Medicare changes from year to year, but 2026 is shaping up to be especially important. Deductibles are rising, prescription drug rules are shifting, and enrollment policies are being updated in ways that can affect both costs and access to care.
For seniors, these changes can feel complicated, but they don’t have to be overwhelming. Understanding what’s different in 2026, from Medicare deductibles and drug coverage to Medigap supplements and Medicare Advantage options, can help you prepare, plan ahead, and make confident choices.
Table of Contents
- Why 2026 Is Different for Seniors
- Deductible Increases in Medicare and Prescription Plans
- Prescription Drug Coverage Updates
- How Medigap Helps Cover What Medicare Doesn’t
- Medicare Advantage Plans: HMO vs PPO
- Why Reviewing Plans Each Year Matters
- Auto-Renewal Rule Changes for 2026
- Open Enrollment Deadlines and Shorter Windows
- Steps You Can Take Right Now
- How Blue Moon Senior Counseling Can Support You
- FAQs
Why 2026 Is Different for Seniors
Every year, Medicare adjusts deductibles, premiums, and coverage details. But 2026 stands out because several changes are happening at once. Deductibles for both Medicare and prescription drug plans are rising, new rules for prescription coverage are taking effect, and updates to enrollment policies will directly affect how seniors manage their care.
Deductible Increases in Medicare and Prescription Plans
Deductibles are the amount you must pay before insurance starts to share the cost of care. In 2026, both Medicare and prescription drug plans will see increases:
- Medicare Part B deductible: $257 (up from $240 in 2025)
- Medicare Part D maximum deductible: $615 (up from $590 in 2025)
Unlike Part B, there isn’t a single set deductible for Medicare Part D. These plans are offered through private insurers, and while Medicare sets a yearly cap, the actual deductible varies from plan to plan. Some plans choose to set it lower than the maximum, and others may offer no deductible at all.
For seniors who take several prescriptions or see providers often, these increases can add up quickly. It’s especially important to review plan details and budget for early-year costs, since deductibles reset every January.
Prescription Drug Coverage Updates
Prescription coverage is one of the areas seniors watch most closely, and 2026 brings some important changes.
Annual Cap on Spending
For 2026, the maximum amount you’ll spend out of pocket on prescription drugs will be $2,100, up from $2,000 in 2025. This cap provides a safety net, but it does mean seniors will pay a little more before reaching that limit.
Insulin Protections
Insulin will continue to be capped at $35 per month or less, with no deductible applied. This protection remains in place for the millions of seniors living with diabetes.
Specialty Medications
Specialty drugs, such as GLP-1 medications used for diabetes or weight management, are becoming more expensive. Many insurers are placing them in higher cost tiers or requiring extra approvals before coverage is approved, which may increase out-of-pocket costs.
Because drug coverage changes from year to year, it’s important to compare your plan during open enrollment. At Medicare.gov, you can enter your zip code and prescriptions to see which plan offers the most affordable coverage and pharmacy options.
How Medigap Helps Cover What Medicare Doesn’t
Traditional Medicare (Parts A and B) covers about 80% of approved medical costs. The remaining 20% falls on the patient, and without extra coverage, that share can add up quickly.
What Medigap Covers
Medigap policies, also called supplemental insurance, are designed to fill that gap. Depending on the plan, Medigap may help pay for co-pays, deductibles, coinsurance, and other out-of-pocket costs. Some plans even cover nearly all of the 20% that Medicare leaves behind, which can make healthcare expenses more predictable.
Who Can Get Medigap
- Medigap is only available if you have Traditional Medicare (Parts A and B).
- You cannot have both a Medicare Advantage plan and a Medigap plan.
- Plans are standardized nationwide (labeled A–N), but monthly costs vary depending on your insurer and location.
How to Review Medigap Plans
Unlike Medicare Advantage, Medigap plans are sold by private insurance companies. To see what’s available in your area, you can use the Medicare.gov Medigap policy search tool. This lets you compare different plans side by side and get contact information for insurers that sell them in your state.
For seniors who want predictable healthcare costs and wide provider access, Medigap is often a valuable choice.
Medicare Advantage Plans: HMO vs PPO
Medicare Advantage (Part C) plans combine hospital, outpatient, and often prescription drug coverage into a single plan managed by private insurers. While they may look appealing on the surface, the type of Advantage plan you choose can make a big difference in the care you receive.
HMO (Health Maintenance Organization)
HMO plans are often advertised with lower premiums, but those savings usually come at a cost:
- Provider networks are smaller, which means fewer doctors and specialists to choose from.
- Referrals are required before you can see a specialist.
- Care outside the network is typically not covered, which is a problem if you travel or need treatment beyond your local area.
It’s also important to know that HMO plans don’t panel with Blue Moon Senior Counseling. If you enroll in an HMO, you would not be able to use that coverage for our services.
While an HMO may seem budget-friendly at first, the trade-offs often lead to limited access, longer wait times, and reduced options for specialized care. For many seniors, that can mean paying more later or missing out on the providers and treatments they really need.
PPO (Preferred Provider Organization)
PPO plans expand what’s possible under Medicare Advantage:
- They include larger networks with far more provider options.
- Out-of-network care is available if needed, though usually at a higher cost.
- No referrals are required, so you can see specialists more directly.
Beyond convenience, a PPO gives seniors greater access to a wider level of care. That broader access often means faster treatment, more specialist options, and fewer limits on where you can go for care.
Why Reviewing Plans Each Year Matters
Even if your plan worked well in 2025, it may not be the best choice for 2026. Every year, insurance companies update their coverage rules, and those small changes can make a big difference in what you pay.
- Formularies: This is the list of drugs your plan covers. A medication that was included last year may be dropped or moved into a higher cost tier. That means your out-of-pocket costs could rise unexpectedly if you don’t check.
- Tier Levels: Plans sort prescriptions into tiers that determine how much you pay. A drug moving from a preferred tier to a non-preferred tier can raise your co-pay or coinsurance significantly.
- Pharmacy Networks: Some plans change which pharmacies they partner with each year. If your local pharmacy is no longer “preferred,” you could end up paying more for the same prescription.
- Provider Networks (for Advantage plans): Doctors, specialists, or hospitals that were covered in 2025 may no longer be included in 2026. This can affect both cost and access to care.
Research shows that seniors who take time to compare plans often save money. In fact, federal reviews have shown that switching plans can save hundreds of dollars each year. Yet most beneficiaries simply let their plan auto-renew without checking, which often leads to higher costs or less coverage.
The best resource is Medicare.gov. Their Plan Finder tool allows you to enter your prescriptions and pharmacy preferences to compare plans side by side. You can also call 1-800-MEDICARE (1-800-633-4227) for help.
Auto-Renewal Rule Changes for 2026
In the past, many seniors allowed their Medicare plans to automatically renew without reviewing the details. Starting in 2026, two important changes mean that approach could now cost you:
- $0 Premium Plans: Auto-renewed $0 premium plans will now cost at least $5 per month unless you actively confirm eligibility.
- Bronze-to-Silver Upgrades: Automatic upgrades from Bronze to Silver plans will end. If you qualify for cost-sharing reductions but stay in a Bronze plan, you’ll miss out on those extra benefits.
These changes make it clear: relying on auto-renew is no longer safe. To avoid unexpected bills or losing benefits, seniors need to review and actively select their coverage each year during open enrollment.
Open Enrollment Deadlines and Shorter Windows
Medicare’s open enrollment is the only time each year when you can make changes to your plan unless you qualify for a special enrollment period. For coverage starting in 2026, the open enrollment window runs from November 1, 2025 through January 15, 2026 in most states.
Beginning in 2027, the open enrollment period will be shortened to just six weeks, ending December 15. While that doesn’t affect this year, it’s a reminder not to wait until the last minute. Making changes early gives you time to compare options, ask questions, and avoid being rushed into a plan that doesn’t fit your needs.
Steps You Can Take Right Now
You don’t have to wait until open enrollment begins to start preparing. A little planning now can make the process much easier:
- Review your current plan: Look at your premiums, deductibles, co-pays, and out-of-pocket spending to see what you typically spend each year.
- Make a prescription list: Write down all your medications and dosages, then enter them into the Plan Finder tool at Medicare.gov to preview 2026 coverage.
- Consider a Medigap policy: If you’re on Traditional Medicare, Medigap can help cover the 20% Medicare doesn’t pay. You can compare Medigap plans in your area at Medicare.gov or by contacting insurers directly.
- Check provider networks: If you’re considering a Medicare Advantage plan, look carefully at which providers are included. Remember, HMOs don’t panel with Blue Moon Senior Counseling, so you would not be able to use that coverage for our services.
- Plan your budget: Factor in higher deductibles and possible drug coverage changes for 2026 so you’re not caught off guard in January.
How Blue Moon Senior Counseling Can Support You
The upcoming insurance changes for 2026 may bring more than financial challenges. For many seniors, the pressure of higher costs, new rules, and confusing coverage options can increase stress, heighten anxiety, or make it harder to adjust to daily life. These shifts can also leave some older adults feeling isolated or overwhelmed as they try to cope on their own.
At Blue Moon Senior Counseling, we specialize in helping seniors manage stress, anxiety disorders, depression, and the difficulties that come with major life adjustments. If the uncertainty of these changes is weighing on you, our licensed therapists can provide the support and tools you need to strengthen your coping skills and find a sense of balance.
Give us a call today at 630-896-7160 or fill out our contact form here.
FAQs
- When does Medicare open enrollment for 2026 begin and end?
Open enrollment runs from November 1, 2025 through January 15, 2026 in most states. Some states may extend the deadline, but it’s best to review and make your choices early. You can compare plans and make changes at Medicare.gov or by calling 1-800-MEDICARE.
- How much will Medicare deductibles increase in 2026?
The Part B deductible will rise to $257, and the maximum Part D deductible will increase to $615. Even though many Part D plans will have lower deductibles, or none at all, any plan that does include one cannot set it higher than $615 in 2026. While the numbers may look small on paper, they can make a meaningful difference in out-of-pocket costs for those managing ongoing health needs.
- Are insulin costs still capped for seniors in 2026?
Yes. Insulin will remain capped at $35 per month or less, and no deductible will apply. This protection continues to be one of the most important safeguards for seniors with diabetes.
- What does Medigap cover, and how can I review plans?
Medigap (supplemental insurance) helps pay for the 20% of costs that Traditional Medicare doesn’t cover, such as co-pays, coinsurance, and sometimes deductibles. You can review Medigap options in your state using the Medigap policy search tool on Medicare.gov or by contacting insurers directly.
