Medicare isn't ending a major service in 2026 but is ending pandemic-era telehealth flexibilities, requiring most virtual visits to be in rural areas or for behavioral health after January 30, 2026, and ending some health plan perks like non-medical benefits, while implementing new rules for insulin costs and drug coverage.
The standard monthly premium for Medicare Part B enrollees will be $202.90 for 2026, an increase of $17.90 from $185.00 in 2025. The annual deductible for all Medicare Part B beneficiaries will be $283 in 2026, an increase of $26 from the annual deductible of $257 in 2025.
Yes, the Medicare Part D "donut hole" (coverage gap) is officially eliminated as of January 1, 2025, thanks to the Inflation Reduction Act, simplifying coverage into three phases: deductible, initial coverage, and catastrophic, with a new $2,000 out-of-pocket spending cap that eliminates the gap where higher costs used to occur.
Medicare Part D plans for 2026 feature a new $2,100 out-of-pocket (OOP) maximum for covered drugs, eliminating the coverage gap, with average premiums projected to decrease, though some plans see increases due to stabilization policies. Key changes include a maximum deductible of $615, insulin cost caps at $35, the addition of the Medicare Prescription Payment Plan, and plans available with $0 premiums in some areas, alongside lower overall average costs for many beneficiaries.
Beginning January 1, 2026, certain medical procedures under Traditional Medicare will require prior authorization in six U.S. states. This means your healthcare provider must obtain approval from Medicare before performing specific services—otherwise, coverage may be denied.
If you're already enrolled in Medicare, you can make changes to your plan during open enrollment. Medicare Open Enrollment for 2026 runs from Oct. 15 through Dec. 7, 2025.
The "best" Medicare Advantage plan for 2026 depends on your location and needs, but top-rated companies often include UnitedHealthcare, Humana, Aetna, Kaiser Permanente, and Wellcare, excelling in areas like low costs, patient experience, and extra benefits (dental, vision). Health systems dropping MA plans and insurer changes (like Humana reducing some coverage) highlight the need to use official Medicare tools or agents to compare plan specifics in your ZIP code for 2026.
Here are some of the biggest Medicare mistakes to avoid:
For 2026, the standard Medicare Part B premium is $202.90 per month, an increase from 2025, with higher-income earners paying more (Income-Related Monthly Adjustment or IRMAA). Most people qualify for premium-free Part A, but if not, premiums range from $311 to $565 monthly. Part D (drug) and Medicare Advantage (Part C) premiums vary by plan, though many MA plans have no additional premium beyond Part B.
The extra $144 added to Social Security usually comes from the Medicare Part B Giveback benefit, offered by some Medicare Advantage (Part C) plans, which pays back some or all your Part B premium, showing up as extra money in your check if it's deducted from your Social Security. To qualify, you need Original Medicare (Parts A & B), pay your own Part B premium, live in a plan's service area, and enroll in a specific Medicare Advantage plan that offers this "rebate," with the amount varying by plan and location.
Yes, President Biden's administration, through the Inflation Reduction Act (IRA), effectively eliminated the Medicare Part D "donut hole" (coverage gap) starting in 2025, replacing it with a simpler structure that includes a $2,000 annual out-of-pocket spending cap and no further drug costs for the rest of the year once that cap is met.
For the average retired worker, the 2.8 percent COLA is expected to increase their monthly benefit by about $56. This will raise the average payment from approximately $2,008 in 2025 to about $2,064 in 2026. Social Security retirement beneficiaries will see this increase reflected in their January 2026 payments.
Yes, health insurance premiums are set to increase significantly in 2026, especially for Affordable Care Act (ACA) marketplace plans, driven mainly by the expiration of enhanced premium tax credits, rising healthcare costs (like specialty drugs and labor), and some new federal policies. Many enrollees could face steep hikes, potentially over 20% or more, as subsidies revert to pre-pandemic levels and insurers account for increased risk, leading to a "rate shock" for some consumers.
Vermont, Utah and Minnesota topped the Commonwealth Fund's Medicare performance scorecard in 2025, whereas Kentucky, Mississippi and Louisiana struggled the most.
Schedule II — drugs with a high abuse risk, but also have safe and accepted medical uses in the United States. These drugs can cause severe psychological or physical dependence. Schedule II drugs include certain narcotics, stimulants, and depressant drugs.