Medicare changed quite a bit for 2026 — and not all of it is good news. Here are the specifics every beneficiary should know, plus what we’re seeing across the carriers we work with.
For specifics about YOUR plan in your ZIP code, book a Healthcare Review and we’ll pull it up together.
The 2026 numbers cheat sheet
| Cost | 2026 Amount | 2025 Amount | Change |
|---|---|---|---|
| Part B standard premium | $202.90 / month | $185.00 | +$17.90 |
| Part B annual deductible | $283 / year | $257 | +$26 |
| Part A inpatient hospital deductible | $1,736 / benefit period | $1,676 | +$60 |
| Part A coinsurance days 61-90 | $434 / day | $419 | +$15 |
| Part D out-of-pocket cap | $2,100 / year | $2,000 | +$100 |
The Part D $2,100 cap — what it actually means
The Inflation Reduction Act’s $2,000 out-of-pocket cap for Part D drugs took effect for the first time in 2025. For 2026, that cap rises to $2,100 — adjusted annually based on the average percentage increase in Part D drug spending.
Plain English: Once you’ve paid $2,100 out-of-pocket for covered Part D drugs in 2026, you pay $0 for the rest of the year for those drugs. No more catastrophic phase math. No more donut hole. Just a hard cap.
For anyone on expensive specialty drugs (cancer, MS, rheumatoid arthritis, etc.) — you now have a known annual ceiling. The cap resets each January 1. It pairs with the Medicare Prescription Payment Plan (below) so you can spread that $2,100 across the year instead of front-loading it.
Medicare Prescription Payment Plan
Started in 2025, continues and codifies for 2026. Lets you spread your Part D out-of-pocket drug costs across monthly installments instead of paying lump-sum at the pharmacy.
What’s new for 2026:
- Automatic election renewal. If you signed up in 2025, your participation rolls into 2026 automatically — no re-enrollment needed. You can opt out anytime.
- CMS finalized the “part two” guidance — program rules are now codified, not just guidance.
- Still works with the $2,100 OOP cap. Once you hit the cap, you stop owing additional drug costs even if you’re on installments.
Sign up: medicare.gov/prescription-payment-plan
2026 IRMAA brackets — income-related Part B + Part D surcharges
Higher-income beneficiaries pay more for Parts B and D. IRMAA is calculated from your 2024 tax return.
Single, head of household, or qualifying surviving spouse
| 2024 MAGI | Part B Premium | Part D Surcharge |
|---|---|---|
| Up to $109,000 | $202.90 (standard) | $0 |
| $109,001 – $137,000 | $284.10 | +$14.50 / mo |
| $137,001 – $171,000 | $405.80 | +$37.50 / mo |
| $171,001 – $205,000 | $527.50 | +$60.40 / mo |
| $205,001 – $499,999 | $649.20 | +$83.30 / mo |
| $500,000+ | $689.90 | +$91.00 / mo |
Married filing jointly
| 2024 MAGI | Part B Premium | Part D Surcharge |
|---|---|---|
| Up to $218,000 | $202.90 (standard) | $0 |
| $218,001 – $274,000 | $284.10 | +$14.50 / mo |
| $274,001 – $342,000 | $405.80 | +$37.50 / mo |
| $342,001 – $410,000 | $527.50 | +$60.40 / mo |
| $410,001 – $749,999 | $649.20 | +$83.30 / mo |
| $750,000+ | $689.90 | +$91.00 / mo |
Life-changing events (retirement, divorce, death of spouse, work stoppage) can be appealed via SSA Form SSA-44.
Enrollment windows for 2026
- Annual Enrollment Period (AEP): October 15 – December 7, 2026 — for plan year 2027.
- Medicare Advantage Open Enrollment (MA OEP): January 1 – March 31, 2026 — for people already on MA, one chance to switch MA plans or return to Original Medicare.
- Initial Enrollment Period (IEP): 7-month window around your 65th birthday.
- General Enrollment Period (GEP): January 1 – March 31, 2026 — for people who missed IEP. Coverage starts the month after enrollment.
- Special Enrollment Periods (SEP): triggered by qualifying life events (job loss, moving, plan termination, etc.).
Carrier observations — what’s changing in MA plans for 2026
Medicare Advantage plans are tightening. Here’s what we’re seeing across the carriers we work with.
Dental benefits dropping
- 96% of MA plans still offer some dental in 2026, but the average annual cap is around $1,300 and falling.
- PPO MAPD plans are increasingly limiting dental to preventative-only (cleanings, X-rays, exams) and dropping coverage for fillings, crowns, and major work.
- More dental providers are refusing to participate in MA networks because reimbursement rates haven’t kept up.
OTC benefits being cut
- OTC (over-the-counter allowance) cards now appear in only 76% of plans in 2026, down from a peak in 2024.
- Allowance amounts are smaller. Many carriers are pulling these back to fund mandatory cost-sharing changes triggered by the $2,100 cap.
- Meal benefits at 60% of plans — also contracting.
Provider networks shrinking
- HMO MAPD networks are contracting in many markets. Specialists, hospitals, and primary care groups are leaving HMOs because reimbursement rates are too low.
- If you were on an HMO in 2025, your doctor may no longer be in-network for 2026 — this is the #1 reason to do a plan review during AEP.
- PPO networks generally hold up better but cost more in premium.
What this means for your AEP review
If you’re on an MA plan in 2026, expect to either pay more, get less, or both — unless you’ve reviewed it and confirmed your doctors and drugs are still covered.
Original Medicare + Medigap + standalone Part D is increasingly competitive vs. MA, especially for people with chronic conditions or specialists they don’t want to lose.
We don’t pressure-sell switches. If your current plan is still the right one, we say that. But you should know what changed so you can make a real decision instead of auto-renewing into a worse plan.
Ready to see how 2026 changes affect you?
Lulu can pull up plans in your ZIP, compare 2026 formularies to what you take, and flag whether it’s time to switch.
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