Brenda Lyle – Florida Today

By Brenda Lyle

Q: Can you preview the changes to Medicare in 2026?

A: A new year is on the horizon, and with it come some pretty big updates to Medicare. If you’re already enrolled (or planning to sign up soon), 2026 is bringing changes you’ll want to know about. Some will hit your wallet, while others might make getting care and prescriptions easier. Let’s break it down.

Expect to Pay a Bit More

Unfortunately, most Medicare costs are going up next year. The Part B premium, which covers doctor visits and outpatient care, is expected to rise to about $206.50 a month (up from $185 in 2025). The Part B deductible will also increase to around $288.

If you have a Part D prescription plan, your deductible could go as high as $615, and the yearly cap on out-of-pocket drug costs will move to $2,100 (up from $2,000). None of this is fun news—but it’s good to plan ahead so these changes don’t catch you by surprise.

Lower Drug Prices Are Finally Happening

Now for some good news! In 2026, the federal government will roll out the first phase of Medicare’s drug price negotiations. Ten popular prescription drugs will have lower, negotiated prices! This is a big deal—especially for people who take expensive medications for chronic conditions like diabetes or heart disease.

Also, the new Medicare Prescription Payment Plan will let you spread your drug costs out over the year — instead of paying big chunks all at once. After sign up, annual re-enrollment is automatic, unless you opt out.

Changes for Medicare Advantage Plans

If you’re on a Medicare Advantage (MA) plan, expect a few adjustments too. The maximum out-of-pocket limit will dip slightly to $9,250 for in-network care. That’s not a huge change, but hey –every bit helps.

Some insurers are also changing or trimming their Medicare Advantage plan options, so it’s worth double-checking that yours will still be available in 2026.

Prior Authorization Comes to Original Medicare (in Some States)

Here’s something new: Original Medicare will start testing prior authorization for certain medical procedures in six pilot states. That means your doctor may need Medicare’s approval before performing one of those services. It’s not nationwide yet, but if you live in a pilot area, you’ll definitely want to stay informed. Luckily for us, Florida is not a pilot state (yet)!

The bottom line? 2026 brings some higher costs, but also new savings opportunities! Take a little time during Open Enrollment (through December 7) to review your options. It could make a big difference in your healthcare and your wallet next year. Questions? Consult the Medicare experts at One Senior Place in Altamonte Springs and Viera.

Brenda Lyle is a Certified Care Manager and Certified Dementia Practitioner with One Senior Place, Greater Orlando. One Senior Place is a marketplace for resources and provider of information, advice, care and on-site services for seniors and their families. Submit your questions to AskOSP@OneSeniorPlace.com. For immediate help, call 321-751-6771 or visit One Senior Place, The Experts in Aging.