Medicare changes for 2026 focus on lowering prescription drug costs (including the new $2,100 Part D cap), expanding telehealth, improving chronic care benefits in Medicare Advantage, and implementing new cost-sharing rules, with some Part B premiums increasing and new AI-assisted prior authorization trials starting in Original Medicare. Key shifts include automatic enrollment in payment plans, tighter rules for MA chronic benefits, and continued insulin caps, driven largely by the Inflation Reduction Act.
Resources:
- Refer to the Medicare and You book that you received in the mail
- Medicare Frequently Asked Questions
- Medicare Helpful Tools
- Call your local area agency on aging and ask to speak to a Benefits Counselor.
- Visit the Eldercare Locator website or call 1-800-677-1116.
- Call 211 anywhere in the USA
Key Changes for 2026
- Prescription Drugs (Part D):
- $2,100 Out-of-Pocket Cap: A new annual limit on out-of-pocket spending for covered Part D drugs.
- Drug Price Negotiations: New negotiated prices for 15 additional drugs, bringing the total to 25, with potential savings.
- Automatic Enrollment: Beneficiaries can automatically enroll in the Medicare Prescription Payment Plan (MPPP).
- Original Medicare (Parts A & B):
- Part B Premium: The standard monthly premium increases to $202.90.
- Part B Deductible: Rises to $283.
- Part A Costs: Deductibles and coinsurance for hospital stays also increase.
- Telehealth: Permanently expanded rules for telehealth, including removing frequency limits for some services.
- Prior Authorization: AI-assisted trials (WISeR Model) begin in six states for faster review.
- Medicare Advantage (Part C):
- Behavioral Health: Updates to cost-sharing for mental health services.
- Chronic Care Benefits: Tighter rules for chronic illness benefits, with transitions to new programs like SSBCI.
- Insulin Cap: The $35 monthly insulin cap continues.
- Other Important Updates:
- Vaccines: Free coverage for ACIP-recommended vaccines continues.
- Digital Tools: New digital tools for easier management.
What to Do
- Understand Your Costs: Be aware of the new Part B premium, Part D cap, and any changes to your MA plan.
- Watch for Mail: Keep an eye out for official Medicare & You handbook updates and plan notices.
By Zanda Hilger, LPC, Founder, Family Caregiver & Program Manager for Family Caregivers Online
We hope this information is helpful to you in the important work you do as a family caregiver.
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