The biggest Medicare changes of 2026 are higher Part B costs, a Part D drug spending cap that rose to $2,100, the first negotiated prices on ten costly drugs, and quieter cuts to extras in some Medicare Advantage plans. Most of it is already in effect. Because Medicare open enrollment is open right now, this is the moment to check whether your plan still fits.
TL;DR
- The standard Part B premium is $202.90 a month in 2026, up $17.90, and the Part B deductible is $283.
- Part D out-of-pocket drug spending is capped at $2,100 for the year, and the maximum Part D deductible is $615.
- Average Medicare Advantage and Part D premiums stayed stable overall, but individual plans trimmed benefits such as dental, vision and hearing.
- Open enrollment runs October 15 to December 7. Read your Annual Notice of Change and re-compare before the deadline.
Table of Contents
- What changed in Medicare costs for 2026
- Part D: the $2,100 cap and the first negotiated drug prices
- Extra Help limits for 2026
- Medicare Advantage and Part D plans: stable premiums, thinner extras
- A better Medicare Plan Finder
- Medicaid eligibility changes starting October 1, 2026
- Our perspective: what actually trips people up
- What to do this open enrollment
- How we help
- FAQ
- Sources
What changed in Medicare costs for 2026
Start with the numbers that come out of your Social Security check or your pocket every month. CMS published the 2026 figures in a fact sheet on Part A and Part B premiums and deductibles.
| Item | 2025 | 2026 |
|---|---|---|
| Standard Part B monthly premium | $185.00 | $202.90 |
| Part B annual deductible | $257 | $283 |
| Part A inpatient hospital deductible (per benefit period) | $1,676 | $1,736 |
| Part A premium, 30 to 39 quarters worked | n/a | $311 a month |
| Part A premium, fewer than 30 quarters | n/a | $565 a month |
The 2025 Part B premium is derived from the published $17.90 increase. Most people pay $0 for Part A because they or a spouse worked at least 40 quarters. The buy-in premiums only matter if your work history is shorter.
Two practical notes. First, higher earners pay an income-related adjustment on top of the standard Part B premium, and it is based on a tax return from two years back. If your income dropped because you retired, you can ask Social Security to reconsider. Second, if you pay for a Medicare Supplement (Medigap) plan, remember that it covers cost-sharing, not the Part B premium itself. You still owe that premium on top.
Part D: the $2,100 cap and the first negotiated drug prices
Prescription coverage saw the most meaningful change. Since 2025, Part D has had a hard ceiling on what you spend out of pocket in a year. For 2026 that ceiling rose from $2,000 to $2,100, and the maximum Part D deductible moved from $590 to $615. Some plans charge a lower deductible or none at all, so the plan, not the law, sets your actual number.
Also new in 2026: lower negotiated prices on the first ten Part D drugs picked under the Inflation Reduction Act. They treat conditions including cancer, diabetes, heart disease and autoimmune disease. CMS explains the program in its Inflation Reduction Act FAQs.
What this means in practice:
- If you take one or more of those ten drugs, your cost at the pharmacy may drop, but only if your plan covers the drug. Check the formulary.
- If you take expensive drugs that are not on the list, the cap protects you from open-ended costs, though $2,100 is still real money.
- If you struggle to pay at the pharmacy counter, ask about the Medicare Prescription Payment Plan, which spreads out-of-pocket costs across the year in monthly amounts rather than lowering the total.
A plan with a low premium and a high deductible can cost more than a plan with a higher premium and no deductible. Run your actual medications through a comparison instead of picking on premium alone. We cover the penalty side of this in our guide to avoiding Part D penalties at 65.
Extra Help limits for 2026
Extra Help, also called the Part D Low-Income Subsidy, pays Part D premiums, deductibles and cost-sharing for people with limited income and resources. According to Medicare.gov, the 2026 limits are:
| Individual | Married couple | |
|---|---|---|
| Income limit | $23,940 | $32,460 |
| Resource limit | $18,090 | $36,100 |
Resources include bank accounts, stocks and bonds. They do not include your home, your primary vehicle or essential household items. People who qualify for Medicaid or Supplemental Security Income generally get Extra Help automatically. Limits are somewhat higher in Alaska and Hawaii.
If you are close to the line, apply anyway. Many people assume they earn too much and never find out. The state also runs Medicare Savings Programs that can pay your Part B premium. Medicare explains them in a guide to getting help with Medicare costs.
Medicare Advantage and Part D plans: stable premiums, thinner extras
CMS announced that average premiums, benefits and plan choices for Medicare Advantage and Part D would remain stable in 2026. An average hides a lot, though. Your plan is not the average plan.
The pattern to watch is this: a premium that looks flat while the extras shrink. Individual plans reduced supplemental benefits like dental, vision or hearing, and some tightened prior-authorization rules. The things to look for in your Annual Notice of Change (ANOC):
- Provider network. Is your primary doctor, your specialist and your hospital still in network for next year?
- Drug formulary and tiers. Did a medication you take move to a higher tier or get dropped?
- Supplemental benefits. Did the dental allowance, the over-the-counter card or the hearing benefit shrink?
- Maximum out-of-pocket. Did the annual limit on medical costs go up?
- Prior authorization. Do services you use now need approval first?
If any answer is a surprise, you have the right to shop. During open enrollment you can switch Medicare Advantage plans, move from Advantage to Original Medicare with a Part D plan, or the reverse. Medigap is different: outside of certain protected windows, insurers in most states can ask health questions before they accept you. Michigan's rules and rates are covered in our Medicare Supplement Plan G rates in Michigan comparison.
A better Medicare Plan Finder
Medicare.gov's Plan Finder got several updates this year. CMS's own Plan Finder update summary, dated September 29, 2026, lists a visual refresh that launched July 27 and further changes aimed at benefits, drug costs, messaging and provider information. October 1 updates give clearer information on preventive services, over-the-counter versus prescription hearing aids, and alerts when a drug's dosing frequency is not covered.
That last alert is useful. A drug can appear covered while a specific quantity or frequency is not. Enter every medication with the exact dose and how often you take it, then confirm the result with the plan before you enroll.
Medicaid eligibility changes starting October 1, 2026
If you or a family member relies on Medicaid alongside Medicare, note that Medicaid.gov describes eligibility changes that took effect October 1, 2026 under federal legislation (P.L. 119-21). Federal funding for full Medicaid and CHIP benefits is now generally limited to U.S. citizens, lawful permanent residents, Cuban and Haitian entrants and COFA migrants, with some limited exceptions. States have been adjusting their systems. If your Medicaid status is in question, it affects the Medicare Savings Program and Extra Help decisions that depend on it, so ask your state agency or a counselor to confirm where you stand.
Our perspective: what actually trips people up
We talk with people approaching 65 and with long-time Medicare members every year, and the headline changes are rarely what causes trouble. The real problems are quieter.
The first is inertia. A plan that was right in 2024 can be wrong now because a doctor left the network or a drug moved tiers. Nothing forces you to look, so many people do not. The second is choosing by premium. A $0 premium plan is not free if your medications land in a high tier or your specialist is out of network. The third is timing. Missing your initial enrollment window can mean a lifelong Part B or Part D penalty, and you cannot always undo it.
Our approach is simple. We start with your doctors, your prescriptions and your budget, then compare plans from the carriers we are licensed with. Our advice costs you nothing, because the carrier pays us if you enroll. We say so up front, because you should know how we are paid. We also stay with you after enrollment, since coverage needs change with health, income and moves.
A free resource worth knowing about regardless of who you work with: Michigan's MMAP counseling program offers unbiased Medicare help, and you can reach the statewide line at 800-803-7174. A second opinion is never a bad idea.
— Brian
What to do this open enrollment
Open enrollment runs October 15 through December 7, and changes take effect January 1. Our open enrollment checklist walks through six plan checks. Here is the short version:
- Find your ANOC. Your plan should have mailed it by now. Read the pages on costs, formulary and network first.
- List what you use. Doctors, hospitals, pharmacies, medications with doses, and any dental, vision or hearing services.
- Re-run the comparison. Use the Plan Finder for next year, not just last year's plan details.
- Check subsidy eligibility. Compare your income and resources with the Extra Help limits above.
- Decide, then enroll before December 7. If you switch, your new plan starts January 1.
- Keep records. Save confirmation numbers and your new card when it arrives.
For Michigan residents, our Michigan Medicare guide covers Advantage, Part D and Medigap options in more detail.
If you are turning 65 or retiring early
Your first enrollment window is seven months long, starting three months before the month you turn 65. Delay without creditable coverage and penalties can follow. If you are retiring before 65, the gap between employer coverage and Medicare is often the hardest part. Our guides on health insurance before Medicare and health insurance at 62 explain how to protect subsidies in the meantime.
How we help
Platinum Benefit Advisors helps Michigan residents and people nationwide compare and enroll in Medicare Advantage, Medicare Supplement and Part D plans, along with health, life and group coverage. Our advisors are licensed with multiple carriers, and our guidance costs you nothing. If you are turning 65, start with our Medicare page. To see everything we offer, visit our services page.
Have questions? We have answers! Contact us to schedule a no-obligation meeting.
- Contact: pbabiz.com/contact
- Call or text: 616-221-4616
- Meet on your terms: In Person • Phone • Virtual
FAQ
What is the monthly premium for Medicare Part A in 2026?
Most people pay $0 because they have at least 40 quarters of work history. If you have 30 to 39 quarters, the 2026 premium is $311 a month. With fewer than 30 quarters it is $565 a month.
What is Medicare Extra Help?
Extra Help is a federal program that pays part of your Part D premiums, deductibles and copays if your income and resources are limited. For 2026 the income limit is $23,940 for one person and $32,460 for a married couple. People with Medicaid or SSI generally qualify automatically, and you can apply through Social Security or Medicare.
Did my Medicare Advantage plan change for 2026?
Probably in some way. Averages were stable, but individual plans changed networks, drug tiers and extras like dental or vision. Your Annual Notice of Change spells out exactly what is different, and open enrollment is your chance to switch if you dislike it.
Is there a cap on prescription drug costs in 2026?
Yes. Part D out-of-pocket spending is capped at $2,100 in 2026, up from $2,000 in 2025. The cap applies to covered drugs on your plan's formulary, so drugs your plan does not cover do not count the same way.
Sources
- 2026 Medicare Parts A & B Premiums and Deductibles, CMS
- 3 Big Medicare Prescription Drug Changes Coming in 2026, AARP
- Medicare Advantage and Prescription Drug Programs Expected to Remain Stable in 2026, CMS
- Reduced Drug Prices and Enhanced Medicare Benefits FAQs, CMS
- Help with drug costs, Medicare.gov
- Get help with your Medicare costs, Medicare.gov
- Medicare Plan Finder 2026 Updates, CMS
- Medicaid.gov
- MMAP, CareWell Services of Southwest Michigan