Medicare 2026: Navigating New Costs and Savings

As we enter 2026, Medicare beneficiaries are seeing some of the most significant structural changes to the program in decades. From the first-ever Part B premiumexceeding $200 to historic savings on weight-loss drugs, here is what you need to know to manage your healthcare budget this year.

1. Higher Base Costs for Original Medicare

Inflation and increased healthcare utilization have pushed base costs up for 2026. If you are enrolled in Original Medicare, keep these figures in mind:

• Part B Monthly Premium: The standard premium has risen to $202.90 (up from $185.00 in 2025). This is the first time the base premium has crossed the $200 threshold.
• Part B Annual Deductible: You will now pay the first $283 of your outpatient care out-of-pocket before Medicare starts to pay.
• Part A Inpatient Deductible: Each hospital "benefit period" now starts with a $1,736deductible.

2. The Prescription Drug Revolution

The Inflation Reduction Act continues to reshape Part D, providing relief for those with high medication costs:

• Annual Out-of-Pocket Cap: Your total spending on covered Part D drugs is capped at $2,100 for the year. Once you hit this limit, you pay $0 for covered drugs for the rest of 2026.
• Weight-Loss Drug Coverage: In a major policy shift, Medicare began covering GLP-1 medications (like Wegovy and Zepbound) for weight loss in 2026. Negotiated deals have brought costs down significantly, with many beneficiaries paying a maximum $50 copay.
• Insulin & Vaccines: The $35 monthly cap on insulin continues, and all ACIP-recommended adult vaccines (like shingles and RSV) remain $0 with no deductible.

3. Medicare Advantage "Extra Perks" Are Shrinking

While Medicare Advantage plans still offer dental and vision, insurers are tightening their belts on "non-health" supplemental benefits.

• New Restrictions: Benefits like gift cards, alcohol, or tobacco are no longer allowed. Plans must now prove that supplemental benefits (like healthy food allowances) directly improve health outcomes.
• Plan Exits: Major carriers like UnitedHealthcare and Humana have exited several rural counties this year. If your plan was discontinued, you should have received a "Non-Renewal Notice" allowing you to switch during a Special Enrollment Period.

4. New Ways to Pay: The "Smoothing" Plan

The Medicare Prescription Payment Plan is now in full swing. This voluntary program allows you to spread your out-of-pocket drug costs into monthly installmentsthroughout the year instead of paying a large lump sum at the pharmacy counter.

Contact the Douglas Insurance Group to see how we can help with any changes that may affect you