If you’re on Medicare — or about to be — 2026 is the year you cannot afford to auto-renew. A lot changed on October 15, and most of it didn’t show up in the glossy mailer your plan sent you.
Some of the changes are genuinely good for beneficiaries. Others are quiet takeaways that only show up when you go to the pharmacy or the dentist and find out the rules shifted. This is the plain-English version of what moved, with the parts that matter most for your AEP review.
The $2,100 Part D out-of-pocket cap is the headline
The Inflation Reduction Act capped Part D out-of-pocket spending at $2,000 for 2025. For 2026, that cap rises slightly to $2,100.
In 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 on those drugs. The old “donut hole” is gone. No more catastrophic-phase math. No more $8,000 specialty-drug surprises in November.
If you’re on expensive medications — cancer drugs, MS therapies, RA biologics, brand-name diabetes drugs — this is a real ceiling. You now have a predictable annual max instead of an open-ended bill.
- The cap resets every January 1, so you start the climb over each year.
- The Medicare Prescription Payment Plan lets you spread that $2,100 across monthly installments instead of paying it up front at the pharmacy in January and February. If you signed up in 2025, your enrollment rolls into 2026 automatically.
IRMAA brackets shifted — check your 2024 tax return
IRMAA is the income-related surcharge on Parts B and D. Higher income means a higher premium, and the bracket cutoffs moved for 2026.
The standard Part B premium is now $202.90/month — up $17.90 from 2025. That’s what you pay if your 2024 modified adjusted gross income was under $109,000 single or $218,000 married filing jointly.
Above those lines, the surcharges climb in five steps, topping out at $689.90/month for Part B if your 2024 MAGI was $500,000+ single or $750,000+ joint. Part D adds its own surcharge of $14.50 to $91.00/month on top of your plan premium.
The trap: IRMAA is based on the most recent IRS-reported return (2024 for 2026 premiums). If a life-changing event has dropped your income since (retirement, divorce, death of a spouse, work stoppage), you can appeal IRMAA using SSA Form SSA-44. We’ve helped clients get thousands back this way.
Medicare Advantage is getting thinner — and the carriers aren’t advertising it
The four big things we’re seeing across UnitedHealthcare, Aetna, Humana, BCBS, and Cigna MAPD plans for 2026:
1. Dental benefits are dropping or going preventive-only. About 96% of MA plans still include some dental, but the average annual cap is around $1,300 and falling. PPO MAPD plans are increasingly limiting dental to preventive only and dropping fillings, crowns, and major work. Check the 2026 EOC, not the 2025 one.
2. OTC allowance cards are being scaled back. Only 76% of plans include an OTC benefit in 2026, down from a peak in 2024. Meal benefits are contracting too. Carriers are funding the mandatory Part D restructure by pulling back on the extras.
3. Provider networks are shrinking — especially on HMOs. Some clients on an HMO in 2025 will find their doctor is no longer in-network for 2026. PPOs hold up better but cost more in premium.
4. Medigap is suddenly competitive again. With MA benefits shrinking and the $2,100 Part D cap making standalone Part D more predictable, the Medigap math is working for more people in 2026.
What this means for you during AEP
AEP runs October 15 – December 7 for plan year 2027. If you’re on an MA plan, doing a real review this year isn’t optional. The only way to know which path is right for you is to compare your specific doctors, your specific prescriptions, and your specific 2026 plan benefits — not what they were in 2025.
A 30-minute Healthcare Review will tell us. We’ll pull your current plan’s 2026 EOC, check your doctors against the new network, run your prescriptions against the formulary, and walk you through what changed. If your current plan is still the right one, we say that. We don’t switch people for the sake of switching.
Book a Healthcare Review: https://calendar.app.google/SLAptEH3ZSyY5k2r9
Craig Gruenbaum, COO, Insured American Family
