What's New for Medicare in 2026? Annual Open Enrollment Period Begins October 15, 2025

The 2026 Medicare Annual Enrollment Period (AEP) begins October 15, 2025, and runs through December 7, 2025. This year marks one of the most significant periods of change in the program's recent history. Driven by the full implementation of the Inflation Reduction Act's drug provisions, a consolidating Medicare Advantage market, and substantial cost increases in Original Medicare, the landscape your clients face is more complex than ever.    

Designed for insurance professionals, this guide breaks down the most critical changes for 2026 and provides the data and context you need to effectively advise your clients. 

2026 Medicare Costs At-a-Glance

Here are the key projected cost changes for 2026 compared to 2025. These figures are the foundation for every client conversation this AEP.  

*Projected figures based on the Medicare Trustees Report. Final amounts will be announced by CMS in late 2025. Last year, these amounts were released in early November.

**Represents the finalized statutory maximum limit. Individual plan costs and deductibles may be lower.

Medicare Part D Changes for 2026

Part D is fundamentally different in 2026. Here’s what you and your clients need to know: 

The $2,100 Drug Cost Cap is Here

The most important change is the annual cap on out-of-pocket (OOP) spending for covered drugs. Once a client's in-plan spending on their deductible and cost-sharing reaches $2,100, they will owe $0 in copayments or coinsurance for covered Part D drugs for the rest of the year. This provides incredible protection for clients on high-cost specialty medications. 

Higher Deductibles & Coinsurance

To manage the new financial risk of the OOP cap, many plans are raising their deductibles (up to the new maximum of $615) and shifting from flat copays to percentage-based coinsurance for higher-tier drugs. This means clients with moderate drug costs who don't reach the cap could actually see their upfront costs increase. 

First-Ever Negotiated Drug Prices

For the first time, Medicare has negotiated lower prices for 10 high-cost drugs. All Part D plans must offer these drugs at the new, lower prices. This means guaranteed savings for clients taking these specific medications.

First 10 Drugs with Medicare-Negotiated Prices for 2026

Source: Centers for Medicare & Medicaid Services

Note: Professionals should advise clients to check specific plan formularies, as implementation details can vary. See the official CMS negotiated prices file for specific 30-day and NDC prices. 

Key Takeaway from Part D Changes 

The Part D landscape is in flux. Running a detailed drug cost comparison for every client using the Medicare Plan Finder remains the best way to ensure the best fit. Pay close attention to the shift toward coinsurance and explain the potential for cost variability to your clients. 

Medicare Advantage: Changes for 2026

The Medicare Advantage (MA) market is a story of contradictions, with lower average costs on the one hand, and shrinking options on the other.

While the national average MA premium is projected to decrease and the maximum out-of-pocket limit is slightly lower at $9,250, choice of plans has dramatically decreased in many areas. National carriers like Humana, Aetna, and UnitedHealthcare are discontinuing plans and exiting hundreds of counties for 2026. Clients in the affected areas may be forced to choose from a much smaller pool of plans.  

In addition, CMS is cracking down on inaccurate provider directories. For 2026 only, there is a new Special Enrollment Period. If a client enrolls in an MA plan using the Plan Finder and discovers within the first three months of coverage that their doctor was listed incorrectly, they have a one-time opportunity to switch plans or return to Original Medicare. 

Key Takeaway 

These changes make local market knowledge more important than ever, as major insurers are discontinuing plans or exiting certain counties for 2026. This means you must verify that each client's current Medicare Advantage plan will still be offered in their service area and be prepared to guide any displaced clients through their options. 

Original Medicare (Parts A & B) Changes for 2026

For clients in or considering Original Medicare, the cost increases for 2026 are substantial and unavoidable. Note that the following figures are projections based on the Medicare Trustees Report; final amounts will be set by CMS later this year. 

Part A Hospital Costs

The inpatient hospital deductible is projected to rise to $1,716 per benefit period. Daily coinsurance for extended hospital and skilled nursing stays is also increasing. 

Part B Premiums & Deductibles 

The standard Part B premium is projected to jump by $21.50 per month to $206.50, an annual increase of $258. The Part B deductible is projected to rise to $288. 

Key Takeaway 

These sharp cost increases in Original Medicare strengthen the value proposition for both Medigap and Medicare Advantage plans. The projected figures for 2026 provide a clear way to illustrate the financial exposure of Original Medicare alone, which can help frame the conversation around solutions designed to limit that risk. 

Sharpen Your 2026 Medicare Expertise with WebCE

Navigating these complex changes requires up-to-date knowledge and expertise. As a trusted leader in online continuing education, WebCE offers a comprehensive catalog of insurance CE courses designed to keep you at the forefront of the industry.

Enhance your ability to serve your clients by exploring courses relevant to this year's AEP, including:    

• Medicare Advantage Plans and Supplemental Benefits 

• Medicare Part D: Prescription Drug Coverage 

• Medicare, Medicaid and Medicare Supplements  

• Medigap: Today's Medicare Supplement Policies 

• Protecting Seniors: Ethical Practices in the Medicare Market 

Be your clients' trusted source. To get started, visit our complete life and health insurance CE catalog or contact our award-winning Support Services at (877) 488-9308 today.