What this year’s Medicare changes mean

Photo by Bermix Studio | Unsplash

By Liz Seegert
Posted on July 11, 2026

If you’re among the roughly 70 million people who get health coverage through Medicare, the federal insurance program for people age 65 and older and some younger people with disabilities, you’re probably already aware of some of the big changes to the system in 2026 — changes that have hit budgets hard.

This year’s 9.7% jump in premiums for Part B, which covers outpatient care, was the biggest increase in four years and eats up more than 25% of this year’s 2.8% annual inflation adjustment for Social Security benefits.

Meanwhile, cost pressures have caused some Medicare Advantage plans sold by private insurers to scale back extra benefits, such as dental, vision and hearing coverage, or eliminate others, such as allowances for transportation and over-the-counter purchases.

In some cases, private insurers have shut down plans or exited markets entirely. Those headline-grabbing shifts, however, aren’t the only big changes to Medicare this year — and not all of the developments hurt your bottom line.

You may benefit from new policies regarding drug pricing and telehealth services. But the new requirements for prior authorization in some areas and possible further shake-ups to Advantage plans? Not so much.

“There’s a lot to think about and a lot to compare, and it can just be really overwhelming,” says Lindsey Copeland, director for federal policy at the Medicare Rights Center.

Here’s the lowdown on this year’s Medicare changes.

Some drugs are getting cheaper

New, lower prices went into effect on Jan. 1 for 10 drugs covered under Medicare Part D, the first price reductions to be negotiated by Medicare directly with pharmaceutical companies under a landmark provision in the 2022 Inflation Reduction Act.

The medications include blood thinners Eliquis and Xarelto, diabetes drugs Jardiance and Januvia, and heart-failure treatment Entresto.

The nearly 9 million Part D beneficiaries who take these drugs will pay about 50% less on average than in 2025, according to the Centers for Medicare & Medicaid Services (CMS).

But individual savings will depend on the particular drug and drug plan, and could range from a few hundred dollars to several thousand, says Gerard Anderson, a professor in the department of health policy and management at Johns Hopkins Bloomberg School of Public Health.

Lower, negotiated prices on an additional 15 drugs, including the diabetes and weight-loss medications Ozempic and Wegovy, will go into effect in 2027.

A third round of negotiations, announced in January, will cover 15 more drugs, including Botox (to treat migraines and muscle conditions, not for cosmetic purposes), the GLP-1 diabetes drug Trulicity, and several cancer medications. Those prices will take effect in 2028.

What to do: If you have diabetes or another condition commonly treated by drugs whose prices have been negotiated by Medicare, but your particular medication is not among them, ask your doctor if it would be appropriate for you to switch to one that is. You could save a bundle.

Telehealth is sticking around

During the pandemic, telehealth became more widely available, but those benefits have been on the government’s chopping block recently.

In February, Congress extended key provisions through 2027. These include allowing beneficiaries to receive services at home by video and audio, regardless of geographic location; audio-only visits for those who can’t use video; and expanded coverage for remote care by physical and occupational therapists and other health providers.

What to do: Ask your doctor’s office which appointments can be handled through telehealth, such as test result reviews or medication check-ins.

Advantage plans could become more restrictive

In January, the Trump administration issued a proposal to keep reimbursement rates to Medicare Advantage insurers nearly flat next year, compared with the 4% to 6% boost insurers had anticipated. The news prompted dire warnings about the possible impact on enrollees.

“Flat program funding at a time of sharply rising medical costs and high utilization of care will impact seniors’ coverage,” said Chris Bond, a spokesperson for AHIP, the national health insurance trade organization, in a statement at the time.

“If finalized, this proposal could result in benefit cuts and higher costs for 35 million seniors and people with disabilities when they renew their Medicare Advantage coverage in October 2026,” Bond said.

In early April, CMS announced the reimbursement rate had been finalized at 2.48%, higher than the initial 0.09% proposal, but probably not high enough to prevent changes in some plans for 2027.

What to do: If you’re enrolled in a Medicare Advantage plan, carefully review the “annual notice of change” you get this fall for any adjustments to premiums, deductibles, co-pays and benefits. That will give you time to consider alternatives before open enrollment, which runs from Oct. 15 to Dec. 7.

If you sign up for an Advantage plan but then have second thoughts, you can switch to a different plan or to original Medicare during open enrollment period from Jan. 1 to March 31.