2026 Medicare Part D & MA Changes
Learn more about what will be changing next year for your Medicare patients.
📋What's Changing in 2026?
Medicare will see several important changes for 2026, including updates to Part D prescription drug coverage, Medicare Advantage rates, and technical aspects of the program. Here are the key highlights:
Key changes include higher deductibles, increased out-of-pocket caps, and base premium adjustments. These changes are designed to provide better cost predictability while maintaining comprehensive coverage.
Expect stable premiums with enhanced patient protections, clearer appeals processes, and better coverage decision transparency.
Income-related adjustments are increasing slightly, and new prior authorization requirements will provide better continuity of care.
💊Medicare Part D Changes
Standard Deductible Increase
Out-of-Pocket Spending Cap
After reaching this cap, enrollees pay $0 out-of-pocket for covered drugs for the rest of the year.
Base Beneficiary Premium
Premium increases are limited to 6% annually through 2029 under the Inflation Reduction Act.
🏥Medicare Advantage Changes
✅ Stable Rate Updates
CMS anticipates premiums and benefits to remain stable without large premium increases. In 2025, the average monthly plan premium actually decreased by $1.23.
⚖️ Appeals Process Clarification
Patients now have the same right to appeal a denial regardless of when the plan makes a coverage decision. This eliminates previous confusion about appeal rights during treatment.
🛡️ Enhanced Bill Protection
Under new rules, patients cannot be stuck with bills until their Medicare Advantage plan makes a final coverage decision. This guarantees appeal rights for any denial affecting ongoing treatment.
📋 Prior Authorization Requirements
Medicare Advantage and Part D plans must now honor medical necessity decisions made during prior authorization processes.
💰IRMAA Changes
Income-Related Monthly Adjustment Amount
Surcharges for those over IRMAA thresholds are increasing by approximately 1%.
2025 Surcharge: $13.70
IRMAA calculations use income figures from 2 years prior.
🏥Special Needs Plans (D-SNPs)
New requirements are designed to improve the enrollee experience when interacting with Dual Eligible Special Needs Plans, providing better coordination between Medicare and Medicaid benefits.
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