We expect most Medicare beneficiaries—whether enrolled in standalone Part D drug plans paired with Medicare Supplement coverage, or in Medicare Advantage plans—to see some level of benefit change in 2026. Some changes will be modest; others will be more noticeable. Rest assured, we’re monitoring the landscape closely and will be here to guide you every step of the way.
🔹 Prescription Drug Coverage: What’s Changing
- Many standalone Part D plans will see higher monthly premiums and increased deductibles.
- Those enrolled in Medicare Advantage plans may also see an increase to their prescription drug deductible or perhaps face a drug deductible for the first time (most PPOs already include a partial drug deductible).
- Most beneficiaries will see a shift from fixed copays (e.g. $47) to coinsurance (e.g., 24%) for Tier 3, 4, and 5 drugs. This change could increase out-of-pocket costs per fill—especially for those who rely on higher-cost medications.
- All beneficiaries will be protected by an annual maximum out-of-pocket cost for prescription drugs of $2,100 in 2026 (up from $2,000 in 2025). The maximum allowed prescription drug deductible is $615 in 2026 (up from $590 this year). Your deductible, copays, and coinsurance all count toward your out-of-pocket maximum.
- Generic drugs should remain largely unaffected.
- Many drug plan formularies—the lists of covered medications—will likely be adjusted.
- Most carriers will reduce the number of plans they offer in 2026. Some may even exit the Part D space altogether. The bottom line: there will be fewer plans to choose from in 2026. It seems the days of the low-cost standalone Prescription Drug Plans and lots of plans to choose from may be numbered, at least for the foreseeable future.
🔹 Medicare Advantage Plans: Navigating Adjustments
- Regardless of carrier or plan type, anticipate some changes.
- PPOs will see more significant adjustments than HMOs. And fewer PPO plans will be offered than in years past.
- Copays, maximum out-of-pocket limits, and ancillary benefits (such as dental, vision, hearing, and over-the-counter allowances) are the most likely areas to be impacted.
- A smaller percentage of enrollees across the country may be affected by service area reductions or plan terminations. If your plan is no longer offered, your carrier will notify you directly. You’ll qualify for a Special Election Period allowing you some extra time to choose a new plan. We’ll be ready to assist you.
🔹 What About Medicare Supplement Plans?
If you’re enrolled in a Medicare Supplement (Medigap) plan, you may wonder why these aren’t mentioned above. That’s because Med Supp plans operate differently—they’re secondary to Original Medicare and not tied to the Annual Enrollment Period. While the Med Supp market is expected to face its own disruptions in the coming years, those changes are likely to unfold more gradually. We’ll address those trends in a future post to keep you informed and ahead of the curve.
Carriers are required to mail ANOC letters by September 30. The ANOC outlines all changes to your plan for the coming year. When yours arrives, take a moment to review it carefully. If you’d like a quick refresher on how to read your ANOC, this post from our archives still holds up well.
While these changes may sound concerning, it’s important not to panic or rush into switching plans. The reality is that nearly all Medicare carriers are adjusting to the same regulatory and market pressures. The grass isn’t necessarily greener elsewhere—it’s just being mowed differently.
We’ve been through market shifts before, and we know how to help you make informed, confident decisions. Our priority remains your best interest: preserving coverage that fits your needs, minimizing disruption, and ensuring you understand your options.
To those of you who’ve referred friends, family, and colleagues to us—thank you. Your trust means everything, and it’s the highest compliment we can receive. If you know someone who could benefit from our guidance, we’d be honored to help.
Let’s continue to navigate this together—with clarity, care, and confidence.
If there are specific topics you’d like us to address in future issues please drop us a line at 65plus@bbginc.net with your suggestions.