Medicare: What’s Changing for 2026
Every year we see a slew of changes to Medicare, primarily involving adjustments to Part A and Part B premiums, deductibles, and coinsurance costs, as well as potential changes to Medicare Advantage (Part C) and Prescription Drug (Part D) plans offered by private companies. Here are some of the most important changes for 2026.
Prescription Drugs (Part D)
Out-of-pocket cap: The annual Part D out-of-pocket threshold is set at $2,100 for 2026 (up from $2,000 in 2025). Once you reach this cap, you won’t pay more for covered Part D drugs for the rest of the year.
Standard deductible: The maximum standard Part D deductible is $615 for 2026 (plans may offer lower/no deductibles).
Drug price negotiation begins at the pharmacy counter: Negotiated prices for the first set of high-spend Part D drugs take effect in 2026. Expect some members to see lower prices on specific medications.
Medicare Prescription Payment Plan (MPPP): If you opt to spread your Part D costs into predictable monthly payments, you’ll be automatically re-enrolled each year (unless you opt out or change plans). Plans must send you a renewal notice.
$35 insulin and $0 adult vaccines continue: Insulins covered by Part D stay capped at $35 for a month’s supply, and ACIP-recommended adult vaccines remain $0.
Medicare Advantage and Plan Quality Dynamics
Average Medicare Advantage (MA) plan payments from Medicare are slated to increase in 2026. This may influence premiums, networks, and supplemental benefits across carriers.
For the 2026 ratings year, the weight of member experience / complaints and access measures drops (from 4x to 2x). New / returning clinical measures (e.g., Kidney Health; Physical / Mental Health) appear with lower weights in 2026 (heavier in 2027). Plan Star changes can impact rebates that fund extra benefits, so expect some reshuffling.
Will tariffs increase health insurance premiums in 2026?
According to a recent KFF report, new tariffs on imported goods are expected to raise the cost of prescription drugs. Since retail prescription drugs make up about 12% of private health insurance spending, several insurance companies are already building these higher costs into their 2026 premium filings.
Some carriers are adding 2 – 4% increases on top of normal year-to-year changes.
The reason: they anticipate paying more for imported medications if tariffs stay in place.
Not all insurers are factoring tariffs in yet – but even the expectation of higher drug costs in influencing premium prices.
Bottom line: prescription drug costs = higher premiums for 2026.
WisCare will keep monitoring these updates so you understand how they may affect your plan choices this fall during AEP.
Prior Authorizations & Interoperability
Plans must begin reporting prior-authorization (PA) metrics / public data in 2026; full PA API requirements take effect in 2027. The goal is faster, more transparent decisions and better data-sharing between plans and providers.
Telehealth Coverage Going Forward
Medicare has allowed many telehealth services during and after the pandemic – such as visits from home (instead of a clinic), seeing a wider range of provider types, and using audio-only calls in certain cases. These flexibilities are guaranteed through September 30, 2025.
Some of these rules are already permanent (like expanded provider eligibility).
Others may end after September 2025 unless Congress or CMS extends them.
Right now, it’s uncertain which specific flexibilities will carry over into 2026.
We’ll keep you updated as decisions are made so you know exactly what telehealth options will remain available in 2026.
Part D Premium Stabilization Demo (Stand-Alone PDPs)
CMS is scaling back the premium stabilization demo for 2026 (applies to stand-alone PDPs, not MA-PDs). The monthly premium increase cap rises (to help plans manage 2025-26 changes), and the monthly subsidy is reduced. This may affect 2026 PDP premiums.