5 Key Medicare Changes Coming in 2026: What to Do Now

Medicare is set for notable updates in 2026, and knowing what’s changing will help you plan your coverage and costs.

Below are the five biggest Medicare changes in 2026, what they mean for you, and simple steps to take now so you don’t leave savings on the table.

1) Negotiated Medicare drug prices go live (Part D)

For the first time, the Medicare Drug Price Negotiation Program takes effect at the pharmacy counter on January 1, 2026. CMS selected an initial set of high-spend Part D drugs for negotiation; beginning in 2026, those drugs must be covered by Part D plans at or below the negotiated Maximum Fair Price (MFP). If you take one of these medicines, your plan’s coinsurance will be based on the MFP rather than a higher list price.

Expect to see savings concentrated in categories like blood thinners and diabetes or heart medications—CMS has published the initial list of selected drugs and timelines, and you can review them on the CMS site and independent explainers like KFF’s overview. Lower prices don’t mean zero cost, but for many enrollees it will reduce percentage-based cost sharing at the pharmacy.

What to do:

• Check the negotiated drug list: Visit CMS’s program page and confirm whether your medications are included for 2026.
• Run a 2026 plan comparison: Use Medicare’s Plan Finder in October to compare your total annual drug costs (premiums + copays) across plans.
• Ask your pharmacist about any lower-cost therapeutic alternatives your plan prefers once MFP prices take effect.

2) Medicare Advantage risk adjustment Model V28 fully phases in

2026 is the third—and final—year of CMS’s phase-in of the updated risk adjustment model (CMS-HCC V28) for Medicare Advantage (MA) and Part D sponsors. CMS began phasing V28 in for 2024 and 2025; by 2026 it’s fully in place. This technical change adjusts how plans are paid for members’ health risks, with the goal of making payments more accurate overall.

Why it matters to you: When plan payments change, plans often rebalance premiums, cost sharing, supplemental benefits (like dental, vision, or OTC allowances), and provider networks. Some enrollees may see richer benefits; others may see trims. This doesn’t change your Original Medicare benefits, but it can influence your MA plan’s value proposition in 2026. For background, see CMS’s payment policy materials summarized in the Rate Announcement fact sheet.

What to do:

• Re-shop your MA plan during the Oct 15–Dec 7 Annual Enrollment Period (AEP) and the Jan 1–Mar 31 MA Open Enrollment Period. Compare premiums, MOOP, drug coverage, and your doctors’ participation.
• Look beyond the headline perks: Weigh core protections (max out-of-pocket, inpatient costs) against supplemental benefits that could change year to year.

3) Part D plan changes in year two of the redesign

While the big Part D redesign began in 2024–2025, 2026 will be the first full year where plans operate with the new benefit structure and the market has adjusted to it. Key features you’ll feel in 2026 include the $2,000 annual cap on out-of-pocket prescription costs (in place since 2025) and the option to spread your costs over the year via the Medicare Prescription Payment Plan (“smoothing”).

Expect plans to fine-tune premiums, preferred pharmacies, and formularies to reflect these changes and the 2026 negotiated prices. If you had very high drug costs before 2025, your spending should remain more predictable under the cap. See CMS’s redesign overview and decision tips via KFF’s Part D redesign explainer.

What to do:

• Enroll in the smoothing option with your plan if you prefer steady monthly payments instead of paying large costs early in the year.
• Double-check your pharmacy is “preferred” in 2026 to get lower copays; this can change annually.
• Apply for Extra Help (LIS): If your income is limited, the Extra Help program can reduce premiums and copays substantially.

4) Medicare telehealth flexibilities extended through 2026

Congress extended several pandemic-era Medicare telehealth flexibilities through December 31, 2026, including the removal of geographic and originating-site restrictions and expanded use of audio-only telehealth in some circumstances. That means more beneficiaries can continue seeing clinicians virtually from home without needing to be in a rural area or specific medical facility. You can review current details on CMS’s Medicare telehealth coverage page.

Impact: Easier scheduling, fewer travel barriers, and continued access to mental health and primary care via telehealth. After 2026, Congress will need to act again to keep these flexibilities, so rules could change in 2027 and beyond.

What to do:

• Confirm your provider offers telehealth and whether a video visit is required or audio-only is allowed for your service.
• Ask your MA plan about any additional telehealth benefits it offers beyond Original Medicare.

5) Star Ratings updates shift some MA plan bonuses and benefits

Each fall, CMS releases updated Star Ratings for MA and Part D plans, reflecting quality and member experience measures. Methodology refinements continue into 2026, which can affect bonus payments to plans. When bonuses go up or down, plans often adjust supplemental benefits, premiums, and cost sharing accordingly.

Impact: You may notice changes in dental, vision, hearing, meal or transportation benefits, or OTC allowances—even if your premium doesn’t change much. The right plan for 2025 may not be the best value in 2026.

What to do:

• Check your plan’s new Star Rating each October and compare it with alternatives in your county.
• Read your Annual Notice of Change (ANOC) carefully; it outlines what’s different in 2026 for your plan.

Key dates and how to prepare

• September: Watch for your plan’s Annual Notice of Change (ANOC) detailing 2026 changes.
• Oct 1: 2026 plan details appear on Plan Finder.
• Oct 15–Dec 7 (AEP): Switch MA or Part D plans for 2026.
• Jan 1, 2026: Negotiated drug prices take effect for the first selected Part D drugs; 2026 coverage year begins.
• Jan 1–Mar 31, 2026 (MA OEP): One additional chance to change MA plans or return to Original Medicare.

Frequently asked questions

Will my drugs automatically be cheaper in 2026?

Only if they’re among the selected Part D drugs with a negotiated MFP. Even then, your exact savings depend on your plan’s cost-sharing structure. Check CMS’s negotiation program hub and compare 2026 plans.

Should I move from Original Medicare to Medicare Advantage (or vice versa) because of these changes?

Not automatically. Base your decision on your doctors and hospitals, prescription list, travel needs, and your tolerance for managed-care rules. Use Plan Finder and consider free, unbiased counseling through your State Health Insurance Assistance Program (SHIP).

How can I lower my drug costs beyond the 2026 changes?

Ask your prescriber about generics and preferred alternatives, enroll in the smoothing option, apply for Extra Help if eligible, and compare plans annually. For select Part B and Part D drugs with price hikes above inflation, you may also see lower coinsurance due to Medicare’s inflation rebates—details are posted by HHS and CMS throughout the year.

Bottom line

The headline Medicare changes in 2026—negotiated Part D prices going live, full implementation of MA risk adjustment updates, the second-year effects of the Part D redesign, continued telehealth flexibilities, and Star Ratings shifts—mean it’s more important than ever to compare your options. Spend an hour this fall with Plan Finder (or a SHIP counselor) to lock in the best mix of premiums, drug costs, and benefits for 2026.