As Medicare’s open enrollment period continues, experts are urging recipients to closely evaluate their coverage options for 2026. While some plans may see modest decreases in premiums, others are expected to rise, and several changes in deductibles, out-of-pocket limits, and coverage rules could significantly affect what beneficiaries pay next year.

Health economists say this year’s enrollment window, which runs from October 15 through December 7, comes at a critical moment. Not only are traditional components of Medicare shifting, but ongoing political uncertainties such as the federal government shutdown could complicate service delivery, provider payments, and claims processing.

“Millions of Medicare beneficiaries will face higher out-of-pocket costs and reduced benefits in 2026,” said Whitney Stidom, vice president of consumer enablement at eHealth. “Comparing coverage options is especially crucial this year.”

Government Shutdown Concerns

If the federal shutdown persists, experts warn that Medicare operations may experience:

• Delays in claims processing
• Disruptions in payments to healthcare providers
• Reduced access to telehealth services

Some of the pandemic-era telehealth flexibilities expired on October 1, and Congress has not renewed them. Doctors say this will create significant access barriers.

“Patients who relied on telehealth, especially those with disabilities, rural residents, or those with limited mobility , will face higher costs and more logistical challenges,” said Dr. Kanwar Kelley, CEO of Side Health.

Understanding Medicare’s Structure

Medicare provides health coverage to about 69 million people in the United States, with roughly 90% aged 65 or older. The program includes:

Part A – Hospital Insurance

Covers inpatient hospital care, skilled nursing facilities, hospice, and some home health services. Only about 1% of enrollees pay premiums for Part A.

Part B – Medical Insurance

Covers outpatient care, doctor visits, and ambulance services. Premiums are typically deducted from Social Security benefits.

About 51% of recipients also choose supplemental coverage such as Medicare Advantage, which bundles Part A, Part B, and often Part D drug benefits.

In 2026, CMS expects about 5,600 Medicare Advantage plans nationwide, though availability varies by state. Some providers, including UnitedHealthcare, plan to reduce service areas or narrow coverage offerings.

Key Medicare Cost Changes Coming in 2026

1. Premium Adjustments

Part B premiums will rise significantly:

• Part B premium:
  $185 (2025) → $206 (2026) — a 12% increase, double last year’s hike.

The increase also exceeds the projected 2.7% Social Security cost-of-living adjustment, meaning many seniors could see reduced take-home benefits.

Why the increase?

• Higher utilization of Part B services
• More enrollees entering the program
• Increased overall healthcare costs

Not all premiums are rising, though:

• Medicare Advantage with drug coverage:
  $16 → $14 per month
• Standalone Part D plans:
  $38 → $34 per month
• Part D inside Medicare Advantage:
  $13 → $11 per month

However, insurers can now raise Part D premiums up to $50 per month, compared with the previous $35 maximum.

“Any premium increase will strain seniors’ budgets as other living costs rise,” Kelley warned.

2. Out-of-Pocket Costs and Deductibles

Medicare Advantage

• In-network out-of-pocket maximum:
  $9,350 (2025) → $9,250 (2026) — a slight decrease

Part D (Prescription Drugs)

• Annual out-of-pocket cap:
  $2,000 → $2,100
• Deductible limit:
  $590 → $615

Part B

• Annual deductible:
  $257 → $288, up 12%

Insulin will remain capped at $35/month, and most vaccines stay fully covered. However, the Trump administration’s 2025 decision to exclude GLP-1 weight-loss drugs (like Ozempic) from Medicare coverage remains in effect.

“These changes have a major impact on seniors living on fixed incomes,” Stidom explained.

3. Prescription Drug Price Changes

About 81% of Medicare beneficiaries are enrolled in Part D.

Fewer Plan Options

Standalone Part D plans will drop from 464 (2025) to 360 (2026).

Drug Price Negotiations

CMS is expected to continue negotiating lower prices on 10 widely used drugs, potentially reducing list prices by 38%–79%. These include:

• Eliquis
• Xarelto
• Januvia
• Jardiance
• Farxiga

Automatic monthly payment plans for prescriptions will continue, helping seniors spread out costs rather than paying upfront.

But Fewer Options Means Some Will Pay More

“Even if average premiums decrease, changes in drug formularies and reduced plan options may increase costs for people taking certain specialty medications,” Kelley added.

Choosing the Right Plan: Expert Advice

Despite these changes, an estimated 70% of Medicare recipients do not compare plans during open enrollment.

Experts urge beneficiaries to:

• Review their annual “Notice of Change” letter
• Compare coverage options using trusted platforms
• Check for changes in drug formularies and tier placements
• Evaluate deductibles, copays, and provider networks

Stidom says using comparison tools or licensed insurance agencies can save seniors up to $1,800 per year.

“People should look at their personal health needs, medications, and budget to choose the right plan,” she said.

Bottom Line

Medicare will undergo significant cost and coverage shifts in 2026. With increases in Part B premiums, adjustments to prescription drug costs, and evolving telehealth access, experts stress that this year’s open enrollment is more important than ever. Careful plan comparison can help seniors avoid unexpected expenses and ensure they receive the care they need.