enrollees with at least one qualifying chronic condition. For 2026, CMS is reinforcing the standard that these benefits must be primarily health-related.
- Exclusion of Non-Health Items: Plans are now explicitly prohibited from offering SSBCI benefits that cover non-healthy foods, alcohol, tobacco products, or general household maintenance not tied to a health need.
- Requirement for Evidence-Based Literature: Plans must establish and maintain an evidence-based bibliography to show that each SSBCI offering is reasonably expected to improve or maintain the health or overall function of the chronically ill enrollee. This means plans must be more strategic and clinically focused in their offerings.
- Impact on Flex Cards: While the popular “flex cards” and allowances for over-the-counter (OTC) items, transportation, and healthy food will largely remain, plans may reduce the dollar amount or limit the items that can be purchased, especially if the current benefit lacked a strong, clinically justified health connection.
B. New Mid-Year Notification Requirement
A key procedural change beginning in 2026 is the requirement for MA Organizations (MAOs) to send a mid-year notification to members about unused supplemental benefits, ensuring members use the benefits they paid for. The notice, sent between June 30 and July 31, must detail which benefits the member has not yet used and provide instructions on how to access them.
Market Dynamics and Network Adjustments
Beyond the IRA, the MA market itself is undergoing a period of recalibration, which affects plan availability and service design. These are crucial changes to medicare advantage plans 2026 for beneficiaries to review.
A. Market Consolidation and The Rise of SNPs
While MA enrollment continues its upward trend, the market is seeing a subtle contraction in the availability of general enrollment plans.
- Fewer Non-SNP Plans: The total count of MA-PD plans available nationwide is declining, particularly the $0 premium offerings, signaling market consolidation and increased financial pressures on plans.
- SNPs as the Growth Engine: Special Needs Plans (SNPs)—especially Chronic Condition SNPs (C-SNPs) and Dual-Eligible SNPs (D-SNPs)—are experiencing rapid growth. This allows carriers to design highly specific, targeted benefits for complex populations.
B. Changes to Medical Costs and Network Access
- Medical Out-of-Pocket Maximum (MOOP): The federal cap on the Maximum Out-of-Pocket limit for in-network medical services in MA plans is decreasing slightly to $9,250 (down from $9,350 in 2025). Keep in mind that most MA plans set their MOOP well below the federal maximum.
- Behavioral Health Parity: MA plans are required to match or improve upon Original Medicare’s cost-sharing for behavioral health services, ensuring that beneficiaries will not pay more for essential mental health or substance use disorder services than they would in Original Medicare.
Your Action Plan for the 2026 Enrollment
The changes to Medicare in 2026 mean that auto-renewing your existing plan without review is riskier than ever. The Annual Enrollment Period (AEP) is your window to act.
- Review the ANOC: Your current MA plan must send you the Annual Notice of Change (ANOC) detailing all 2026 changes by September 30th. Pay close attention to your Part D costs and supplemental benefits.
- Budget for Part B: Factor the new $202.90 standard Part B premium into your 2026 monthly budget.
- Use the AEP: The Annual Enrollment Period runs from October 15 – December 7, 2025. Use this time to compare your current coverage against new offerings to ensure you are maximizing the benefit of the $2,100 drug cap while maintaining access to your preferred doctors and essential supplemental benefits.
Frequently Asked Questions (FAQs) About 2026 Medicare Changes
1. What changes are coming to Medicare in 2026?
The biggest changes include the $2,100 annual cap on out-of-pocket costs for Part D prescription drugs, the automatic enrollment in the Medicare Prescription Payment Plan, tighter regulations on Medicare Advantage supplemental benefits (SSBCI), and significant increases to the Part B premium ($202.90) and deductible ($283).
2. Can I change Medicare Advantage plan in January 2026?
Yes. If you are already enrolled in an MA plan, you can switch to another Medicare Advantage plan or switch back to Original Medicare (with or without a Part D plan) during the Medicare Advantage Open Enrollment Period (MA OEP), which runs from January 1 to March 31 each year.
3. Can I change my Medicare plan after enrollment 2026?
For most people, the main opportunity to change is during the Annual Enrollment Period (AEP) (October 15 – December 7). You have one additional opportunity during the MA OEP (January 1 – March 31). Outside of these times, you may only change your plan if you qualify for a Special Enrollment Period (SEP) due to a specific life event (like moving or losing employer coverage).
4. Will my existing supplemental benefits be guaranteed in 2026?
No. The medicare advantage supplemental benefits 2026 changes are inevitable as plans adjust their offerings based on the new CMS rules and financial projections. You must thoroughly review your plan’s Annual Notice of Change (ANOC) to confirm if your dental, vision, transportation, or healthy food allowances are changing, being reduced, or being eliminated.
5. Is there any change in Part A costs for 2026?
Yes, the costs for Medicare Part A (Hospital Insurance) are increasing. The inpatient hospital deductible will rise to $1,736 per benefit period in 2026 (up from $1,676). Daily coinsurance amounts for extended hospital and skilled nursing facility stays are also increasing.
Medicare updates can be confusing. At Zumanely, we simplify the process by offering personalized, compassionate guidance tailored to your unique health and financial needs.
We help you:
- Review the latest medicare advantage plans changes 2026
- Compare plan options for 2026
- Evaluate supplemental benefits and coverage gaps
- Make better decisions about your healthcare
You don’t have to navigate these changes alone.
Get a free consultation from Zumanely today. Zumanely is here to help every step of the way.