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Medicare Changes 2026: Costs, Part D and Advantage Updates

Older woman collects a prescription at pharmacy

The biggest Medicare changes for 2026 are higher Part A and Part B costs, a $2,100 annual out-of-pocket threshold in Part D, a $615 maximum Part D deductible, and a slightly lower average Medicare Advantage premium. Your plan’s Annual Notice of Change (ANOC) shows how your own coverage is shifting. Medicare’s yearly Open Enrollment runs October 15 to December 7, so this is the window to compare your plan with the alternatives and decide whether to stay or switch.

Below, we walk through each change with the official numbers, explain how to read your ANOC, and show what to do next if you live in Colorado.

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TL;DR

The standard Part B premium is $202.90 a month in 2026, and the Part B deductible is $283. The Part A inpatient hospital deductible is $1,736.
Part D now has a $2,100 out-of-pocket threshold, a deductible capped at $615, and a $35 monthly limit on covered insulin.
CMS estimates the average Medicare Advantage premium will fall from $16.40 to $14.00, and supplemental benefits such as dental and vision stay consistent overall.
Your plan’s ANOC lists what changes for you. Review it before Open Enrollment ends on December 7.
Extra Help can bring your drug premium and deductible to $0 if your income and resources fall under the 2026 limits.

What is changing in Medicare in 2026
Original Medicare: Part A and Part B costs
Part D: the biggest change for prescription costs
Medicare Advantage: what to expect
Extra Help: lower drug costs for people with limited income
How to read your Annual Notice of Change (ANOC)
Your choices during Open Enrollment
Perspective
Get a second set of eyes on your plan
FAQ
Sources

What is changing in Medicare in 2026

Two layers of change matter. The first is the set of annual cost adjustments to Original Medicare. The second is a regulatory package: on April 4, 2025, CMS finalized a Contract Year 2026 rule covering Medicare Advantage and Part D. It touches prescription drug coverage, the Medicare Prescription Payment Plan, special needs plans for people who have both Medicare and Medicaid (D-SNPs), Star Ratings, and the Medicare Drug Price Negotiation Program. It also puts provisions of the Inflation Reduction Act of 2022 into effect for the 2026 contract year.

Most people feel these changes in three places: the monthly premium, what they pay at the pharmacy, and what their Advantage or Part D plan decides to change for the year. We take them in that order.

Original Medicare: Part A and Part B costs

Original Medicare costs rise every year. According to the CMS 2026 Parts A and B fact sheet, the numbers are:

Item 2026 amount Standard monthly Part B premium $202.90 Annual Part B deductible $283 Part A inpatient hospital deductible (per benefit period) $1,736

The Part A deductible was $1,676 in 2025, so it went up by $60. The same CMS fact sheet notes that longer hospital stays and skilled nursing facility care add daily coinsurance on top of the deductible.

Why the Part A deductible matters more than it looks

The $1,736 applies to each benefit period, not each calendar year. Someone who is hospitalized, recovers, and is admitted again after a gap can face it more than once in a year. That is why many people pair Original Medicare with a supplement or choose an Advantage plan with a hospital copay structure. Our guide to avoiding multiple Part A deductibles in Colorado explains how the rule works in practice, and our overview of Medicare costs in 2026, including IRMAA and copays covers the higher-income surcharges.

Older patient resting beside a hospital bed

Part D: the biggest change for prescription costs

Prescription drug coverage sees the most meaningful improvement. According to the CMS 2026 rate announcement fact sheet, Part D in 2026 includes:

An out-of-pocket threshold of $2,100 for catastrophic coverage, after which you no longer pay for covered drugs.
Monthly cost-sharing for a covered insulin product limited to the lesser of $35, 25% of the drug’s maximum fair price, or 25% of the negotiated plan price.
$0 cost-sharing for recommended adult vaccines.
A requirement that Part D plans offer the Medicare Prescription Payment Plan, which lets you spread out-of-pocket drug costs across the year in monthly installments rather than paying at the counter.

Medicare.gov also states that for 2026 no drug plan may have a deductible above $615. Many plans charge less, and some have no deductible on certain drug tiers, so the formulary and tier structure matter as much as the premium.

On premiums, CMS projects the average stand-alone Part D premium will fall from $38.31 in 2025 to $34.50 in 2026. An average hides a wide range. Your own plan’s premium could be higher or lower, which is why the ANOC matters.

If you are also weighing what newer or specialty therapies cost beyond your plan’s drug list, a look at peptide therapy cost in 2026 shows how one provider frames Medicare-related copays. For covered prescriptions, the cap and the payment plan above are the protections that apply.

For a deeper walkthrough, see our posts on the new $2,100 cap, Medicare prescription drug costs in 2026, and how to check your Part D deductible. Despite what some headlines suggested, Part D is not going away either: we cover that in Is Medicare Part D ending in Colorado in 2026?

Medicare Advantage: what to expect

CMS describes the 2026 Advantage and Part D markets as expected to remain stable. The agency estimates the average monthly Advantage premium drops from $16.40 in 2025 to $14.00 in 2026, announced on September 26, 2025. Supplemental benefit offerings like hearing, dental, and vision remain consistent.

Two cautions keep that headline in perspective:

An average is not your plan. Each Advantage plan sets its own premium, copays, networks, drug formulary and extra benefits, and a plan can change any of them from one year to the next.
Stable overall does not mean unchanged for you. Provider networks, the pharmacies that count as preferred, and prior authorization rules vary by plan. That is the kind of detail an ANOC spells out.

Choices also differ by county. If you want to see what is offered where you live, choosing among plan types is easier with a side-by-side view of Medicare Advantage versus Medigap, and plan choices for the coming year are covered on our Medicare Advantage plans page. Remember that if the plan you picked for a given year does not fit, Open Enrollment is when you can change it.

If you are looking for a broader sense of how providers handle insurance billing and what payment options exist for care outside a plan, insurance, billing and payment options at one clinic offer an example of the questions worth asking any provider about plan acceptance.

Extra Help: lower drug costs for people with limited income

Extra Help, also called the Part D Low-Income Subsidy, is one of the most underused parts of Medicare. For 2026, Medicare.gov’s Extra Help publication gives these limits for an individual: annual income below $23,940 and resources below $18,090. Once you qualify, you are enrolled in a plan where you pay $0 for your drug plan premium and deductible.

If your income sits near that line, apply or ask for help screening your eligibility. The Social Security Administration processes applications, and a broker can help you pick a drug plan that works well with the subsidy.

How to read your Annual Notice of Change (ANOC)

The ANOC is a document your Medicare Advantage or Part D plan sends you each year before Open Enrollment. It sets out what will be different about your plan in the coming year. Medicare.gov advises people to review the ANOC each year before Open Enrollment to decide whether to make changes, and notes that costs, benefits and providers can change annually.

Here is a practical way to go through it in about 30 minutes:

Premium and deductible. Compare the new monthly premium and the drug deductible with what you pay now.
Your medications. Check that every drug you take is still on the formulary, at what tier, and whether the pharmacy you use is still preferred.
Your doctors and hospitals. Confirm each is still in network.
Out-of-pocket maximum. For Advantage plans, check the yearly limit and the copays for specialists, emergency care and hospital stays.
Extra benefits. Look at dental, vision, hearing and any over-the-counter allowances for reductions or additions.
Prior authorization. Look for services that now require approval before you receive care.

If anything surprises you, mark it and compare it with other plans available in your county before December 7.

Your choices during Open Enrollment

Per Medicare.gov, Open Enrollment runs October 15 through December 7 every year. In that window you can join, switch or drop a Medicare Advantage plan or a Part D plan, or switch from Advantage back to Original Medicare. Changes take effect on January 1.

Because the schedule repeats each year, the practical advice is steady: look at your ANOC in September or early October, compare options as soon as Open Enrollment starts, and decide well before the deadline. Our annual enrollment prep checklist for Castle Pines lists what to gather first.

Perspective

We hear the same thing from Colorado clients every fall: the letter arrives, the numbers look about the same, and it goes in a drawer. The trouble is that a plan can keep its name and its premium while changing the formulary, the network or the deductible underneath.

Our view is that the 2026 changes reward people who look. A $2,100 threshold and a $35 insulin limit are real protections, but how much they help depends on which drugs you take and which plan holds them. The same drug can sit on different tiers in different plans.

That is why we work independently across multiple carriers, and why we stay with clients after they enroll. We help with the annual review, with claims questions, and with appeals and grievances when a plan says no. Choosing a plan is one decision. Making sure it keeps working for you is the other half.

Zach

Get a second set of eyes on your plan

Simply Insurance is an independent brokerage in Castle Pines serving Colorado residents. We compare Medicare Advantage, Medicare Supplement (including Plan G and Plan N quotes) and Part D plans across carriers, help with annual enrollment, and stay available for claims, appeals and yearly reviews. You can see our full list of services or start with Medicare planning.

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If your ANOC raised questions, bring it with your medication list and doctors’ names. We will walk through it with you.

FAQ

What is the Part B premium in 2026?

The standard monthly Part B premium is $202.90, with an annual deductible of $283. Some people pay more based on income, through the income-related monthly adjustment amount (IRMAA). Our Medicare costs guide explains it.

What is the Annual Notice of Change, and when do I get it?

It is the yearly letter from your Advantage or Part D plan describing changes to costs, benefits and coverage. Plans send it ahead of Open Enrollment so you can review it before the October 15 start. If you have not received yours, contact your plan or call 1-800-MEDICARE.

What is Medicare Extra Help?

Extra Help is a program that lowers Part D costs for people with limited income and resources. For 2026, an individual must have income below $23,940 and resources below $18,090 according to Medicare.gov. Qualifying members pay $0 for their drug plan premium and deductible.

Can I change my Medicare plan right now?

If you are reading this between October 15 and December 7, yes. During Open Enrollment you can join, switch or drop Advantage and Part D plans, or return to Original Medicare. Outside that window, changes are allowed only in specific situations, so ask a licensed broker whether you qualify.