As we head into 2026, the Medicare landscape is shifting again, primarily driven by the
ongoing rollout of the Inflation Reduction Act. While 2025 was the year of the “Drug Cost Cap,” 2026 is the year we see the first-ever negotiated prices for some of the most expensive medications on the market.
Here are the confirmed updates for 2026:
For the first time in history, Medicare has negotiated lower prices directly with manufacturers for 10 high-cost drugs. These new “Maximum Fair Prices” go into effect on January 1, 2026.
The $2,000 cap introduced in 2026 is indexed for inflation.
2026 Limit: The annual out-of-pocket cap for prescription drugs (Part D) is $2,100.
What this means: Once you spend $2,100 on covered medications in 2026, your
coinsurance drops to $0 for the remainder of the year.
Medicare Part B costs are increasing as medical costs and service demands rise.
Standard Monthly Premium: $202.90 (up from $185.00 in 2026). This is the first
time the standard premium has crossed the $200 threshold.
Annual Deductible: $283 (up from $257 in 2026).
For those who do not qualify for premium-free Part A, or for those facing a hospital stay:
Inpatient Hospital Deductible: $1,736 per benefit period (up from $1,676).
Daily Coinsurance (Days 61-90): $434 per day.
Provider Directory Accuracy: CMS is launching a new “Special Enrollment Period” in 2026. If you joined a Medicare Advantage plan based on an inaccurate provider directory (e.g., you thought your doctor was in-network but they weren’t), you may be allowed to switch plans.
Behavioral Health Parity: Medicare Advantage plans must now ensure their mental health and substance use disorder benefits are no more restrictive than those for medical/surgical services.
Shift in Supplemental Benefits: Some Medicare Advantage plans are slightly scaling back “extra” perks like over-the-counter allowances or meal deliveries to offset the costs of the new Part D drug caps. It is more important than ever to read your Annual Notice of Change (ANOC).
