Major updates to the Medicare program are set for 2026. As the Main Open Enrollment Period begins on October 15th, it’s crucial to understand how these changes may impact your healthcare coverage, including premiums, out-of-pocket costs, benefits, and plan availability, and how they fit into your overall financial plan.
Below, we highlight the major Medicare changes from the Inflation Reduction Act of 2022 and how the OBBBA provisions may affect your plan options. Knowing these updates can help you make informed decisions and select the coverage that best aligns with your healthcare needs and resources.
Prescription Drugs: Stable Out-of-Pocket Caps
Probably the most significant and welcomed change will be the very small increase in the cap for out-of-pocket costs for prescription drugs under Medicare Part D. Currently at $2,000, the cap will only increase to $2,100 for 2026. While still a 5% increase, considering there were no cap limits in the past, this limited increase represents major relief, especially for those who spend much more on medication each year.
In addition, Medicare (particularly the Centers for Medicare and Medicaid Services) is stepping up efforts to negotiate prices on high-cost drugs, which could mean further cost savings for those requiring these types of expensive, yet critical, medications.
Lastly, under the Medicare Prescription Payment Plan (where enrollees can spread their drug costs over the year instead of paying all up front each time at the pharmacy), if you opt in to this program in 2026, you won’t be required to opt in again for 2027; you’ll be automatically re-enrolled unless you opt out within the new required three-day window.
Medicare Part B & D Deductibles Are Rising
While the deductibles for Medicare Parts A & B usually garner more attention, your Part D plan may also have a deductible that must be paid as well. Part D plans vary, but if so, in 2026 this deductible will increase from $590 in 2025 to $615. The Part B deductible is expected to increase from $257 to $288.
You pay all out-of-pocket costs until you meet your plan’s full deductible, then 25% coinsurance on Part D expenses until you reach the above cap of $2,100 in 2026.
Vaccines and Insulin Could Be More Affordable
Vaccine discussions are prominent in the media today, but what may not be discussed enough is the savings recipients will enjoy for vaccines and insulin. Starting in 2026, all vaccines on the current CDC-recommended vaccines will be free under Part D with zero cost-sharing through 2026, despite changes occurring under the current CDC administration.
If you require regular insulin, monthly costs will be hard-capped at $35 or 25% of the negotiated or “maximum fair price” (set by the Price Negotiated Program), whichever is lower.
Increasing Premiums for Part B and Part D
On the downside, Medicare recipients will see a substantial 11% increase to their Part B base premiums in 2026. Part B base premiums will rise from $185 in 2025 to $206.50 per month, while the Part D initial base premium is expected to increase by 6% from $36.78 to just about $39 per month.
It’s important to note that Part D plans are offered by private companies who may not have set next year’s premiums yet, so your actual Plan D premium could be higher or lower. Some Part D plans have $0 premiums, so it may pay to shop around.
Medicare Advantage Plans May Have Less Extras
For those who opted for Medicare Part C (also known as Medicare Advantage) instead of Traditional Medicare, the Special Supplemental Benefits (or SSBCI) they may have enjoyed are expected to be curtailed. These are the non-medical features that are intended to promote well-being and functioning for those with chronic conditions. Now-excluded benefits will include designated “non-healthy” food, alcohol, tobacco, cannabis products, and cosmetic procedures.
This is a growing trend among private insurers to curtail supplemental benefits such as nutritional supplements, transportation, and others.
Steps to Take Now
Given all of these changes and more, here are some action steps to take to prepare:
- Don’t blindly re-enroll in your Medicare plan: It may be more comfortable to just re-enroll, but this could cost you coverage and money. Check to see that your healthcare provider network has not shrunk and your doctor(s) are no longer included. Shop around to confirm your coverage is still the best for your area and your particular healthcare needs.
- Review your Part D plan list of covered drugs: These lists, called “formularies,” include the covered medications under your plan. Many times pharmacy benefit managers review and change these lists and pricing strategies. Therefore, it’s important that your Part D coverage includes your needed medications each upcoming year.
- Get assistance if you need it: Oftentimes, a Medicare insurance consultant, broker, or a financial planner knowledgeable in Medicare can be very helpful in guiding you through these changes, considerations, and decisions so you can make informed choices that are right for you.
Support for Your Medicare and Retirement Decisions
At Win Wealth Solutions, we guide you through the complexities of Medicare, OBBBA, and healthcare planning to create strategies tailored to your needs. Our goal is to help make your retirement and finances less stressful, so you can fully enjoy the golden years you’ve earned and envisioned.
To schedule a meeting, call (949) 413-8387 or email Nguyen@WinWealthSolutions.com.
About Nguyen
Nguyen Tran is founder and financial advisor at Win Wealth Solutions, an independent financial services firm based in Los Angeles, California. Dedicated to assisting clients with their greatest financial concerns, Win Wealth offers comprehensive investment management and financial strategies, coupled with unbiased advice and recommendations. As a first-generation immigrant, Nguyen thrives off hearing clients’ stories, hopes, and dreams, and loves sharing his knowledge to help them find better solutions to their situations. With over 20 years of experience, he has helped clients retire, pay for their kids' college, and build lasting wealth.
Nguyen studied finance and marketing and obtained a BS in Business Administration from Cal Poly Pomona, and he holds the Chartered Retirement Planning Counselor™, CRPC™ designation. He is committed to lifting his team and clients to new heights and giving back to the community through scholarships, donations, and volunteering. Raised in Modesto, Nguyen now resides in Hancock Park, Los Angeles, with his wife and two kids. Outside of work, he enjoys playing sand co-ed flag football in Huntington Beach, hiking, organizing trips, and gardening. To learn more about Nguyen, connect with him on LinkedIn.
Disclaimer: The information provided in this article is intended for general informational purposes only. It is believed to be reliable; however, Nguyen Tran and Win Wealth Solutions cannot guarantee its accuracy or completeness. It is essential to understand that laws, regulations, and circumstances may change, and the content provided in this article may not always reflect the most up-to-date information. Readers are strongly encouraged to consult with qualified professionals, including attorneys, tax and financial advisors, to ensure that any actions or decisions align with their needs, objectives, and overall financial plan. Securities and investment advisory services offered through Osaic Wealth, Inc. member FINRA/SIPC. Osaic Wealth is separately owned and other entities and/or marketing names, products or services referenced here are independent of Osaic Wealth.