Medicare is continuing to change, and it’s important to understand which benefits you can expect so you can decide whether Original Medicare or a specific Medicare Advantage plan is the best choice for you.
Healthcare costs are increasing each year, and retirees need to be especially aware of these rising expenses as they move into retirement. One way to help manage these costs is by choosing the most suitable Medicare plan for your individual needs.
As Medicare open enrollment approaches, we’ll share more about the upcoming changes to Medicare benefits and how the program will be managed in 2026.
What Are the Main Updates for 2026?
Some changes to Medicare have been introduced due to provisions included in the Inflation Reduction Act of 2022. There were also questions about whether the Trump administration would maintain these changes or change them. So far, it appears they are continuing with most of the provisions, although with some modifications to better reflect their plans. This includes moving forward with Medicare price negotiations.
As changes take place, here are the key updates from the Inflation Reduction Act and Medicare plans that are expected for 2026. Of course, we’re happy to discuss how these changes may affect you personally when we go over your Medicare options.
What to Expect in 2026:
2026 will bring changes to how prescription drugs are paid for, which could impact how you budget for medications. It’s important to be prepared for these changes and adjust your financial planning accordingly.
- The cap on drug costs under Part D will now be adjusted each year based on inflation. This means that the maximum you’ll have to pay for prescription drugs could rise alongside inflation, so it’s wise to stay updated on these changes for better financial planning.
- You can also expect an increase in the deductible for Part D, which means you’ll have to pay more before your benefits begin. This could lead to higher out-of-pocket expenses.
- There will be new limits on special supplemental benefits for those with chronic illnesses under Medicare Advantage plans. This could affect the range and amount of benefits available to individuals with long-term health conditions.
- Good news for people living with diabetes: insulin costs will be capped, helping to keep out-of-pocket expenses more predictable and possibly reducing financial strain for those who use regular insulin treatments.
- In 2026, you may also benefit from zero cost-sharing for adult vaccinations, making it more affordable to stay up to date with immunizations and protect your health.
- Some states will also introduce prior authorizations for traditional Medicare by 2026. This means you might need advance approval for certain services, which could affect your planning. We are licensed in many states and will inform you about changes in your area and how they impact your healthcare.
“McKnight & McKnight are wonderful to work with! Heather and Bob are super nice and professional, and I highly recommend them!
I came to them needing guidance regarding insurance plans, and immediately I could tell how knowledgeable they were upon the first interaction. They were quickly able to point me in the right direction, and help me identify the best coverage.
It is a pleasure being a client of theirs, and I would recommend giving them a call if you need guidance with your next insurance plan. Thanks again Heather and Bob!” –Zachary T.
What You Can Do Now
Because the cost increases take effect in 2026, there are several steps you can take now to prepare. Here are some options we can go through during a phone call or when you book an appointment online.
1. Budget for Increased Premiums:
For those on a fixed income, healthcare expenses can add up quickly. It may be worth cutting back on non-essential spending to cover the projected Medicare premium increases. Although an extra $21.50 per month for Part B premiums may seem small to some, it could be significant to others.
If your income is above the IRMAA threshold, you’ll pay higher costs in 2026. You may be able to reduce your taxable income and, therefore, lower your IRMAA liability. Some financial advisors suggest moving from traditional IRA funds to a Roth IRA, also known as a Roth conversion. Charitable donations can also help lower your taxable income.
If you’ve had a life-changing event that caused a drop in income, such as marriage, divorce, the death of a spouse, job loss, or a reduction in income, you may contact the Social Security Administration to request a reduction.
We can help you find a plan that fits your needs and budget. We can also guide you toward supplemental programs like Extra Help, a CMS program that helps those with limited income and resources with prescription drug costs. In some areas, you may qualify automatically if you receive Medicaid for your Part B premiums, or through Supplemental Security Income. These programs can help cap prescription costs at a low, predetermined amount, though the full impact of drug pricing, new medical technology, and inflation on 2026 premiums remains to be seen.
2. Consider a Medicare Advantage Plan:
Medicare open enrollment occurs from October 15 through December 7. During this time, you can switch to a Medicare Advantage (Part C) plan, which about half of Medicare beneficiaries are enrolled in.
Medicare Advantage offers the same Parts A and B coverage as Original Medicare, but it is provided by a private insurance company. As such, there is a wide range of costs between plans, with many enrollees finding reduced monthly Part B premiums and no premiums for prescription drug coverage.
Switching plans can be a tough decision, especially with all the conflicting information available about health insurance and Medicare. Our team is dedicated to helping you understand the nuances of the various plan options so you can make an informed decision about which benefits will be most beneficial to you.
As licensed agents, we will thoroughly review plans from different insurance companies in your area, based on your individual needs. We will also let you know any limitations in your policy, so you won’t be surprised by restrictions such as being limited to in-network providers or having delays or denials due to prior authorization rules.
Please schedule an appointment with us at (813) 792-2301 or online. We promise to make the process simple and fast.
3. Consider Purchasing a Medigap policy
Another option to consider is Medicare Supplement Insurance, also known as Medigap. This is a separate insurance policy offered by private companies to individuals enrolled in Original Medicare. Medigap can help cover up to 100% of your Part A coinsurance, hospital costs, and deductible, as well as up to 100% of your Part B coinsurance, copayment, and deductible. However, the amount your Medigap policy will cover depends on the specific plan you select.
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4. Review Your Medicare Plan with McKnight & McKnight
Each year, Medicare beneficiaries have the chance to change their plans. You may choose to join, switch, or leave a Medicare Advantage Plan or a Medicare Part D drug plan. You can also switch to Original Medicare or keep your current coverage. If you have already reviewed your options and are satisfied with your current plan, there’s no need to make any changes.
That said, it’s a good idea to review your coverage every year. Medicare costs, benefits, and healthcare providers can change, and some states may have additional updates that affect your plan. By comparing your options, you may find a plan that better suits your needs or helps you save money.
If you need help, we are here to assist you in reviewing the Original Medicare and Medicare Advantage plans available in your area to find the one that best meets your needs.
