If you're a senior covered by Medicare, you should be aware of some important changes happening this year. Some of these changes could increase your costs or make it harder to get care.
Here's what you need to know about how Medicare will look different in 2026.
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1. Medicare premiums are going up
The first big change to know about is that Medicare premiums are going up.
Specifically, premiums will hit $202.90 per month for most seniors who pay the standard premium. This is a $17.90 increase as premiums are increasing from $185 in 2025.
Since most people pay premiums from their Social Security benefits, this will mean that retirees lose some of the Social Security COLA adjustment retirees received in 2026.
2. Deductibles and spending caps for Medicare Part D are increasing
For those with Medicare Part D prescription drug coverage, there's another change on the horizon. The Medicare Part D deductible and out-of-pocket spending caps are both increasing as they're adjusted upward to account for the impact of inflation.
Here's how Medicare Part D deductibles and spending caps will change from 2025 to 2026:
- The maximum out-of-pocket cap is increasing from $2,000 in 2025 to $2,100 in 2026.
- The standard deductible is increasing from $590 in 2025 to $615 in 2026.
The out-of-pocket cap was first introduced in 2025, so retirees may not have been expecting a 5% increase so soon.
3. Original Medicare testing prior authorization
Starting on Jan. 1, Medicare is launching a six-year pilot program to require prior authorization before certain medical devices or procedures are covered. The prior authorization requirements will apply in:
- Arizona
- New Jersey
- Ohio
- Oklahoma
- Texas
- Washington
It doesn't apply to all services, but to a select list of procedures that the Centers for Medicare and Medicaid Services has determined are potentially wasteful.
If the program is successful, it could potentially spread to more states and more services and introduce a new hurdle before retirees can get care.
What can Medicare beneficiaries do about 2026 Medicare changes?
Medicare beneficiaries need to prepare for these changes, including higher costs for their medical coverage and their prescription drugs.
The reality is that seniors often face significant out-of-pocket medical expenses even with Medicare coverage. It's important for retirees to ensure they have money saved to cover their care needs in their later years.
Contributing to retirement accounts and investing wisely, or optimizing the investments in your current account if you're already retired, can help you ensure you can afford the healthcare services you need.
