Preparing to enroll in Medicare can be confusing at best.
Among the most perplexing aspects: different enrollment periods for different parts of Medicare, and missed deadlines that can lead to penalties, sometimes permanent penalties.
Plus, there is no coverage for some health care costs, like vision, dental, hearing aids, and long-term care, so coverage requires doing even more homework.
Then, once you think you know what to expect, things change and it seems like you have to start over again.
As 2026 approaches, Medicare beneficiaries are facing one of the biggest sets of changes in years. It’s a good-news/bad-news scenario.
In the “good” column: lower out-of-pocket costs on many high-cost medications. In the “bad” column: rising caps and stricter plan rules that could increase expenses.
Knowing what’s coming and when to act could save hundreds of dollars and prevent coverage headaches.
If you used the monthly installment drug payment option in 2025, you will be automatically reenrolled in 2026 unless you actively opt out by December 31, 2025. The policy is intended to reduce administrative hassle, but it may catch some beneficiaries unaware.
Medicare to offer lower drug costs in 2026
Starting January 1, 2026, Medicare will implement negotiated prices for some of the most high-cost prescription medications. The medications don’t have competition and are among those that drive the most Medicare spending.
“Medicare’s 2026 updates are the first meaningful attempt to lower prescription drug costs for seniors while still encouraging plan accountability and coverage transparency. Beneficiaries should review their coverage carefully to maximize savings and avoid unexpected costs,” according to an AARP Medicare analyst.
These are the new drug prices for 2026; the savings is significant:
- Eliquis, to prevent and treat blood clots, will drop from $521 to $231 per month.
- Jardiance, used to treat type 2 diabetes, chronic heart failure, and chronic kidney disease, will drop from $573 to $197 per month.
- Xarelto, to prevent blood clots, will drop from $517 to $197per month.
- Farxiga, to treat type 2 diabetes and chronic kidney disease, will drop from $556 to $178 per month.
- Entresto, to treat chronic heart failure, will drop from $628 to $295 per month.
- Enbrel, to treat several inflammatory conditions, including rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and plaque psoriasis, will drop from $7,106 to $2,355 per month.
- Imbruvica, to treat certain B-cell cancers, will drop from $14,934 to $9,319 per month.
- Stelara, to treat autoimmune inflammatory conditions, including Crohn’s Disease, will drop from $13,836 to $4,695 per month.
- NovoLog, to lower blood sugar, will drop from $495 to $119 per month.
The goal is to reduce out-of-pocket spending, with AARP estimating roughly $1.5 billion in savings for beneficiaries in the first year.
Related: Something unusual just showed up in Medicare’s 2026 preview
While the lower drug cost is a welcome relief for many, other cost protections are changing for everyone.
The out-of-pocket spending cap for Medicare Part D plans will increase from $2,000 to $2,100, and the annual deductible rises to $615. Beneficiaries with heavy prescription use may face higher upfront costs despite lower drug prices.
Changes in Medicare Advantage (MA) plans
Medicare Advantage (MA) enrollees will benefit from improved network transparency. The updated Plan Finder tool will show more clearly whether doctors and hospitals are in-network. If you discover your provider isn’t included, you may be eligible for a special one-time enrollment correction window in early 2026.
However, MA plans are tightening rules for non-medical supplemental benefits, such as transportation, meals, alcohol, and cannabis products. Due to cost concerns, a pilot program providing extra perks for chronically ill enrollees will end January 1, 2026.
Prior authorization pilot program in original Medicare
Original Medicare will launch a multi-state pilot program requiring prior authorization for certain devices, procedures, and services starting January 1, 2026, according to Medicare.
This six-year experiment could expand nationally and uses algorithmic or AI tools, prompting some concern among providers and patient advocates about potential delays or denials.
Key Medicare dates to remember:
- October 15 – December 7, 2025: Open Enrollment Period. Review your plan, check your prescriptions, and switch plans if needed.
- December 31, 2025: Deadline to opt out of automatic monthly drug-payment plan re-enrollment.
- January 1, 2026: Lower drug prices go into effect; Part D out-of-pocket cap rises; prior-authorization pilot starts; MA non-medical benefit restrictions begin; chronic-care benefit pilot ends.
- Early 2026: Updated Plan Finder launches with improved network data; one-time enrollment correction window opens.
What Medicare users should do
- Check if you take any of the 10 medications benefiting from negotiated pricing.
- Review your Part D deductible and out-of-pocket limits.
- Confirm that your providers are in-network under your MA plan.
- Understand which non-medical benefits may no longer be offered.
- Be aware of prior-authorization rules if enrolled in Original Medicare.
“Beneficiaries need to reshop their Part D plans carefully,” advises Robert Powell, CFP, RMA, former editor & publisher, Retirement Daily on TheStreet.
Enter all your meds in Medicare Plan Compare, he says. “Enter at least four pharmacies, including mail order, CVS, and Walgreens. Some pharmacies may be out of network. Rule them out.”
Powell explains that despite the $2,100 cap and negotiated prices, many drugs are not on the formulary and, therefore, not covered: “If your drug is a brand name and there’s a generic available, ask your doctor to prescribe that. If your drug is a brand name with no generic and not covered, ask your doctor to write to the plan to ask for an exception, given your condition.”
Medicare 2026 offers historic drug-price relief but also brings higher deductibles, stricter coverage rules, and program changes that could affect your costs. Beneficiaries who prepare now — reviewing their drug lists, checking provider networks, and comparing plan options — can take full advantage of the savings while avoiding costly surprises.
Open enrollment is your window to make adjustments that will shape your 2026 coverage.
“Don’t just settle for the plan with the lowest premium. Do the work,” urges Powell. The only good news is that you can reshop your plan every year. The bad news is that, given trends in health care, it only gets worse from here.
Related: Dave Ramsey, AARP warn on Medicare; 2026 changes coming
