I always like to start with the broad strokes before we dig into the weeds. Here’s the overview of major changes coming to Medicare in 2026 (and yes, weeds are coming, so bring your magnifying glass):

1. Premiums and deductibles are rising
2. Prescription drug (Part D) changes get more upgrades (and lower prices!)
3. Medicare Advantage faces tightening rules and insurer exits
4. Original Medicare may see more prior authorization requirements in certain states
5. Automatic features, like auto-renewals and expanded options (like HSA contributions), creep in
6. Provider payment bumps and funding pressures create ripple effects
7. Uncertainty from macro-political factors (like “One Big Beautiful Bill” or deficit triggers) looms in the background

Let’s take them one by one, and then I’ll give you my best strategies for navigating them without losing your mind.

Premiums and deductibles: your wallet’s going to get a workout

If you’ve been paying attention to cost-of-living increases (COLAs), you know that health care inflation has a mischievous habit of running faster than everyone else. In 2026, Medicare is no exception.

Projections suggest the standard Part B premium (that’s outpatient/physician coverage) will rise to about $206.50/month, up from $185 in 2025. (Kiplinger) And the Part B deductible is expected to rise from $257 to around $288. (medicareresources.org) For those in the hospital, daily copays and lifetime reserve day costs will also inch upward.

Now, before you groan, here’s one saving grace: that COLA you’ll receive from Social Security is likely to cover at least part of that increase — for many people, the extra Medicare withholding won’t completely wipe out your Social Security boost. (medicareresources.org) But for retirees on fixed incomes or tight budgets, that margin is getting thinner.

Then there’s Income-Related Monthly Adjustment Amounts (IRMAA): if your modified adjusted gross income (MAGI) is above certain thresholds, you pay more for Part B and Part D. Those surcharges will also likely creep upward in 2026. (Kiplinger) If you’ve done Roth conversions or have other income spikes, now’s a good time to think ahead and smooth those out.

Prescription drugs (Part D): more caps, more options, more strings attached

One of the most talked-about changes in 2025 was the elimination of the “donut hole” and the imposition of a $2,000 annual out-of-pocket cap for drug costs. Those changes stick around — and in 2026, that cap will increase to $2,100 (yes, inflation never takes a vacation). (Kiplinger) Also, the maximum deductible for Part D plans will climb from $590 to $615. (medicareresources.org) After you hit that deductible (if your plan has one), many plans will still expect you to pay 25% coinsurance until you reach the out-of-pocket cap.

Here’s a twist: the Medicare Prescription Payment Plan (MPPP) (which lets you spread your prescription drug costs across the year) becomes more automatic. Starting in 2026, if you’re enrolled in the MPPP, you’ll be automatically re-enrolled each year unless you opt out. The idea is to reduce friction in staying enrolled, but you’ll get a renewal notice with new terms so you can opt out if it doesn’t suit you. The plan sponsors will have three calendar days to process opt-out requests (vs. the more aggressive 24-hour earlier proposal).

Despite these pressure points, interestingly, average Part D premiums are projected to decrease slightly (from $38.31 to $34.50) thanks to continued use of premium stabilization subsidies. (medicareresources.org) Yet insurers will have greater flexibility to raise premiums (up to $50/month increases), meaning different plans may behave quite differently. And some plans might reduce drug coverage or adjust formularies to balance costs. (Kiplinger)

The bottom line: you can no longer be passive about your drug plan. If your prescriptions change, or your plan changes coverage, you’ll want to compare before locking in for the year.

Medicare Advantage: the squeeze is real

If you’re in a Medicare Advantage (MA) plan, 2026 is going to be especially stressful, like being in a traffic jam with falling rocks overhead.

First, many insurers are scaling back or exiting markets altogether. UnitedHealth, Aetna, Humana, and others are pulling back in some counties. (Investopedia) That means fewer plan options in certain counties, especially rural or less profitable ones. Some people may find their current MA plan is no longer offered in 2026 which forces you to consider switching.

Second, benefit reductions are a risk. Under the “Special Supplemental Benefits for the Chronically Ill” (SSBCI) rules, CMS has codified lists of non-allowable supplemental benefits that MA plans can’t offer starting 2026. Some plans might drop extras like expanded nutrition services, transportation to nonmedical appointments, or in-home support. (Kiplinger) Also, more prior authorization and utilization controls may be used by MA plans to reign in costs. The maximum out-of-pocket limit (in-network) for MA is actually projected to decrease slightly in 2026 to $9,250, down from $9,350 in 2025. (medicareresources.org) That’s welcome, but many folks’ actual usage never hits the cap; the change is more technical than revolutionary.

Why are insurers doing this? Because government reimbursements are under pressure, health care costs keep rising, and utilization is higher than expected. (Reuters) Interestingly, CMS’s final decision for MA plan payments in 2026 raised reimbursement rates by 5.06%, more generous than initially proposed. That gives insurers a bit more breathing room, but the squeeze remains tight, especially for plans in low-population or high-cost regions.

All that means if you’re in an MA plan, don’t assume your plan will remain in 2026, check the Annual Notice of Change (ANOC), compare alternatives, and be ready to switch during Open Enrollment.

Prior authorization may invade Original Medicare in some states

One of the traditional selling points of Original Medicare (Parts A and B plus a standalone Part D) is that it usually does not require much in the way of prior authorizations or rigid utilization reviews (unlike many private plans). But changes are creeping in.

In 2026, six states will require prior authorization for certain services under Original Medicare — a shift from the current norm. (Kiplinger) That means some services that used to be “just covered” may now need approval in advance. The exact services that require prior approval will be state-specific. Also, Medicare Advantage plans already use prior authorizations extensively, so this is a narrowing of the gap. (Medicare)

What’s behind this? Pressure to restrain costs, reduce unnecessary utilization, and make care more “efficient” (a polite word for sometimes “more restrictive”). If you live in or move to one of these states, you’ll want to find out which services need prior approval, your doctor’s office should be able to help.

Auto-renewals, HSA contributions, and more automatic features

2026 also brings more “set it and forget it” features in Medicare (but with small catches). The Medicare Prescription Payment Plan (MPPP), as I mentioned, becomes auto renewed unless you opt out. That can be a relief, but you should still review whether your plan’s terms (payment schedules, interest, fees) change each year.

Another development: starting January 1, 2026, seniors with Medicare Part A who are still working and covered by a high-deductible health plan will be allowed to continue contributing to Health Savings Accounts (HSAs). (Clarity Wealth Development) That’s good news if you’re in that rare category, it gives you more tax-advantaged flexibility. Note: it applies to Part A, meaning someone might still hold off on Part B enrollment strategically if allowed, but one must tread carefully because late enrollment penalties are punitive. (I don’t recommend gaming the system without professional counsel.)

There’s also talk about expanding Medicare to include vision, dental, and hearing services, though those are in proposal stages and not guaranteed to fully roll out in 2026. I’m guessing probably not?

Physicians, funding pressures, and “One Big Beautiful Bill” uncertainty

Medicare isn’t an island. What happens at the federal level, in budgets, deficits, and legislation — affects how doctors and hospitals treat Medicare patients, and how sustainable Medicare’s promises are over time.

One potential shock comes from a legislative concept dubbed the “One Big Beautiful Bill.” Without getting too political, suffice it to say that if automatic cuts to entitlement spending trigger, Medicare could lose billions in funding. Some analysts anticipate Medicare could face $45 billion in cuts in 2026 if Congress doesn’t intervene. (Investopedia) Those cuts could translate into lower reimbursements to providers, which could discourage some from accepting Medicare patients, or shift costs onto beneficiaries.

On the flip side, there’s a small bright spot: physician reimbursement increases. Proposals suggest that doctors will get a 2.5% bump (or possibly up to 3.8% for certain practices) in their Medicare payments in 2026. (Clarity Wealth Development) That could help keep more doctors willing to accept Medicare, though it’s uncertain whether practices will feel it materially after costs and staffing pressures. Still, it’s a welcome development after years of reimbursement stagnation. (Axios)

All of this is happening in an environment of tight federal budgets, increasing health care costs, and shifting demographics (i.e. more retirees relative to workers). The political winds are gusty, so Medicare changes can still be tweaked before final rollouts.

The biggest threat: simply doing nothing

Here’s the harsh truth: one of the biggest risks you face in 2026 is being passive, assuming your existing plan, doctor network, or prescription coverage will just roll forward without issue. Because in many cases, it won’t.

If you fail to review your Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) that insurers send each fall, you may miss critical cuts or shifts in coverage. Many retirees default to “stay put,” but in 2026 that could cost you hundreds or even thousands more. Also, missing Open Enrollment (Oct. 15 to Dec. 7, 2025) could lock you into a bad plan for the year (or force you to use a fallback option).

Also, if your Medicare plan is being discontinued in your area (as many MA plans will be), waiting too long could leave you scrambling. And if you’re hit by higher IRMAA surcharges because of transient income spikes, you could be pinched financially unless you plan strategically.

So before 2026 hits, make it a medication-check, benefit-audit, and doctor-network recon mission.

Don’t wait until it’s too late, get your financial house in order today!

Happy retirement planning!