Medicare
Medicare 2026: What's New This AEP
Premium changes, the new $2,000 Part D cap, and what to re-shop this October
Every fall, Medicare beneficiaries face a 7-week window to switch plans for the following year — the Annual Election Period (AEP), October 15 through December 7. For 2026, the changes are larger than usual: the Inflation Reduction Act fully phases in its Part D out-of-pocket cap, and Part B premiums have adjusted. Here's what beneficiaries should know before AEP arrives.
The $2,000 Part D out-of-pocket cap
Starting 2025 (and continuing in 2026), Part D drug spending is capped at $2,000 out-of-pocket per year. This is the largest Medicare structural change in over a decade and benefits anyone on expensive medications.
- ·Caps apply to standard Part D out-of-pocket — premiums and excluded drugs don't count
- ·The traditional 'donut hole' coverage gap is functionally eliminated
- ·Beneficiaries on insulin, biologics, or specialty drugs may see dramatic out-of-pocket reduction
- ·Plans can now offer the 'Medicare Prescription Payment Plan' to spread costs across 12 months
Standard 2026 Part B premium
The standard Part B premium for 2026 is $202.90/month for income up to $106,000 (individual) or $212,000 (joint). Higher-income beneficiaries pay more via IRMAA — based on the tax return from two years prior.
- ·Standard premium: $202.90/month
- ·IRMAA tiers apply above $106K individual / $212K joint
- ·IRMAA is set by 2024 tax return for 2026 premiums
- ·Submitted SSA-44 appeals work for life-event-driven income drops (retirement, death, divorce)
Medicare Advantage plan changes
Every fall, Advantage plans publish their Annual Notice of Change (ANOC) — required by September. The ANOC outlines changes to networks, formularies, and benefits for the following year. Many beneficiaries get the ANOC and don't read it.
- ·Provider network changes happen yearly — your doctor might not be in-network in 2026
- ·Drug formularies update — your medications may move tiers or get removed
- ·Premiums and out-of-pocket limits can change
- ·Extra benefits (dental, vision, hearing, gym, OTC) vary year to year
What to do during AEP
Use this checklist between October 15 and December 7:
- ·Pull your ANOC from your current Advantage plan and read it
- ·List your current medications and verify they're on the 2026 formulary
- ·Verify your doctors and preferred hospital are in-network for 2026
- ·Compare your current plan against 2-3 alternatives — networks and prices change
- ·Submit any plan change by December 7 (effective January 1)
Common mistakes to avoid
- ·Don't auto-renew without reviewing the ANOC — your situation or the plan probably changed
- ·Don't switch off Medigap to Medicare Advantage without understanding underwriting on the way back
- ·Don't choose a Part D plan on premium alone — total annual cost (premium + drug costs) matters more
- ·Don't trust a single carrier's call center to compare across the market — they'll only recommend their own plan
The Takeaway
The 2026 AEP is a meaningful window — the $2,000 cap alone changes Part D math for many beneficiaries. Pull your ANOC, verify your providers and drugs, and run a real comparison. If you'd rather not do the work alone, an independent Medicare agent can compare every plan in your county at no cost to you.
Free 2026 Medicare plan review
We compare every plan in your county and tell you honestly which fits your doctors, drugs, and budget. No cost to you. AEP closes December 7.
Go deeper
Medicare 101 — The 4 Parts Explained
Parts A, B, C, and D in plain English. What each covers, what they cost, and the enrollment window you can't miss.
ReadEvery Enrollment Window You Can Use
IEP, AEP, MA OEP, Medigap OE, GEP, and SEPs — when each one applies and what happens if you miss them.
ReadOriginal Medicare vs Advantage vs Supplement
The 3 main paths through Medicare — pros, cons, and which fits your situation.
ReadMedicare Supplement Plans, Side by Side
Plan G, Plan N, Plan F, and High Deductible G — what each covers, typical rates, and who they fit.
ReadEducational content only. Not financial, tax, or legal advice. Always consult a licensed professional before acting on the information in this post.