5 Medicare Changes Coming in 2026 — And What They Mean for You

If you’re turning 65 soon or already enrolled, you’ve probably heard talk about Medicare changes coming in 2026. Some of these updates could affect your monthly premiums, prescription drug costs, and access to care—so it’s normal to wonder what they mean for you personally. Like many of our clients, you might be asking…

“Will this cost me more?”

“Will I lose access to my doctors?”

“Do I need to change plans?”

Let’s walk through five important Medicare updates that could affect your coverage — and your wallet — next year. I’ll also share what you can do now to prepare and protect your retirement savings.

(If you want the full walkthrough, you can watch our video on the topic here.)

1. Medicare Part B Premiums Are Going Up

In 2026, the standard monthly premium for Medicare Part B (which covers doctor visits and outpatient care) will rise to $202.90 — up from $185 this year. The annual Part B deductible is also increasing to $283. (CMS)

If you’re drawing Social Security, a “hold harmless” rule may limit your premium increase — but many will still feel the bump.

Also Income Related Monthly Adjustment Amount (IRMAA) threshold increased only slightly from $106,000 to $109,000 for 2024 income if you file individual tax returns (or $212,000 to $218,000 if you file joint taxes)

> What this means for you: Even small increases can add up over time, especially if you’re on a fixed income. If you’re still deciding between Original Medicare and Medicare Advantage, understanding total costs (not just premiums) is key.

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2. A New Pilot Program Could Bring Prior Authorization to Original Medicare

Starting in 2026, Medicare is launching a five-year pilot program in select states called “WISER”, which adds prior authorization requirements to certain services under Original Medicare. (CMS)

This is a big shift — until now, prior authorizations were mostly a Medicare Advantage thing. We don’t expect this will result in a large amount of denied claims, like we see in Medicare Advantage, but we think it could help avoid surprise future Medicare bills.

> What this means for you: If you live in New Jersey, Ohio, Oklahoma, Texas, Arizona, or Washington, this may impact your access to some treatments. The good news? We’re not seeing major cause for concern yet, and we’ll continue monitoring how this rolls out.

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3. Prescription Drug Costs Are Shifting (Again)

The average Part D drug plan premium is rising slightly to $38.99/month. Also, the annual out-of-pocket cap for prescriptions is increasing to $2,100, up from $2,000.

One big trend? More clients are changing plans to avoid unnecessary costs. In fact, 63% of our clients changed Part D plans last year — saving an average of $2,000 annually.

> What this means for you: You could be overpaying for prescriptions without even knowing it. That’s why looking closely at drug plans are critical, as the little plan details can make a big cost difference.

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4. Medigap Plan G Prices Are Rising Fast

Over the past 12 months, we’ve seen Plan G supplement premiums jump by 30–70%. That’s not a typo. These increases are making high-deductible plans and alternatives more attractive for some.

> What this means for you: If you have heard “Plan G is always best,” it’s time to reconsider. Our clients are surprised at how much they can save by exploring other options — especially with an independent coach running the numbers.

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5. Medicare Advantage Plans Are Disappearing in Some Areas

Some major Medicare Advantage providers are pulling out of markets or consolidating plan options. That means fewer choices — and for some, losing their plan altogether.

> What this means for you: It’s still important to ask your providers which specific Medicare plans are accepted before your finalize your Medicare decision. We believe health insurance only works when your preferred providers accept it.

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What You Can Do Right Now to Prepare for 2026

These changes highlight why your initial Medicare decision is so important — and why reviewing your coverage each year is essential to protecting your health and finances.

If you’re enrolling for the first time or want a second opinion on your current plan, our Medicare Enrollment Concierge service is here to help.

It’s a done-for-you, independent service that includes:

• Personalized Medicare Interview

• Thorough plan research (no sales or commissions!)

• One-on-one consultation to review your options

• Help with Medicare enrollment paperwork

• First-year bonus: Annual drug plan review (where we saved clients $2,222 in 2024)

You’ll save 20–60 hours of research, avoid costly mistakes, and get peace of mind knowing you made the right decision for your unique situation.

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Take the Stress Off Your Shoulders

Medicare isn’t one-size-fits-all — and with so many changes coming, it’s more important than ever to get expert, unbiased guidance.

Let us help you make a confident Medicare decision that fits your life now and protects your future

Help for First-Time Medicare Enrollment

If you are enrolling into Medicare for the first time, The Medicare Coach can help you get organized, avoid costly timing mistakes, and choose confidently with our Medicare Enrollment Concierge services.

Conclusion

Medicare can be a fantastic benefit, but only when you get the timing right, protect your future options, and choose coverage based on your doctors, medications, lifestyle, and budget. If you want help making sure you are doing this the right way, The Medicare Coach can guide you through a clear step by step decision so you feel confident before you enroll, would that be helpful?