What to Expect from Upcoming Medicare Changes in 2026
As the Medicare Annual Enrollment Period (AEP) approaches, many of you are wondering what changes are coming to Medicare in 2026. While the Centers for Medicare & Medicaid Services (CMS) doesn’t release specific details until October 1, 2025, staying informed about potential updates can help you prepare. In this post, we’ll explore the types of changes Medicare may introduce, look at examples from previous years (clearly noted as past changes), and explain why working with a trusted local agent is the best way to navigate these updates.
Types of Medicare Changes to Anticipate
Each year, CMS announces updates to Medicare plans, including Medicare Advantage (Part C), Medicare Prescription Drug Plans (Part D), and related policies. These changes can affect how you access care, your out-of-pocket costs, and the medications covered. While we can’t share 2026 specifics yet (per CMS rules), here are the general areas where changes often occur:
- Network Changes: Medicare Advantage plans may adjust their provider networks, adding or removing doctors, hospitals, or specialists. This can impact where you receive care.
- Copay Changes: Copayments for services like doctor visits, hospital stays, or prescriptions may increase or decrease, affecting your budget.
- Pharmacy Changes: Part D plans may update their preferred pharmacy networks, which could change where you fill prescriptions for the best savings.
- Drug Plan Changes: Formularies (lists of covered drugs) in Part D plans may shift, with new medications added, others removed, or changes in cost-sharing tiers.
Examples of Past Medicare Changes (From Previous Years)
To give you a sense of what to expect, let’s look at some examples of changes Medicare has made in previous years. These are historical examples and not reflective of 2026 changes:
- Network Changes (2024): Some Medicare Advantage plans in 2024 expanded their provider networks to include more behavioral health providers, such as marriage and family therapists, to improve access to mental health care. Others tightened networks, requiring enrollees to confirm their doctors were still in-network.
- Copay Changes (2025): In 2025, CMS required Medicare Advantage plans to cap cost-sharing for behavioral health services at no more than Traditional Medicare rates, reducing coinsurance for mental health visits from up to 50% to 20% in some plans.
- Pharmacy Changes (2025): Part D plans in 2025 introduced requirements for pharmacies to enroll in the Medicare Drug Price Negotiation Program’s data module, ensuring better access to negotiated drug prices at the point of sale.
- Drug Plan Changes (2024): In 2024, Part D plans eliminated the “donut hole” coverage gap, capping out-of-pocket drug costs at around $3,300–$3,800 for some enrollees, later reduced to $2,000 in 2025. This made high-cost medications more affordable.
These past changes show how Medicare evolves to improve access and affordability, but they also highlight the need to review plans annually to ensure they still meet your needs.
Why You Should Stay Ready
With potential changes to networks, copays, pharmacies, or drug coverage on the horizon, it’s crucial to be proactive. On October 1, 2025, CMS will release the official 2026 Medicare changes, including updates to Medicare Advantage and Part D plans. These details will help you decide if your current plan still fits or if it’s time to switch during the AEP (October 15–December 7).
To make sense of these changes, consult a trusted local agent who knows your area’s healthcare landscape. A qualified agent will review the new Summary of Benefits, check provider and pharmacy networks, and explain how changes affect your costs and care. They’ll simplify the process, ensuring you choose a plan tailored to your health and budget.
Contact Me for Personalized Guidance
Don’t navigate Medicare changes alone! As a licensed agent in Northeast Florida, I’m here to make the process easy and stress-free. Contact me today to schedule a consultation for October 1st, and we’ll review the 2026 updates together to find the best plan for you. Call 904-534-5664 or visit FloridaHealthWealth.com/schedule-appointment/ to book your appointment!
Medicare Disclaimer: I am a licensed insurance agent, but I do not offer every Medicare plan available in your area. For a complete list of plans, please visit Medicare.gov or call 1-800-MEDICARE to explore all your options and ensure you find the best plan for your needs.