Medicare plans can change from year to year—sometimes for the better! Here’s a look at some of the Medicare changes taking place in 2026.
What’s new for Medicare in 2026?
3-minute readPublished 05/30/2024Updated 05:02 PM EST, 09/19/2025
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Key points
- Part D annual out-of-pocket costs are capped at $2,100
- 1-month supply of covered insulin products is capped at $35
- Medicare Prescription Payment Plan (MPPP) participants will be automatically re-enrolled for the following year
- There is no cost sharing for adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP)
- Prior authorization for Original Medicare will be tested in 6 states
Annual out-of-pocket limit for Medicare Part D now capped at $2,100
If you have Medicare Part D and your out-of-pocket costs for covered drugs reach $2,100, you’ll pay nothing for covered Part D drugs for the rest of your plan year. The cap was $2,000 in 2025.
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3-minute readPublished 05/30/2024Updated 05:02 PM EST, 09/19/2025
$35/month insulin costs now apply annually
Insulin costs for Medicare beneficiaries have been capped at $35/month since 2023. For 2026 and beyond, your monthly insulin copay will now be the lowest of these 3:1
- $35
- 25% of the drug’s negotiated price
- 25% of the new Medicare-negotiated Maximum Fair Price (MFP)
Automatic re-enrollment in a Medicare Prescription Payment Plan
The Medicare Prescription Payment Plan (MPPP) is a program that allows eligible Part D enrollees to pay out-of-pocket prescription drug costs in monthly payments instead of all at once. If you participate in an MPPP, you’ll be automatically re-enrolled the following year unless you opt out.
No-cost sharing for adult vaccines
Medicare recipients have had access to a limited number of free vaccines since 2023. Starting in 2026, there is no cost sharing for adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) and covered under Part D. The Part D deductible also does not apply.
Prior authorization for Original Medicare being tested in 6 states
Starting Jan. 1, The Centers for Medicare and Medicaid Services (CMS) will start testing prior authorization requirements for certain Medicare services in 6 states. The affected states are New Jersey, Ohio, Oklahoma, Texas, Arizona and Washington. The test will use the Wasteful and Inappropriate Service Reduction (WISeR) Model to evaluate prior authorizations for 17 services identified as vulnerable to fraud and abuse.2
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Source
- “Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program ,” CMS.gov, last accessed Aug. 19, 2025.
- “WISeR (Wasteful and Inappropriate Service Reduction) Model ,” CMS.gov, last accessed Aug. 19, 2025.