Written by Corrie Pelc and David Mills — Fact checked by Jennifer Chesak, MSJ
On January 1, there will be some changes consumers should note for Medicare, a federal health insurance program for adults ages 65 and older in the United States.
Every year, older adults have between October 15 and December 7 to enroll in Medicare or make changes to their plans.
There are four main parts to Medicare:
- Part A helps to cover inpatient care in hospitals, skilled nursing facilities, and home healthcare.
- Part B is for outpatient coverage, including diagnosis and treatment of illnesses at the doctor’s office, as well as preventive services such as vaccines and wellness visits.
- Part C, also known as the Medicare Advantage plan, is bundled coverage that includes Parts A, B, and sometimes Part D.
- Part D provides coverage for prescription medications
There are some changes to Medicare Advantage and Part D coverage plans in 2026. This article aims to explain what these changes will look like.
Medicare Advantage premiums to increase in 2026
An estimated 51% of Medicare recipients have supplemental health insurance such as a Medicare Advantage plan.
The Centers for Medicare & Medicaid Services (CMS) estimates there will be about 5,600 Medicare Advantage Plans available nationwide in 2026. That is close to the numbers from 2025, when the number of options decreased from the previous year.
The number of plans available to an individual Medicare recipient varies from state to state.
Additionally, some Medicare Advantage providers, including UnitedHealthcare, have announced plans to reduce their service areas and/or coverage options.
The average monthly premium for Medicare Advantage plans with prescription drug coverage is expected to decrease from $16 in 2025 to $14 in 2026.
Fewer Medicare Part D plans available
It is estimated that about 81% of Medicare recipients are enrolled in Part D, which covers prescription drug expenses.
The number of stand-alone Part D plans is forecasted to decrease from 464 nationwide in 2025 to 360 in 2026.
The CMS estimates that monthly premiums for stand-alone Part D plans will drop from $38 in 2025 to $34 in 2026. Premiums for Part D, which is part of Medicare Advantage plans, will decrease slightly from $13 to $11 per month.
However, insurance companies will be allowed to raise Part D premiums as much as $50 per month, higher than the current $35 monthly maximum.
Medicare officials are expected to continue to negotiate prices for drugs covered under Part D.
Experts say that could result in discounts of 38% to 79% on list prices on 10 widely used prescriptions, including blood thinners Eliquis and Xarelto, as well as diabetes medications Januvia, Jardiance, and Farxiga.
People with Part D plans will also continue to have the option to utilize an automatic prescription payment plan that spreads out drug costs over the year. People who currently have this plan will be automatically re-enrolled for 2026 unless they opt out.
Medicare recipients may feel effects of any premium increases
“Any cost increase to medical premiums will be significant as prices are rising for other goods and services. In the end, it means less money in consumers’ pockets.”
— Kanwar Kelley, MD, a specialist in otolaryngology head and neck surgery, obesity medicine, and lifestyle medicine as well as the co-founder and chief executive officer of Side Health in Orinda, CA.
Despite these price reductions, experts say some Medicare recipients could still pay more for prescription drugs.
“Although the price of Part D (drug benefits) may reduce overall, the reduction in options and changes to covered medications could result in higher costs for consumers of certain specialty medications,” Kelley noted.
Changes to Medicare out-of-pocket expenses
The annual out-of-pocket limit for in-network services for Medicare Advantage recipients will decrease slightly from $9,350 in 2025 to $9,250 in 2026.
The annual cap on out-of-pocket expenses for Part D drugs will increase slightly from $2,000 in 2025 to $2,100 in 2026.
The maximum out-of-pocket cost for insulin will remain $35 per month, and most vaccines will continue to be covered under Part D.
However, earlier this year, the Trump administration decided against Medicare covering the cost of GLP-1 weight-loss drugs such as Ozempic. However, this class of medication is still covered when prescribed for other reasons, such as type 2 diabetes and certain heart conditions.
What are special enrollment periods for Medicare?
There are some changes to Medical Advantage plan services that may be beneficial to consumers.
The Medical Plan Finder is a tool offered by Medicare designed to help enrollees determine if doctors and hospitals are part of their Medical Advantage plan network.
There will also be some special enrollment periods in 2026 for Medicare Advantage users.
The first runs from January 1 to March 31. This enrollment window allows participants to switch Medicare Advantage plans if they discover their healthcare providers are not within the network covered by their current plan.
The second begins on December 8 and lasts until February 28. It allows enrollees to sign up for a new Medical Advantage plan if their current coverage is terminated.
“Beneficiaries should be proactive during the Medicare annual enrollment period, as comparing plans from multiple insurers can help people save money and find the right option for them.” — Whitney Stidom, vice president of consumer enablement at eHealth
An enrollee can also sign up for a new Medicare Advantage plan between January 1 and December 1 if they discover they received inaccurate information about whether a healthcare professional was in their network.
Older adults can also take advantage of special enrollment periods if they have a qualifying life change event or turn 65 during the 2026 calendar year.
How government shutdown affects Medicare
There may also be uncertainties if the federal government shutdown lasts for an extended period.
One is that the processing of claims by recipients and payments to medical providers could be delayed.
Another is that telehealth services could be reduced. This could affect patients with mobility issues, those living in rural areas, or individuals with caregiver constraints. Some telehealth programs that were offered over the past several years expired on October 1, and Congress did not take action to renew them.
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