My brain is easily triggered toward and tends to default to music lyrics when I hear something like this. If you are old enough perhaps you too defaulted to the song by George Harrison, Here Comes the Sun, doo-doo-doo…
Anyway, it is time for Medicare’s Annual Enrollment Period (AEP), which begins October 15th and runs through December 7th. It’s a wild time. Huckleberry Finn might say, “It’s enough to make a body tired of bein’ human.” Indeed!
Going into the season to sign up for the 2026 plans, here are seven major Medicare changes you ought to know:
Part B premiums and deductibles are increasing.
That is no surprise, but the size of the projected increase is. Unofficial estimates have the premium going up to $206.50 from $185, over 11%, and the deductible is going up to $288. I don’t like this, but the cost of medical care is rising at a pace of about three times the national inflation rate, or consumer price index (CPI).
Part D maximum out of pocket is increasing to $2100.
No big surprise there. However, Part D premiums are up in reflection of the increased rules placed on the private insurance companies. Which has led to a larger concern, there are few companies offering prescription drug plans. If they can’t make money, they pull out of the market.
Reduced benefits for Medicare Parts B and D.
CMS or the Center for Medicare and Medicaid Services made the grand decision to change the way that Medicare Advantage (MA) plans and Medicare prescription drug (PDP) plans get paid. Essentially, they are going to pay them less, while requiring them to pick up greater costs. You don’t have to be a genius to figure out that this is a formula for disaster. As a result, companies are offering fewer benefits. One company has eliminated their fitness club benefit from most plans, including mine. I estimate that I will be losing about $100 per month in benefits. UGH!
Expanded prior authorization.
For nearly two decades I’ve heard people tell me that they don’t have Prior Authorization (PA) with their Supplements like in Medicare Advantage Plans. True, supplements don’t have PA, but ORIGINAL MEDICARE does have PA. They always have. Which, FYI, are the same PA requirements for Medicare Advantage plans. And now in 2026, Medicare is testing a new model for expanded prior authorization. This affects everyone.
Ten additional drugs will have lower costs in 2026.
Drugs that I see often like Eliquis, Jardiance or Xarelto.
CDC recommended vaccines continued to be offered at no cost.
Provided they are given at the pharmacy, not the doctor’s office. However, some of the vaccines recommended by the CDC’s Advisory Committee for Immunization Practices that are currently covered are being called into question. Most notably are the Covid 19, RSV and Shingles vaccines.
The GOP is tightening Medicaid requirements.
And some are losing their Medicaid. Although the number of those on Medicaid account for 13% of the people in government health programs, they account for 35% of the expenses.
As I write this blog, the lawmakers of this country are wrestling with the government shutdown and how to bring a reasonable working budget to the table. A main sticking point is health care. While the Affordable Care Act is the biggest source of contingency, the fact remains, the cost of health care in America is a huge drain on the US Budget. And it appears to be one that has no clear solution. So we take this one year at a time.
I based this Blog on an article in Investopedia written by Jeanine Skowronski. She did a marvelous job and went into far more detail than I did.
But the main take away I got from this as a reader was, Prepare for the 2026 Medicare Enrollment period. Read about your plan and know what the changes are going to be. And as Jeanine Skowronski wisely added to her blog, seek the help of an independent agent that can help you understand your options.
Let us know if we can help you. And don’t wait until the last minute to call, it could be too late.
Our office number is 317-606-5426.