What are the changes to Medicare benefits for 2026?
Medicare changes for 2026 include increases for Medicare Part B and Part A premiums and cost-sharing, changes in average premiums for Medicare Advantage and Part D plans, a slight decrease in the maximum out-of-pocket limit for Medicare Advantage plans, adjustments to income-related premium surcharges for Medicare Part B and Part D, an increase in the Part D deductible and the cap on out-of-pocket costs for drugs covered under an enrollee’s Medicare Part D coverage, and new negotiated pricing for some drugs covered under Part D.
Here’s a full rundown of changes to Original Medicare cost-sharing and premiums, the high-income brackets, improvements to Medicare Part D prescription drug coverage, and more.
Medicare Part D premiums and deductibles
Medicare Part D is private prescription drug coverage for Medicare beneficiaries. Part D coverage can be offered as a stand-alone plan (PDP) or integrated with a Medicare Advantage plan (MA-PD). Original Medicare does not provide outpatient prescription drug benefits, so enrollees need Part D unless they have creditable drug coverage from another source, such as a current or former employer.
How is Medicare Part D coverage changing in 2026?
Starting in 2025, the Inflation Reduction Act implemented a $2,000 cap on out-of-pocket costs for drugs covered by Part D plans, and gave Part D enrollees the option to spread their drug costs out in equal payments throughout the year. The out-of-pocket cap is indexed annually. For 2026, it will increase to $2,100.
The Part D donut hole was eliminated altogether as of 2025, and that will continue to be the case in 2026. The Inflation Reduction Act will also continue to ensure that Medicare Part D prescription drug enrollees can receive recommended vaccines at no cost, and covered insulin products with copays capped at $35/month.
To address concerns about premium increases for 2025 stemming from the Inflation Reduction Act changes, the federal government announced a voluntary PDP premium stabilization program for 2025, under which participating insurers would receive additional federal funding to reduce overall premiums. Although the premium stabilization program is voluntary for insurers, 99% of PDP enrollees were in plans that opted into the program for 2025.
For 2026, the premium stablization program will still exist, but it will provide smaller subsidies to the Part D plans ($10/month instead of $15/month), and it will allow participating plans to increase premiums by a larger amount (up to $50/month, as opposed to the $35/month cap for 2025).
Average Part D premiums for 2026 won’t be available until the fall of 2025. But for 2025, average premiums for stand-alone Part D plans (PDPs) decreased slightly, from an average of $41.63/month in 2024 to an average of $40/month in 2025.
Although there were fewer PDPs available for 2025 than there were in 2024, there continue to be numerous options available in each state, with a wide range of premiums. On the low end of the spectrum, there are PDPs available with premiums as low as $0/month in 2025. On the high end, there are PDPs with premiums of more than $100/month.
How much is the Medicare Part D deductible in 2026?
The maximum Medicare Part D deductible will be $615 in 2026, up from $590 in 2025. Part D plans can have lower deductibles, or no deductible at all. But if they have a deductible, it can’t be more than $615 in 2026.
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Medicare Advantage costs and enrollment
Medicare Advantage plans combine Medicare Part A, Part B, and usually Part D, into one private plan. These plans also generally include various additional benefits that aren’t covered by Original Medicare, such as routine dental and vision.
How are Medicare Advantage costs changing for 2026?
Average Medicare Advantage premiums (paid in addition to the premium for Medicare Part B) for 2026 will be published in the fall of 2025. For 2025, average Medicare Advantage premiums decreased, dropping from $18.23/month in 2024 to $17/month in 2025. (That’s just an average; actual premiums vary widely. Most enrollees are in plans with no separate premium, so they only pay the premium for Medicare Part B.)
Some insurers that offer Medicare Advantage plans are planning to exit the market or scale back their service areas at the end of 2025. We also saw this at the end of 2024,, in addition to benefit changes that included (for some plans) higher deductibles, coinsurance instead of copays, reductions in supplemental benefits, or provider network changes.
Is the Medicare Advantage out-of-pocket maximum changing for 2026?
Yes, the Medicare Advantage maximum out-of-pocket limit (for in-network services covered under Medicare Part A and Part B) will decrease slightly to $9,250 in 2026. Unlike most recent years when the out-of-pocket limit has increased each year, the 2026 limit is a reduction from the $9,350 limit that applies in 2025. But average out-of-pocket caps are typically well below the allowable maximum.
Medicare Part B premiums and deductible
Medicare Part B covers outpatient and physician costs. Medicare Part B has out-of-pocket costs when enrollees receive covered care — an annual deductible and 20% coinsurance — and it also has a monthly premium that’s paid by nearly all enrollees (high-income enrollees pay more than the standard premium for Part B).
Is the Medicare Part B standard premium increasing for 2026?
The 2026 Part B premium won’t be published by CMS until the fall of 2025. But the Medicare Trustees Report projects that the standard premium (for those not subject to the high-income surcharge) will be $206.50/month. This would be an increase of $21.50/month over the 2025 premium, but again, the exact amount won’t be final until the fall of 2025.
For most Medicare Part B enrollees, the premiums are automatically deducted from Social Security checks. The cost-of-living adjustment (COLA) for 2026 also won’t be finalized until the fall of 2025, but it’s projected to add about $54/month to the average retiree’s check.
If the projections for the Part B premium increase and COLA are accurate, the COLA will more than cover the full increase in Medicare Part B premiums for virtually all enrollees, so most Social Security recipients will still see larger checks in 2026, despite the larger Part B premium being withheld.
But it’s also important to note that the projected Part B premium increase will eat up almost 40% of the projected average COLA, leaving retirees with only about 60% of their COLA left over to cover other expenses.[/hio_question]
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How much is the Medicare Part B deductible for 2026?
The 2026 Medicare Part B deductible also won’t be finalized until the fall of 2025. But the Trustees Report projects that it will be $288, up from $257 in 2025.
Some enrollees have supplemental coverage that pays their Medicare Part B deductible. This includes Medicaid, employer-sponsored plans, and Medicare Supplement (or Medigap) Plans C and F. But since the beginning of 2020, Medigap Plans C and F have no longer been available to newly eligible enrollees (this is discussed in more detail below).
Many Medicare Advantage plans have copays and deductibles that don’t necessarily increase in lockstep with the Medicare Part B deductible. So although their benefit designs fluctuate from one year to another, the changes aren’t the same as the deductible and copay changes that apply to Original Medicare.
Medicare Part A premiums, deductible, and coinsurance
Medicare Part A covers hospitalization costs. Medicare Part A has out-of-pocket costs when enrollees need hospital care, although most enrollees do not pay a premium for Medicare Part A. But you’ll have to pay a premium for Medicare Part A if you don’t have 40 quarters of work history (or a spouse with 40 quarters of work history).
Are Medicare Part A premiums increasing in 2026?
Roughly 1% of Medicare Part A enrollees pay premiums; the rest are entitled to free premiums based on their earnings history or a spouse’s. For enrollees who pay premiums for Medicare Part A, the premiums are projected to increase slightly for 2026 (as with the figures above for Part B, these are projections from the Medicare Trustees Report, and the final numbers will be announced by CMS in the fall of 2025). Depending on how much work history the person has, the 2026 Part A premiums (for the 1% of beneficiaries who have to pay a premium) are projected to be either $310/month or $563/month, up from $285/month or $518/month in 2025.
Is the Medicare Part A deductible increasing for 2026?
Yes, the Medicare Part A deductible is projected to increase for 2026, although it will not be finalized until the fall of 2025. The Medicare Part A has a deductible that applies to each benefit period, rather than a calendar year deductible like Medicare Part B or typical health insurance plans (a Medicare benefit period begins when a person is admitted for inpatient care, and ends when they have not received any inpatient care for at least 60 days). The deductible generally increases each year, and it is projected to be $1,716 in 2026, up from $1,676 in 2025.
The Medicare Part A deductible applies to all Original Medicare enrollees who receive inpatient care, although many enrollees have supplemental coverage that pays all or part of the Medicare Part A deductible.
How much will Medicare Part A copayments be in 2026?
The Medicare Part A deductible covers the enrollee’s first 60 inpatient days during a benefit period. If the person needs additional inpatient coverage during that same benefit period, there’s a daily copayment (this used to be called coinsurance, but Medicare now refers to it as a copayment).
The daily copays for inpatient days 61-90 will is projected to grow to $429/day in 2026 (up from $419/day in 2025), and the copay for lifetime reserve days is projected to grow to $858/day (up from $838/day). As is the case for the other numbers above, these are projections from the Trustees Report and final numbers will be published by CMS in the fall of 2025.
How much is the Medicare Part A skilled nursing facility copayment in 2026?
Original Medicare covers up to 100 days in a skilled nursing facility care if the patient has an inpatient hospital stay of at least three days before being transferred to a skilled nursing facility. After day 100, all skilled nursing facility expenses are the responsibility of the beneficiary (unless they have supplemental coverage that provides additional benefits).
Although the first 20 days of a covered stay in a skilled nursing facility have no cost-sharing, there’s a copayment that applies to days 21 through 100 in a skilled nursing facility. That copayment is $209.50 per day in 2025, and the Trustees Report projects that it will grow to $214.50/day in 2026.
Medicare supplement insurance (Medigap) plans
Can I still buy Medigap Plans C and F?
As a result of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), Medigap Plan C and the high-deductible Medigap Plan F are no longer available for purchase by people who become newly eligible for Medicare on or after January 1, 2020.
People who became Medicare-eligible prior to 2020 can keep Medigap Plans C or F if they already have them or apply for those plans at a later date, including for 2026 coverage. (Medical underwriting applies in most states if you’re switching from one Medigap plan to another after your initial enrollment window ends, but some states have guaranteed-issue Medigap plans even after the initial enrollment period has ended.)
Medigap Plans C and F cover the Medicare Part B deductible in full (The Part B deductible is $257 in 2025, but is projected to increase to $288 in 2026). But other Medigap plans require enrollees to pay the Medicare Part B deductible themselves. The idea behind the change is to discourage overutilization of services by ensuring that enrollees have to pay at least something when they receive outpatient care, as opposed to having all costs covered by a combination of Medicare Part B and a Medigap plan.
Because the high-deductible Medigap Plan F was discontinued for newly eligible enrollees as of 2020, there is a high-deductible Medigap Plan G available instead.
The income-related monthly adjusted amount (IRMAA)
Will there be inflation adjustments for Medicare beneficiaries in high-income brackets in 2026?
Yes. The threshold for high-income surcharges (and each of the income brackets) will increase again for 2026, and the surcharges at each income level are also expected to increase.
Medicare beneficiaries with high incomes pay more for Medicare Part B and Medicare Part D prescription drug coverage. But what exactly does “high income” mean? The high-income brackets were introduced in 2007 for Medicare Part B and in 2011 for Medicare Part D prescription drug plans, and for several years they started at an income of $85,000 ($170,000 for a married couple).
But the income brackets began to be adjusted for inflation as of 2020. For 2025, the threshold where the surcharge starts to be added is $106,000 for a single individual. This threshold is projected to increase to $109,000 in 2026. The surcharge in 2026 will be based on modified adjusted gross income reflected on 2024 tax returns, since those are the most recent tax returns on file when 2026 begins; there’s an appeals process you can use if your income has changed since then.
CMS will publish the 2026 high-income premium surcharges in the fall of 2025. In 2025, the Medicare Part B premium for high-income beneficiaries ranges from $259/month to about $629/month, depending on how high their income is. And the Medicare Part D high-income surcharge (added to the beneficiary’s plan-specific premium) ranges from $13.70/month to $85.80/month, depending on income.
Learn more about the income-related monthly adjusted amount (IRMAA).
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.
Footnotes
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