Posted in Triplett & Carothers on August 5, 2026

Medicare coverage is undergoing some significant cost and policy changes in 2026. How much these changes will affect you depends on your medical needs, your income and other similar factors. Healthcare costs remain an area of concern for seniors, especially those facing rising premiums, deductibles and prescription drug prices. Some of the changes have hit hard — for instance, the 9.7% increase in Plan B premiums, the largest increase in four years.

However, not all changes are bad. In fact, some new prescription drug and telehealth services policies will benefit Medicare enrollees.

Here are some of the sweeping changes that may directly impact your Medicare coverage:

• One of the biggest changes is that 10 commonly used prescription drugs are getting cheaper. The medications include blood thinners Eliquis and Xarelto, diabetes drugs Jardiance and Januvia, and heart-failure treatment Entresto. Part D beneficiaries who take these drugs will now pay about half of what they paid in 2025 for the same drugs. Depending on the drug, patients can see out-of-pocket savings of hundreds or even thousands of dollars. Coming in 2027, patients can expect to see lower costs for another group of 15 drugs, including diabetes and weight-loss drugs.

• Thanks to a congressional extension, telehealth will continue to be available through 2027. Regardless of where they live, beneficiaries can schedule audio and video appointments when and where they need them. Many appointments, such as reviewing test results or medication check-ins, can be performed remotely.

• If you live in Arizona, New Jersey, Ohio, Oklahoma, Texas or Washington state, you will need to have prior authorization before receiving care for certain medical conditions. These conditions include some steroid injections for pain management and some nerve-stimulation techniques used to treat Parkinson’s disease, incontinence and sleep apnea. While the first step in the approval process is provided by an artificial intelligence-assisted screener, licensed clinicians will have the final say.

• Some enrollees will see an increase in their out-of-pocket expenses for prescription drug plans. The Medicare Part D cap rose from $2,000 to $2,100. The maximum Part D deductible also rose from $590 the previous year to $615 in 2026.

• In 2025, original Medicare and Medicare Advantage prescription drug enrollees had the option of paying for their drugs in monthly installments rather than all at once. To make enrollment easier, those enrolled in 2025 were automatically renewed for the same monthly payment plan this year. This eases the burden for participants and plan sponsors by allowing them to continue unless they made changes to their current coverage.

• The Medicare Advantage plan has now limited the types of coverage for chronically ill patients. According to the new ruling, to be covered there must be “a reasonable expectation of improving or maintaining the health or function of someone who has a persistent medical condition.” Benefits that are not covered include cannabis, certain cosmetic procedures, funeral expenses and life insurance, groceries or utilities.

This is just a summary of complex provisions. For the final word, consult official government sites and qualified financial advisers.

Reach out to Roz Carothers and her team at Triplett & Carothers to learn more.

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