With all the news coming out about Medicare 2026, many beneficiaries are wondering how these changes will affect them during this year’s Annual Enrollment Period (AEP). From drug cost caps to plan networks, there’s a lot to unpack. Below, we’ve answered some of the most common questions to help you prepare with confidence before AEP begins on October 15, 2025.
1. What’s happening with prescription drug costs in 2026?
Medicare Part D’s out-of-pocket maximum is rising slightly, from $2,000 in 2025 to $2,100 in 2026. This means once you reach that threshold, your plan covers the rest of your covered prescription expenses for the year. The Part D deductible will also increase modestly, to $615.
In addition, Medicare continues to enforce a $35 monthly cap on insulin (or 25% of the cost, whichever is lower) and zero cost-sharing for recommended adult vaccines. These protections are designed to keep lifesaving medications and preventive care affordable.
2. What is the Prescription Payment Plan, and how does it work now?
The Medicare Prescription Payment Plan allows you to spread out your drug costs across the year instead of paying large amounts at the pharmacy counter. Beginning in 2026, if you enroll in this program, you’ll be automatically re-enrolled each year unless you choose to opt out. Opt-out requests must also be processed quickly—within three calendar days—so you won’t get stuck with coverage you don’t want.
This feature provides budgeting stability and helps avoid sudden, unaffordable expenses for costly medications.
3. Will my premiums and coverage costs change?
Yes—though modestly. The Part B standard premium is projected to rise to around $206.50 per month, and deductibles for both Parts A and B are expected to increase slightly as well (Part A to about $1,716). While these adjustments may not seem large, they can add up over time and should be factored into your overall budget for the year.
4. How will these changes impact my choice of plans?
The combination of new cost caps, deductibles, and ongoing drug price negotiations may change the relative value of certain plan types. For example, some people may find Medicare Advantage Prescription Drug (MA-PD) plans more cost-effective, while others may benefit more from a stand-alone Part D plan.
Additionally, Medicare Advantage plan availability can shift each year. Networks of doctors and hospitals, supplemental benefits like dental or vision, and coverage rules may look different in 2026. Reviewing these changes carefully is essential to avoid unexpected disruptions in care.
5. What should I watch for as AEP approaches?
During AEP, you’ll receive an Annual Notice of Change (ANOC) and an Evidence of Coverage (EOC) from your plan. These documents outline all the changes to costs, formularies, networks, and coverage rules for 2026. Reviewing them with a trusted advisor ensures you don’t miss anything.
Medicare 2026 brings important updates designed to make drug costs more manageable and preventive care more accessible. But with changes to premiums, deductibles, and plan networks, it’s vital to review your options carefully this AEP.
At The Jones Group, our agents are here to help you analyze your plan choices and guide you through the enrollment process with confidence. Contact us today!
