Most seniors who turn 65 get coverage either through traditional Medicare or a Medicare Advantage plan. Whether you already have this insurance in place or are signing up for Medicare for the first time this year, there are certain key rules that govern the program in 2026.
Here's what you need to know.
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1. Medicare premiums are going up
The first key rule change that you need to be aware of is that Medicare Part B premium costs are going up in 2026. Medicare Part B covers outpatient care, such as doctor visits.
Medicare premiums increase in most years because of the rising costs of medical care. In 2026, however, the increase is substantial. Premiums went up nearly 10%, rising from $185 in 2025 to $202.90 in 2026. This is the standard premium, while high earners pay an additional charge.
If you're collecting Social Security, premiums are generally taken right out of your checks. With the 2.8% Social Security COLA, you won't see your check go down, but you will see some of your annual cost-of-living adjustment disappear.
2. Medicare deductibles are rising
Medicare deductibles are also increasing in 2026. Deductibles are the amount that seniors pay out of pocket for services before Medicare pays for the remainder of the covered costs.
This year, the deductible for Medicare Part B beneficiaries is increasing by $26. While the annual deductible was $257 in 2025, it's going up to $283 in 2026.
The annual deductible for Medicare Part A is also going up, as well. Medicare Part A pays for hospital and inpatient care. The deductible for Part A, which you'll have to pay if you're admitted to a hospital, is increasing from $1,676 in 2025 to $1,736 in 2026.
This is extra money you must pay out of your Social Security or retirement plans.
3. Certain Medicare services will need preapproval in 2026
Finally, another key rule change has to do with prior authorizations. Original Medicare rarely requires prior authorizations, but Medicare Advantage plans often cover services only if you get approved before you receive care.
In 2026, though, the Wasteful and Inappropriate Service Reduction (WISeR) Model is going into effect in six states: New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington. Medicare beneficiaries in these states will need to get preapproved for certain kinds of care that are considered potentially "wasteful," including:
- Arthroscopic lavage and arthroscopic debridement to treat osteoarthritis
- Bioengineered skin substitutes for the treatment of chronic non-healing wounds affecting the lower limbs
- Cellular/tissue-based products applied to wounds on the lower limbs
- Cervical fusion surgery
- Deep brain stimulation to treat Parkinson's and essential tremor
- Electrical nerve stimulators
- Epidural steroid injections (except for facet joint injections)
- Hypoglossal nerve stimulation to treat obstructive sleep apnea
- Impotence treatment
- Incontinence control devices
- Percutaneous image-guided lumbar decompression to treat spinal stenosis
- Percutaneous vertebral augmentation
- Phrenic nerve stimulation
- Sacral nerve stimulation for the treatment of urinary incontinence
- Skin and tissue substitutes
- Surgically induced lesions of nerve tracts
- Vagus nerve stimulation
If you relied on these services and live in one of the six states mentioned above, you'll face new hurdles in getting your treatments paid for by Medicare.
Be aware of all these rule changes, and plan accordingly for the added costs that you'll incur due to Medicare's 2026 changes.
