Attention retirees: some changes to Medicare in 2026 may surprise you

If you’re nearing retirement or already living it, keeping tabs on Medicare could save you thousands. Healthcare costs are likely only going in one direction... up. And 2026 will introduce subtle but important changes to how Medicare works, particularly under a new administration now led by Dr. Mehmet Oz. Yes, that Dr. Oz.

So far, the Trump administration has decided to stick with much of the 2022 Inflation Reduction Act‘s approach to Medicare reform. That includes negotiated drug prices and affordability protections. But some updates have been quietly tweaked to align more closely with the administration’s goals – especially in how Medicare Advantage operates and what out-of-pocket costs you’ll face.

Let’s walk through some updates to Medicare you’ll want to know about before open enrollment rolls around again in the fall. Also remember that the State Health Insurance Assistance Program (SHIP) is on hand with free guidance.

What changes are coming to Medicare?

Insulin costs stay capped – with clearer limits

If you’ve been benefiting from the $35 monthly insulin price cap, you can relax - it’s here to stay in 2026. But the way it’s applied will become more standardized. Your insulin will cost the lesser of $35, 25% of the drug’s “fair price,” or 25% of the negotiated plan price, and deductibles won’t apply.

This locks in one of the more popular recent Medicare reforms, offering peace of mind for diabetics managing tight budgets.

Medicare Advantage is getting stricter on ‘wellness extras’

For those in Medicare Advantage plans with chronic illnesses, 2026 will bring limits on what special supplemental benefits can be offered. CMS has finalized a list of services and items that can’t be counted as health-related support, such as alcohol, tobacco, cannabis, cosmetic treatments, and funeral planning.

This means plans that once included fringe perks may now need to drop them – or justify them differently. If you rely on Medicare Advantage for services beyond traditional healthcare, it’s worth reviewing your plan closely before re-enrolling. The government website also offers a chat service to answer specific doubts.

Part D drug spending cap will rise, slightly

You’ll pay more next year, but not much more. In 2026, the out-of-pocket cap on prescription drugs will increase to $2,100, up from $2,000 in 2025. This inflation-linked rise won’t impact everyone, but if you’re on costly medications, it means budgeting for an extra $100 over the year.

Keep in mind that the cap applies to total yearly spending on prescription drugs under Part D. If you’re already brushing up against the current limit, plan accordingly.

Adult vaccines remain free – but check the list

Medicare Part D plans will continue to waive deductibles and co-pays for adult vaccines recommended by the CDC’s Advisory Committee on Immunization Practices. But here’s the twist: that list isn’t static. It’s updated annually, and vaccines can be added... or removed.

If you’re planning international travel or want to stay current on shingles, flu, or pneumonia vaccines, check what’s covered in 2026 before booking your appointment. And remember: Medicare doesn’t cover all travel-related vaccinations, so consult your doctor about what’s needed for specific destinations.

Prescription payment plans will renew automatically

Introduced in 2025, the Medicare Prescription Payment Plan allowed beneficiaries to spread out prescription drug costs across the year instead of paying everything upfront. In 2026, the process becomes more hands-off: if you’re in the plan, you’ll be auto-renewed unless you actively opt out.

This may sound convenient, but read the fine print. CMS now allows three calendar days (up from one) for plan sponsors to process opt-out requests. So if you don’t want to continue, plan ahead, and don’t assume anything will cancel itself.

Medicare may not change overnight, but these types of administrative updates add up, so it’s best to stay in the know.

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