Q&A: Answering the Top 10 Questions from 2026 Plan Changes

You’re not imagining it. The 2026 Medicare changes feel bigger.

Every fall, people tell me the same thing: “I just got my plan notice and I have no idea what any of this means.”

If that’s you, you’re not alone.

Medicare plans change every year — sometimes a little, sometimes a lot — and 2026 brings some major updates. From new drug pricing rules to out-of-pocket cost shifts, the fine print is easy to miss (and expensive to ignore).

Here are the top 10 questions I’m hearing right now about 2026 Medicare plan changes, answered in plain English.

Because plan costs go up almost every year — but not always for the same reasons. Carriers adjust for higher medical expenses, new benefits, or inflation. Sometimes the plan itself changes; other times, your county’s rates shift.

Tip: Don’t focus only on the monthly premium. Check what’s happening with copays, coinsurance, and drug costs — that’s where the real price creep hides.

Big changes are coming from the Medicare drug price negotiation program, which starts kicking in this year. That means some commonly used drugs will see lower negotiated prices — but it depends on which ones you take and what your plan covers.

So while some people may pay less, others could see formulary reshuffling or higher tiers on certain medications. Always recheck your drug list during AEP.

In 2026, the coverage gap (the donut hole) is finally being phased out as part of the Inflation Reduction Act. Once you hit the initial drug spend limit, your costs won’t jump like before.

It’s good news — but don’t assume your drug spending will automatically drop with your Part D plan. Plans can still shift drugs around or raise cost-sharing in other ways.

Networks change every year. Your doctor might’ve left the plan, or the plan dropped certain providers to save money.

If that happens, you can:

• Check Medicare.gov for other in-network plans that include your doctor

• Call your provider to see what plans they’re staying with

• Review your options during AEP to avoid surprise out-of-network bills in January

The maximum out-of-pocket limit (MOOP) is going up again in 2026. Some plans now have limits as high as $8,850 for in-network care. That’s the ceiling on what you’d pay for covered medical costs — not counting drugs or premiums.

If your plan advertises a “low MOOP,” double-check what services count toward it. A lower number doesn’t always mean better protection.

Some are, yes — but “more” doesn’t always mean “better.”

Many plans are increasing allowances for things like dental cleanings or hearing aids, but also tightening which providers you can use or how often you can claim them.

Always read the fine print so you’re not surprised by per-visit caps or reimbursement limits.

The temporary telehealth flexibility from the pandemic is becoming more permanent in 2026. Most Medicare Advantage plans are keeping or expanding virtual care options.

Just make sure to check if your plan covers out-of-state telehealth visits — especially if you travel or split time between homes.

Yes — some plans are adding new wellness perks like fitness reimbursements, grocery allowances, and transportation to appointments.

Just remember: these extras can sound great but shouldn’t be the main reason you pick a plan. Coverage for your doctors, drugs, and major costs still comes first.

If your plan is discontinued or leaving your county, you’ll get a Special Enrollment Period (SEP) to pick a new plan. That usually runs through the end of February, with coverage starting January 1 if you enroll during AEP.

Don’t wait to be automatically reassigned — compare your options and make sure the replacement plan actually meets your needs.

Technically, no — your plan will renew automatically. But doing nothing is still risky.

Even if your plan name stays the same, the benefits and costs rarely do. Always read your Annual Notice of Change (ANOC) and confirm your drugs, doctors, and premiums still work for you in 2026.

A quick review now saves a year of frustration later.

This year’s Medicare changes are some of the biggest in recent memory — especially for drug coverage and out-of-pocket costs.

Before you let your plan roll over, take an hour to review your coverage on Medicare.gov or with a trusted advisor. Look at your total cost, not just the premium, and make sure your doctors and prescriptions still line up.

Doing a little homework now can save you hundreds (or thousands) later.