Medicare
Medicare 2026: What's New This AEP
Premium changes, the new $2,000 Part D cap, and what to re-shop this October
Quick answer
For 2026, the biggest Medicare change is the $2,000 yearly cap on Part D out-of-pocket drug costs, which ends the old 'donut hole.' The standard Part B premium is $202.90 a month, with higher earners paying more through IRMAA. Review your plan's Annual Notice of Change and re-shop between October 15 and December 7.
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
Frequently asked questions
What is the $2,000 Part D cap?
Starting in 2025 and continuing in 2026, your out-of-pocket spending on Part D prescription drugs is capped at $2,000 a year. Premiums and excluded drugs don't count toward it, and the old 'donut hole' coverage gap is functionally gone. People on insulin, biologics, or specialty drugs may save the most.
What is the standard Part B premium for 2026?
The standard Part B premium is $202.90 a month for income up to $106,000 for an individual or $212,000 for a couple. Higher earners pay more through IRMAA, which is based on your tax return from two years earlier.
When is the Medicare Annual Election Period for 2026?
The Annual Election Period runs October 15 through December 7. Any plan change you make takes effect January 1. It's the window to switch Medicare Advantage or Part D plans for the next year.
What should I check during AEP?
Pull your plan's Annual Notice of Change and read it, confirm your medications are on the 2026 formulary, verify your doctors and hospital are in-network, and compare your current plan against two or three alternatives before December 7.
Should I auto-renew my Medicare Advantage plan?
Not without reviewing the Annual Notice of Change first. Networks, drug formularies, premiums, and extra benefits change every year, so a plan that fit this year may not fit next year.
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.
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ReadEducational content only. Not financial, tax, or legal advice. Always consult a licensed professional before acting on the information in this post.