8 Medicare Changes Every Enrollee Should Know About in 2026

According to the folks at Fidelity, a 65-year-old person who retired in 2025 could expect to spend $172,500, on average, on medical and healthcare expenses throughout their retirement. That doesn't even include long-term care, over-the-counter medications, or most dental services. For a married couple, the average total is $345,000. It's certainly no secret: Healthcare costs in retirement can be staggering.

Fortunately, once we turn 65, we can get a lot of healthcare coverage from Medicare. It's not that simple, though. You need to select the form of Medicare that will work best for you (that is, "original" Medicare or a Medicare Advantage plan) and to consider supplemental policies, too.

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It's also important to understand that Medicare changes over time. Here, then, are eight recent changes to Medicare to know about in 2026.

1. Costs are rising

This won't surprise many people, but as they do just about every year, Medicare premiums are increasing in 2026. Most folks who pay the standard premium price will be paying $202.90 per month, up about 10% from 2025 levels. (Higher-income folks pay steeper premiums.)

If, like many people, your Medicare premiums are taken out of your Social Security benefits, you'll see them shrink accordingly, or, at least, you'll receive a smaller bump from the annual Social Security COLA -- which was 2.8% for 2026.

2. Prescription coverage costs are rising, too

If you have prescription drug coverage via a Medicare Part D plan, you'll be dealing with a higher deductible in 2026 as well as a higher out-of-pocket spending cap. The standard deductible is rising to $615 in 2026 from $590 in 2025 -- a 4% jump.

The out-of-pocket spending cap, meanwhile, is increasing by 5%, from $2,000 in 2025 to $2,100 in 2026. If you think that's annoying, know that until recently, there was no cap at all on out-of-pocket spending in Part D. Note, too, that the increases are tied to inflation.

3. You may need prior authorizations

If you're in a Medicare Advantage plan, you'll likely be required to get a "prior authorization" before certain treatments, procedures, equipment, etc. will be covered. This has not been the case for original Medicare -- it was simply up to doctors to prescribe whatever they deemed necessary.

But now, original Medicare is looking into requiring prior authorizations and is testing it for six years in Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington. It's using artificial intelligence (AI) in this testing, too.

4. Some costs are shrinking

The news isn't all bad. The Biden administration won some cost reductions for some prescription drugs, and the Trump administration has done so, as well. Of particular interest to many might be that certain medications used for weight loss, including GLP-1 drugs, are seeing their costs fall -- in 2026 and/or 2027.

5. Medicare Advantage coverage is shrinking

While original Medicare doesn't cover hearing, eye, and dental health, Medicare Advantage plans generally do, and they often feature other coverage, too, such as for chronically ill members. In 2026, some of that is being eliminated, such as cosmetic procedures and cannabis products.

6. The Medicare Prescription Payment Plan gets auto-renewed

If you make use of the Medicare Prescription Payment Plan (MPPP), which allows you to spread the cost of your prescriptions over a year instead of paying in full when you pick up each installment, this is for you: Instead of having to reenroll in this program each year, you'll now be automatically reenrolled, and it will be on you to opt out, if you want to. This should be a plus for most folks using the plan.

7. Insulin costs are capped

Insulin costs were shrunk considerably beginning in 2023, and those caps are now going to apply each year. Medicare enrollees will enjoy a cap of $35 for each one-month supply of insulin product -- and they won't have to pay a deductible for it, either.

8. Free vaccines

Medicare offers free vaccines, updating its list regularly. Adult vaccines covered are ones recommended by the Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices. Vaccines and who should get which ones when have been in the news a lot lately, with the CDC changing some of its recommendations, particularly for children. So it's a good idea to double-check your Medicare coverage to see which vaccines are currently covered.

These are most of the major changes to Medicare for 2026. If you're a retiree or are nearing retirement, it's not a bad idea to keep tabs on further changes, as some could have a big impact on your finances.

Be sure to have a solid retirement plan in place, too.

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