💊 2026 Medicare Drug Plan Changes – What You Need to Know 💊

Medicare’s drug coverage rules and regulations continue to change under the Inflation Reduction Act. Here are some key updates for 2026 that affect your options for prescription drug coverage bundled with a Medicare Advantage or stand-alone Part D plan with any insurance companies.  This includes formulary changes, increased costs and less extras for everyone.

Key 2026 Changes

  • $2,100 yearly cap: Beginning Jan 1, 2026, your annual out-of-pocket costs for covered Part D prescriptions are capped at $2,100 (premiums not included).

  • Deductible increase: The standard Part D deductible rises to $615 in 2026 (up from $590 in 2025).  

  • Medicare sets lower prices on select high-cost drugs with newly negotiated drug prices: Eliquis, Xarelto, Januvia, Jardiance, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, and NovoLog/Fiasp.

  • Payment plan option: If you used the Medicare Prescription Payment Plan in 2025 and stay in the same plan, you’ll be automatically re-enrolled for 2026.

What This Means for You

  • If you take expensive medications, the new $2,100 cap offers protection from runaway costs for covered medications.

  • If you are in a Medicare Advantage plan (MAPD), these changes apply to your drug coverage just like stand-alone Part D (PDP).

  • If you receive Extra Help (LIS), your copays remain low: up to $5.10 for generics and $12.65 for brands.

  • If you switch plans, you’ll need to re-enroll in the Payment Plan if you want to spread your drug costs across the year.

📌📌📌Action Steps After October 1st

  1. 🔍 Log in after October 1st to Check Your Medications + Pharmacies
    Use your plan’s portal or your account at Medicare.gov (for Medicare Advantage or stand-alone Part D) to:
    ∙ Verify your medications are still covered

    ∙ Check for any changes in tiers, prior authorizations, or cost-sharing

    ∙ Review how these costs apply before you reach the $2,100 annual cap (premiums not included)

  2. 📊 Be patient while the deep dive happens behind the scenes — after the October 1st plan documents are released, we run reports for those new to Medicare or some with extreme medications. Seasoned brokers spend the second week of October comparing notes and finalizing changes in the local market, such as network negotiations. By October 15th, we should have a deeper understanding of the prescription coverage options in the Medicare & You 2026 handbook. Watch for another email from me by Halloween.

  3. ⚠️ Important:  Contact your agent to enroll in a new Medicare Advantage Plan. Please don’t submit Medicare Advantage updates directly on Medicare.gov—you’ll lose my services as it removes me as your agent of record.