Millions of Americans enrolled in Medicare are being urged to carefully review their coverage options during the 2024–2025 open enrollment period, as significant cost and coverage changes are coming in 2026.
Health policy experts warn that rising premiums, shifts in Medicare Advantage offerings, and adjustments to deductibles may affect how much seniors pay—and what services they can access.
Whitney Stidom of eHealth explains:
“Millions of Medicare beneficiaries will face higher out-of-pocket costs and reduced benefits in 2026. Comparing plans is especially critical this year.”
Open enrollment runs from October 15 to December 7, allowing people aged 65+ to join Medicare or switch plans.
1. Premiums Are Rising for Some Plans and Falling for Others
Medicare recipients can expect notable premium changes in 2026:
Part B premiums increasing
- Part B premium rising from $185 → $206
- A 12% jump, double the increase seen the previous year
- Outpaces the projected 2.7% Social Security cost-of-living adjustment
Reasons for the increase include:
- Higher demand for Part B services
- Increased enrollments
- Rising hospitalization and outpatient care costs
Medicare Advantage premiums decreasing
- Average monthly cost expected to fall from $16 in 2025 → $14 in 2026
Standalone Part D premiums decreasing
- Part D premiums dropping from $38 → $34 per month
- Part D premiums within Advantage plans falling from $13 → $11
However, insurers will now be allowed to raise Part D premiums up to $50/month, higher than the previous $35 cap.
Dr. Kanwar Kelley warns:
“Any cost increase will be significant, especially as overall living costs rise.”
2. Deductibles and Out-of-Pocket Costs Will Shift
Medicare Advantage
- In-network out-of-pocket maximum:
$9,350 → $9,250 (slight decrease)
Part D drug coverage
- Out-of-pocket limit:
$2,000 → $2,100 - Insulin cap remains $35/month
- Most vaccines still fully covered
Part B deductible increasing
- $257 → $288 (12% increase)
Part D deductible increasing
- Maximum deductible rising from $590 → $615
Stidom notes:
“Changes to copays and deductibles greatly impact seniors, especially those living on fixed incomes.”
Additionally, Medicare will not cover GLP-1 weight-loss drugs like Ozempic, following a decision earlier this year.
3. Coverage Options Are Changing—Including Telehealth Access
Medicare Advantage plans
- CMS expects about 5,600 plans nationwide in 2026, similar to 2025
- But some major insurers—including UnitedHealthcare—plan to reduce service areas or trim coverage
Telehealth reductions
Several temporary telehealth programs expired on October 1, and Congress did not renew them.
Dr. Kelley warns that reduced telehealth access could disproportionately harm:
- Seniors with disabilities
- Rural residents
- Patients relying on caregivers
- Individuals with mobility limitations
Switching back to in-person care may increase:
- Travel costs
- Time off work
- Care delays
- Missed appointments
Kelley explains:
“Telehealth restrictions will lead to gaps in care and higher long-term costs.”
Understanding the Basics of Medicare Coverage
More than 69 million Americans are enrolled in Medicare.
Part A
- Covers inpatient hospital care, skilled nursing, hospice
- 99% of recipients pay no premium
Part B
- Covers doctor visits, outpatient services, ambulance care
- Premiums deducted from Social Security
About 51% of recipients have a Medicare Advantage plan to supplement traditional coverage.
Prescription Drug Costs: Discounts and Fewer Plan Options
An estimated 81% of Medicare users have Part D prescription coverage.
Plan availability shrinking
Standalone Part D plans will decline from:
- 464 plans (2025) → 360 plans (2026)
Drug price negotiations
CMS is negotiating prices on 10 widely used prescriptions. Expected discounts range from:
➡️ 38% to 79% off list prices
Drugs include:
- Eliquis
- Xarelto
- Januvia
- Jardiance
- Farxiga
Payment smoothing continues
Beneficiaries can still spread out their annual drug costs under the “prescription payment plan,” and current users will be automatically re-enrolled.
Still, Kelley warns:
“Fewer plan options and changes to covered medications could mean higher out-of-pocket costs for some patients.”
What Medicare Recipients Should Do During Open Enrollment
Surprisingly, 70% of Medicare recipients do not compare plans.
Experts strongly recommend that beneficiaries:
- Compare premiums
- Check drug formularies
- Review out-of-pocket limits
- Evaluate plan networks
- Confirm specific medical needs and medications are covered
Most recipients should have received an Annual Notice of Change summarizing 2026 updates.
Stidom suggests using licensed insurance services or Medicare marketplaces, noting that some seniors can save up to $1,800 per year by switching plans.
“Private marketplaces make it easier to compare Medicare Advantage plans side-by-side based on health needs and location.”
She also emphasizes reviewing Part D coverage closely since costs and covered drug lists can change year to year.
Final Takeaway
Medicare costs and coverage will shift significantly in 2026, with higher Part B premiums, evolving Advantage and Part D options, and adjustments to deductibles. Telehealth access may also shrink.
The most important action seniors can take is to review and compare plans carefully during open enrollment to avoid unexpected costs and ensure their medical and prescription needs remain fully covered.
