As we approach the 2026 Annual Enrollment Period (AEP), Medicare beneficiaries need to be aware of several significant updates that will take effect. These changes—ranging from cost adjustments to enhanced benefits—can influence your plan choices and out-of-pocket expenses.
Here’s what to know and how to prepare.
4 Key Changes Shaping 2026
1. Increased Out-of-Pocket Cap for Part D
Medicare Part D enrollees will see the maximum out-of-pocket limit rise to $2,100, up from $2,000 in 2025. While a modest bump, this cap continuation still offers critical protection against skyrocketing drug costs. Once you hit the cap, your plan covers the rest of your covered prescription expenses for the year, giving you peace of mind and predictability. This feature is especially important for individuals who take multiple high-cost medications, as it prevents unlimited spending and helps protect retirement savings.
2. Auto-Enrollment in Prescription Payment Plan
If you’re enrolled in the Medicare Prescription Payment Plan (which lets you spread drug costs across the year), you’ll now be automatically re-enrolled each year, unless you opt out. Plus, opt-out requests must be processed within 3 calendar days. This change reduces the chance of accidentally losing the benefit and ensures continued budgeting flexibility for prescription costs. Instead of paying hundreds of dollars all at once at the pharmacy counter, enrollees can spread those payments into manageable monthly amounts—helping avoid financial strain and surprise bills.
3. Insulin and Vaccine Cost Protections
Medicare maintains a $35 monthly cap on insulin (or 25% of the price, whichever is lower) and zero cost-sharing for recommended adult vaccines. These protections not only keep lifesaving medications affordable but also encourage preventive care, helping beneficiaries manage chronic conditions and avoid costly complications down the road. For many, this stability makes it easier to stick to treatment plans without worrying about fluctuating costs.
4. Higher Part D Deductible
The maximum allowed deductible for Part D plans increases to $615 in 2026, a $25 rise over 2025.
Impacts on Coverage Choices
Medicare’s premiums, deductibles, and plan options will also shift in 2026. These changes can affect both your monthly budget and your access to care, making it especially important to review how your current coverage stacks up against new offerings.
- Part A & B Premiums: Expect modest increases in your Medicare Part B premiums and Part A & Part B deductibles. For example, the Part B standard premium is projected to climb to around $206.50/month. The Part A deductible will be around $1,716, and the Part B deductible will be $288.
- Plan Networks & Benefits: MA plans’ availability may shift in your area. Review any changes in networks, supplemental benefits, and coverage rules carefully.
What to Watch for as AEP Approaches (Oct 15 – Dec 7, 2025)
- Annual Notices of Change (ANOC) and Evidence of Coverage (EOC): Give us a call to review your plan documents and check for changes in costs, formularies, networks, and rules for 2026.
- Compare Options: The Jones Group agents are here to help analyze plans and ensure your 2026 plan meets your needs.
- Insulin and Vaccine Access: Confirm that your drugs and immunizations remain covered with no or lower cost-sharing.
Staying informed and proactive will help you navigate the 2026 AEP with confidence and choose the Medicare plan that truly fits your needs.
At The Jones Group, we specialize in guiding Medicare beneficiaries through every step of the process—from turning 65 to retirement, to qualifying for special assistance. Our team takes the confusion out of Medicare by helping you compare options, understand changes, and enroll in the plan that’s right for you. Contact us today to get expert, local support you can count on.
