Mark your calendar. The annual Medicare Open Enrollment window is about to open, so it’s time to go shopping and compare the Medicare plan you have now with what’s available in 2026.
The annual open enrollment window runs October 15-December 7. This is the time when you can make any change to your health coverage no matter what Medicare arrangement you’ve set up. For example, you can:
- Switch from Original Medicare to a Medicare Advantage plan
- Switch from Medicare Advantage to Original Medicare
- Change from one Medicare Advantage plan to another
- Enroll in a Medicare Part D prescription drug plan
- Change Medicare Part D prescription drug plans
- Disenroll from a Medicare Part D prescription drug plan
- Switch from a Medicare Advantage plan with drug coverage to one without
- Switch from a Medicare Advantage plan without drug coverage to one with
- Purchase a Medicare supplement (Medigap) policy
In other words, the Open Enrollment period is the time you can make any needed change to your Medicare coverage. Changes take affect January 1 of next year.
Seven Medicare Changes for 2026
Prescription payment plan updates
2025 was the first year for the Medicare Prescription Payment Plan (MPPP). It allowed those with Medicare prescription drug coverage to spread the cost of their prescriptions over the calendar year instead of paying the full price every time you picked up a prescription.
The plan has been improved for 2026 to make it easier. If you were enrolled in MPPP in 2025, you will be automatically re-enrolled unless you opt out. You’ll also receive a separate renewal notice after the end of the annual election period which includes the payment plan’s upcoming terms and conditions.
If you decide to opt out, plan sponsors have to process your request within three calendar days.
Cap on Part D prescription drug expenses indexed for inflation
For the first time in 2026, the cap on out-of-pocket prescription drug costs will be indexed for inflation. In 2025 the cap was $2,000. Next year that goes up to $2,100. That means you’ll be liable for an additional $100 dollars of drug costs.
Maximum Medicare Part D deductible is going up
If your Part D prescription drug coverage has a deductible, it’s going up. The maximum deductible for every Part D plan increases from $590 to $615
You pay all out-of-pocket costs until you meet your plan’s full deductible. After that, you’ll pay 25% coinsurance for both generic and brand-name drugs. This continues until your total out-of-pocket spending on covered Part D drugs reaches $2,100 for 2026.
Limit on special supplemental benefits for the chronically ill (SSBCI) on Medicare Advantage
Medicare Advantage (MA) plans are known for the extra benefits they provide to their subscribers. Some MA plans tailor the special benefits based on the enrollee’s medical condition. The Centers for Medicare & Medicaid Services (CMS) finalized and codified a non-exhaustive list of non-allowable supplemental benefits that are offered under the Special Supplemental Benefits for the Chronically Ill (SSBCI) category.
In the Final Rule, the CMS adopted the non-exhaustive list of non-primarily health-related items or services that “do not meet the standard of having a reasonable expectation of improving or maintaining the health or overall function of the enrollee.” Some of the items include:
- Alcohol
- Tobacco
- Cannabis products
- Non-healthy food
- Life insurance
- Hospital indemnity insurance
- Funeral planning and expenses
- Procedures that are solely cosmetic in nature and do not extend upon Traditional Medicare coverage
- Broad membership programs inclusive of multiple unrelated services and discounts
Insulin costs capped
For 2026 and each subsequent year, the applicable cost-sharing amount is the lesser of:
- $35
- 25% of the maximum fair price established for the covered insulin product under the Medicare Drug Price Negotiation Program
- 25% of the negotiated price of the covered insulin product under the stand-alone Medicare prescription drug plan (PDP) or MA plan with prescription drug coverage (MA-PD plan)
Zero cost-sharing for adult vaccines
Medicare beneficiaries have had access to a limited number of free vaccines since 2023. However, free vaccines are now a permanent feature of Medicare Part D plans. Part D insurers must continue to waive deductibles and cost-sharing for adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP).
The list of free vaccines is updated every year, so just because a vaccine is on the list this year doesn’t mean it will be on the list next year.
If you are traveling outside of the country, you may want to consult the CDC’s list of recommended vaccinations depending on your destination.
7. Prior authorizations for traditional Medicare are coming to six states in 2026
Beginning January 1, 2026, CMS will begin using AI to save money by avoiding unnecessary care for people on Original Medicare. The new process will be tested in New Jersey, Ohio, Oklahoma, Texas, Arizona and Washington. CMS says AI will not be determining if a procedure is approved or denied; that will still be done by a human.
Review your Medicare plan every year
What’s the old phrase? “Nothing is certain but death and taxes.” That applies to Medicare. Plans can change from one year to the next and the new plan may not be what you need. That’s why the Open Enrollment Period is so important.
By now, you should have received the Annual Notice of Changes (ANOC) from your current Medicare provider. Read it. Compare this year’s benefits to next year’s. And if the plan doesn’t provide what you need, find one that will.
If you need help finding a better plan locate your state SHIP program (State Health Insurance Assistance Program) for unbiased help. Or find a good independent Medicare insurance agent who has access to multiple Medicare providers and may be aware of plans you aren’t. It’s worth the time you spend doing your homework to make sure you have the best Medicare plan for you next year.
Disclaimer
This information is presented for informational purposes only and does not constitute an offer to sell, or the solicitation of an offer to buy any investment products. None of the information herein constitutes an investment recommendation, investment advice or an investment outlook. The opinions and conclusions contained in this report are those of the individual expressing those opinions. This information is non-tailored, non-specific information presented without regard for individual investment preferences or risk parameters. Some investments are not suitable for all investors, all investments entail risk and there can be no assurance that any investment strategy will be successful. This information is based on sources believed to be reliable and Alhambra is not responsible for errors, inaccuracies, or omissions of information. For more information contact Alhambra Investment Partners at 1-888-777-0970 or email us at info@alhambrapartners.com.
