💊 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 $2,100 cap helps protect against runaway costs.

  • These changes apply whether you're enrolled in an Advantage Plan with Rx or a stand-alone Prescription Drug Plan.

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

  • If you switch drug plans, you must re-enroll in the Payment Plan with your new carrier to spread costs throughout the year.

📌 Action Steps 📌

🔍 Log In to Check Your Medications + Pharmacies
📊 Reach out to your agent for help with Medicare Advantage Plans
(joining, leaving, switching, replacing)
📅 Be Enrollment-Period Aware  

🔍 Log In to Check Your Medications + Pharmacies
Use your plan’s portal, your agent's enrollment/quoting link (Shawn Marie) or call the number on the back of your card or access your account at Medicare.gov.

  1. Verify your medications are still covered in 2026

  2. Check tier, prior authorization (PA), step therapy (ST), and quantity limits (QL).

  3. Review how these costs apply before you reach the $2,100 annual cap and add your premium for the plan.


📊 Reach out to your agent for help

‐ You’d like confirmation that your current Advantage Plan is still the right fit.

‐ You’re looking to switch or replace a discontinued Advantage plan and need help choosing between a few narrowed-down options.

‐ You want full guidance from the start.

⚠️ Important:  Use your agent's link, go to a class or contact us to enroll in a new Medicare Advantage Plan or to quote a new Mediap.
If you enroll on Medicare.gov for an Advantage Plan —you’ll lose your agents’ services and the 800# becomes your agent.

📊 YOUR PATIENCE & COOPERATION will pay off so we can serve you best as we work carefully to make sure you’re positioned in the right plan for you. Click your agent’s name to sign up for a class, get quotes or ask for help!

    • Oct 15 – Dec 7: Annual Enrollment Period (AEP/OEP)
      Approved applications take effect January 1st.

      • Enroll in a Medicare Advantage Plan

      • Enroll in a Part D Prescription Drug Plan

      • Return to Original Medicare

  • ⚠️ Special Enrollment Period (SEP) — If your plan is ending, try to secure new coverage before December 31 to avoid a gap.

    • If you choose a new Advantage Plan by December 7, it will start January 1. You’ll also have the option to use your discontinuation letter to apply for a Medigap and Prescription Drug (Part D) plan without answering health questions anytime through February 28.

    • If you’re healthy enough to pass medical underwriting, you can apply for a Medigap plan without using your discontinuation letter.

    • If you wait until after December 7, you’ll need to use your discontinuation letter to enroll in either an Advantage Plan, a drug plan, or — if your health isn’t strong enough for underwriting — a Medigap plan.

    • Coverage, generally, is the first of the month after the plan gets your request.

    • Jan 1 – Mar 31: Medicare Advantage Open Enrollment Period (MAOEP)

      Approved changes take effect the 1st of the month following application.

      • Switch Advantage Plan to Advantage Plan.

      • Return to Original Medicare from an Advantage Plan.

      • Shop Medigap Rates

      • You cannot join or change a stand-alone Rx plan.

      • You cannot join an Advantage plan coming from Original Medicare during this time unless you qualify for a special election period.

  • PERA requires a decision of accepting or declining their group medicare Advantage Plan.

    1. Verify your medications are still covered in 2026.

      1. Check tier, prior authorization (PA), step therapy (ST), and quantity limits (QL).

      2. Explore pricing using different brands of retail pharmacies and a plan’s preferred mail-order.

      3. Review how these costs apply before you reach the $2,100 annual.

      4. Add your premium for the plan.

      5. All plans offer the Medicare Prescription Payment Plan (M3P) that allows you to spread out payments, if needed.

  • 🔹

    🔹 Medicare.gov
    🔹 Call 1-800-MEDICARE
    ‍ ‍ TTY Number: 1-877-486-2048

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