Your Guide to the Major Medicare Changes Coming in 2026

If you’re looking ahead to plan your healthcare costs, you’re asking the right questions. Major changes are on the horizon for Medicare, especially concerning prescription drug costs. This guide will walk you through exactly what to expect in 2026, focusing on the most significant updates so you can be prepared.

The Biggest Change for 2026: Negotiated Prescription Drug Prices

The most impactful Medicare change scheduled for 2026 comes directly from the Inflation Reduction Act. For the first time ever, Medicare will have the power to negotiate prices directly with drug manufacturers for certain high-cost prescription drugs. This is a landmark shift designed to make essential medications more affordable for millions of seniors.

The negotiated prices for the very first group of selected drugs will take effect on January 1, 2026. This means that if you take one of these medications, your out-of-pocket costs for it could be significantly lower.

How Does Drug Price Negotiation Work?

The process is a multi-year effort managed by the Centers for Medicare & Medicaid Services (CMS). Here is a simple breakdown of the timeline leading up to the 2026 changes:

1. Drug Selection: CMS identifies a list of high-expenditure, single-source drugs covered under Medicare Part D. These are typically brand-name drugs without generic or biosimilar competition that have been on the market for several years.
2. Negotiation Period: CMS and the drug manufacturers enter a negotiation period to agree on a “maximum fair price” for each selected drug. This process began in 2023 for the first round of drugs.
3. Implementation: The newly negotiated, lower prices become effective for all Medicare Part D plans starting in 2026.

This negotiation power will expand over time. While it starts with 10 Part D drugs in 2026, the list will grow to include an additional 15 Part D drugs for 2027, 15 more Part B and Part D drugs for 2028, and 20 more Part B and Part D drugs for 2029 and beyond.

Which Drugs Will Be Cheaper in 2026?

CMS has already announced the first 10 drugs selected for price negotiation. The prices agreed upon in 2024 will go into effect in 2026. If you are prescribed any of the following medications, you may see lower costs:

• Eliquis: Used to prevent blood clots.
• Jardiance: Used to treat diabetes and heart failure.
• Xarelto: Another common medication for preventing blood clots.
• Januvia: Used to treat type 2 diabetes.
• Farxiga: Used for diabetes, heart failure, and chronic kidney disease.
• Entresto: A medication for heart failure.
• Enbrel: Used to treat rheumatoid arthritis and other autoimmune conditions.
• Imbruvica: A treatment for certain types of cancer, including mantle cell lymphoma.
• Stelara: Used for psoriasis, psoriatic arthritis, and Crohn’s disease.
• Fiasp; Novolog: Brand names for insulin aspart, used to treat diabetes.

It is important to check with your specific Part D plan closer to 2026 to understand the exact cost-sharing for these medications.

Important Context: The $2,000 Out-of-Pocket Cap in 2025

To fully understand the landscape in 2026, you need to know about the major change happening the year before. Starting in 2025, a new law will cap annual out-of-pocket prescription drug costs for Medicare beneficiaries at $2,000.

This is a huge relief for people with very high drug costs. Before this change, there was no hard limit on what a person could spend in a year. This 2025 cap eliminates the “catastrophic coverage” phase, providing much-needed financial protection and predictability. When 2026 arrives, this $2,000 cap will still be in place, and the newly negotiated drug prices will work alongside it to further lower overall costs for many people.

What About Medicare Part A and Part B in 2026?

The most significant legislative changes for 2026 are focused on prescription drugs (Part D). As of now, there are no major structural reforms planned for Medicare Part A (Hospital Insurance) or Part B (Medical Insurance) in 2026.

You can still expect the standard annual adjustments to occur. This includes:

• Part B Premium: The standard monthly premium for Part B will likely be adjusted, as it is every year, based on program costs.
• Part B Deductible: The annual deductible for Part B will also see its standard yearly adjustment.
• Part A Deductible: The inpatient hospital deductible for Part A is also adjusted annually.

These routine adjustments are part of how Medicare operates and are not considered major structural changes. The core benefits and services covered by Original Medicare (Parts A and B) are expected to remain consistent.

How to Prepare for the 2026 Changes

While 2026 may seem far away, being informed is the best way to prepare. Here are a few steps you can take:

• Review Your Medications: Take a look at your current list of prescriptions. See if any of your medications are on the list of the first 10 drugs selected for negotiation.
• Stay Informed: Pay attention to Medicare communications and news as 2025 and 2026 approach. More details will become available about the exact negotiated prices.
• Plan for Open Enrollment: During the annual Open Enrollment Period (October 15 to December 7), you have the chance to review and change your Part D or Medicare Advantage plan. In the fall of 2025, it will be especially important to compare plans to see how they cover the newly negotiated drugs.

By understanding these upcoming changes, you are positioning yourself to make the best possible healthcare decisions for your future.

Frequently Asked Questions

Will my Medicare Part D premium go down in 2026? Not necessarily. While the price of specific high-cost drugs will be lower for Medicare, the overall effect on monthly premiums is complex. Premiums are based on the total costs of all drugs covered by a plan. The changes are primarily designed to lower your out-of-pocket costs for specific medications rather than guarantee a lower monthly premium for everyone.

Do these changes affect Medicare Advantage plans? Yes. If you have a Medicare Advantage plan (Part C) that includes prescription drug coverage (MA-PD), these changes will apply to you. Your plan must offer the negotiated prices for the selected drugs and will also be subject to the $2,000 out-of-pocket cap that starts in 2025.

How will I know exactly how much I will save on a negotiated drug? The exact savings will become clear during the Medicare Open Enrollment period in the fall of 2025. At that time, all Part D and Medicare Advantage plans will release their detailed coverage information for 2026, including the specific copayments and coinsurance for the drugs with newly negotiated prices.