Medicare costs changed in 2026—Part B premiums and deductibles are higher, Part A hospital costs increased, and Part D now has a firm annual out-of-pocket cap. Here’s what beneficiaries should review and why it matters.
The 30-second takeaway
2026 brought higher Parts A & B costs, updated Part D cost rules (including a clear annual out-of-pocket cap), and continued Medicare Advantage (MA) plan shifts that make it smarter than ever to review coverage—not just renew it on autopilot.
1) 2026 Medicare cost updates (Original Medicare)
Part B (doctor & outpatient care)
Standard Part B premium: $202.90/month (2026)
Part B annual deductible: $283 (2026)
Why it matters: Even small premium increases add up over a full year—and the deductible affects when Original Medicare starts sharing costs.
Part A (hospital insurance)
Inpatient hospital deductible: $1,736 per benefit period (2026)
Coinsurance amounts for longer stays also increased (the “days 61+” range is where people feel it fastest).
Advisor note: “Benefit period” surprises clients. It’s not “once per year”—it can happen more than once, depending on the timing of inpatient stays.
2) Part D in 2026: a clearer cap, different planning
The big headline: the annual out-of-pocket cap
If a client has Medicare drug coverage (Part D), their yearly out-of-pocket costs for covered Part D drugs are capped at $2,100 in 2026. Once they hit it, they won’t pay cost-sharing for covered Part D drugs for the rest of the calendar year.
The Part D deductible ceiling
No Part D plan can have a deductible higher than $615 in 2026 (some plans may be lower or $0).
Medicare Prescription Payment Plan (helps cash flow—not total cost)
The Medicare Prescription Payment Plan is an option that lets enrollees spread out-of-pocket drug costs across the calendar year through their plan. It can smooth monthly budgeting, but it doesn’t reduce the actual drug cost—it changes the payment timing.
Advisor-friendly way to explain it:
“This can make expensive months feel more manageable—but it doesn’t change what the medication costs overall.”
3) Medicare Advantage in 2026: plan availability and benefits can shift
Medicare Advantage plans can change premiums, copays, networks, formularies, and extra benefits year to year. CMS projected increased MA payments in 2026 (which doesn’t automatically mean richer benefits for every plan, but it’s part of the environment).
Practical takeaway: Encourage clients to re-check:
Whether their doctors/hospitals are still in-network
Whether their prescriptions are still covered and on the same tier
Whether key extras (dental/vision/hearing, OTC, transportation) changed
4) Enrollment windows to know (and remind clients about)
Annual Open Enrollment (AEP)
October 15 – December 7 (changes generally effective January 1).
Medicare Advantage Open Enrollment Period (MAOEP)
January 1 – March 31 (only if they’re already in an MA plan; they can switch MA plans or return to Original Medicare and add Part D).
5) A simple 2026 “Medicare Review Checklist” you can paste into emails
Here’s a quick client-facing checklist:
Confirm providers: Are your doctors and preferred hospitals still in-network?
Confirm prescriptions: Any formulary/tier changes? Any new prior authorizations?
Estimate drug spend: Will you likely approach the $2,100 Part D cap?
Consider budgeting tools: Would the Prescription Payment Plan help smooth monthly expenses?
Compare total annual cost: Premiums + copays + deductibles + max out-of-pocket (not just the premium).
Disclosure
This article is for informational and educational purposes only and does not constitute legal, tax, or medical advice. Plan availability, benefits, formularies, provider networks, premiums, and cost-sharing vary by plan and can change annually. Please review official plan documents and consult appropriate professionals regarding your specific situation.