The Medicare system is constantly evolving. As a government program, you can count on changes and updates to premiums, deductibles, drug coverage, and eligibility rules every year. Laws like the “One Big Beautiful Bill Act,” and many others have made projected increases in 2026 a major talking point.
It’s more important than ever for Medicare enrollees, specifically Medicare Advantage enrollees, to review their options. That’s what we’re here to help do! Do not panic. Staying informed is the best response.
First, What’s Changing for Medicare in 2026
As of right now in October 2025, recent legislation has led us to believe that these current projections are likely. Nothing is finalized, however, but these are credible estimates based on the information we have.
| Item | 2025 Cost / Status | Projected 2026 Cost / Status | What That Means in Plain Language |
|---|---|---|---|
| Part B Premium | $185 / month | ~$206.50/month (≈ 11.6% increase) Investopedia | You’ll pay about $21.50 more per month for Part B (doctor visits, outpatient care, etc.), unless you have higher-income adjustments. |
| Part B Deductible | $257 annually | ~$288 (≈ 12% increase) medicareresources.org | Before Medicare starts covering 80% of outpatient/physician costs, you’ll pay more out of pocket. |
| Part D (prescription drug coverage) | Base beneficiary premium $36.78, deductible $590 Investopedia | National average premium projected to be $38.99 (+ about 6%), deductible $615. | Your drug plan premium could be higher based on your medications and preferred pharmacy. |
| Out-of-pocket caps for prescription drugs | $2,000 catastrophic threshold in 2025 Kiplinger | Projected $2,100 Kiplinger | After you reach a certain high level of drug spending, your out-of-pocket costs are capped, but that upper limit is moving. |
Why These Changes Don’t Have to Be Overwhelming (and What You Can Do)
Knowing that costs are rising can feel discouraging, but remember, these things change every year. But the good news is: you have choices. Shopping around can help reduce how much you pay out of pocket or in premiums. Here are some tips:
- Know your enrollment windows
- The Medicare Annual Enrollment Period, or AEP, (Oct 15 – Dec 7) allows you to switch Medicare Advantage plans or drug plans or move back to Original Medicare. There are pros and cons to each decision you make, so it’s important to work with someone knowledgeable before switching your plan. Note, if it sounds too good to be true – it probably is! Don’t fall for a scam. AEP is for Medicare Advantage (also known as Medicare Part C), and Medicare Part D (Prescription Drug Coverage) plan changes. Medicare Supplement, also known as Medigap, plans are not part of the enrollment period and no action is necessary regarding supplement plans.
- There is also a Medicare Advantage Open Enrollment Period (Jan 1 – Mar 31) if you’re already in a Medicare Advantage plan.
- Understand total cost, not just the monthly premium
- A plan with a low premium may have higher deductibles, copays or coinsurance, or restrictions (e.g. fewer doctors in network).
- Especially with the expected rise in Part B deductible, it pays to compare — how much you’ll spend in the year considering everything, not just what comes out each month.
- Check prescription drug coverage closely
- If you take medications regularly, the plan’s drug formulary (which drugs are covered and at what tier) matters a lot. Higher deductibles or premiums may offset savings if your drugs are expensive or have limited coverage.
- Consider whether Extra Help or subsidy programs apply to you.
- Watch the IRMAA (Income-Related Monthly Adjustment Amount)
- If your income is above certain thresholds, you’ll pay an extra surcharge. With rising premiums, that surcharge can grow. Monitoring your income and how it’s reported (tax returns etc.) matters.
- If your income is above certain thresholds, you’ll pay an extra surcharge. With rising premiums, that surcharge can grow. Monitoring your income and how it’s reported (tax returns etc.) matters.
- Use the tools and resources available
- The official Medicare “Medicare & You” handbook is updated annually — contains summaries, explanations, and tools. Medicare.gov (PDF)
- Medicare.gov has a Plan Finder tool to compare costs and benefits in your ZIP code.
- All of this can be confusing, but finding an independent firm who can shop all different carriers can be to your benefit at no extra cost to you.
- Don’t wait until costs are in effect
- Projections are given well in advance. Even though final premium/deductible amounts might not be official until later in the year, you can start comparing now so you’re ready during open enrollment.
The Untold Value of Shopping / Reviewing Your Plan
Here’s why it’s worth taking the time:
- Potential savings: Switching plans can often reduce out-of-pocket spending or monthly premium costs — or both.
- Avoid surprises: Benefit changes, network changes, or drug formularies can shift. If you stay in the same plan without reviewing, you might be surprised by what’s no longer covered or more expensive.
- Benefits specific to your needs: Some plans may offer extra perks (like vision, dental, telehealth, fitness programs) that just weren’t relevant before, but might be more useful now. As a reminder, vision, dental, hearing, and fitness programs are not part of Original Medicare.
- Peace of mind: Knowing that you’ve done the homework reduces worry when premiums or deductibles rise.
Cheaper Does Not Always Equal Better
Not every cheaper-looking plan is better. Before you make a decision solely on price, look at these possible pitfalls:
- Plans with narrow provider networks (you may have to change doctors or travel farther).
- Higher copays/co-insurance or deductibles that might hit you if you need more care than expected.
- Formularies with high tiers or limited access for your regular medications.
- Penalties for late enrollment in Part D if you didn’t maintain drug coverage.
Plan Now
Yes — Medicare costs are rising in 2026. But those increases don’t mean you’re powerless. By reviewing your situation ahead of open enrollment, comparing plans, and understanding both premiums and out-of-pocket costs, you can often make choices that lessen the impact.
If you’re unsure where to start, reach out to our team now to start comparing your options. It’s easy, just send an email to health@abenefitsolutions.com right now to get in touch with our team. As an independent broker, we look at different carriers and Medicare supplements to show you what your options are.