8 Changes Shaping Your Medicare Coverage in 2026

3. Some enrollees get another chance to switch plans

The 2026 Medicare Plan Finder included, for the first time, information about which doctors and other providers are included in a Medicare Advantage plan’s network.

The enhancement meant consumers didn’t have to leave the plan finder to see if their doctors, hospitals and other clinicians were included in an insurer’s provider network. Previously, that information could only be obtained by visiting a plan’s website, calling each company or working with an insurance broker. The provider directory is being updated with new information as CMS receives it.

Enrollees who choose original Medicare can see any physician who accepts Medicare, which is about 98 percent of all doctors who aren’t pediatricians, according to KFF, a nonpartisan health policy nonprofit headquartered in San Francisco with a presence in Washington, D.C.

About half of Medicare beneficiaries have Medicare Advantage plans, the privately run alternative to original Medicare. These plans limit participants to their lists of providers and charge more or require full payment for out-of-network services.

If Medicare Advantage enrollees who used plan finder during their first three months on a new plan discover that its information was wrong and their doctors are not in-network, they’re eligible to switch to a new plan that includes their providers. Or they can go to original Medicare during a special enrollment period for 2026 only. Be sure to determine whether the providers you want really do take your insurance.

4. Deductibles and spending caps for Part D plans go up

The $2,000 limit on out-of-pocket expenses for prescription drug plans, which includes stand-alone plans that go with original Medicare and drug coverage provided through Medicare Advantage plans, rose 5 percent this year to $2,100.

The $100 increase reflects the annual percentage increase in average spending for covered Part D drugs that occurred in 2024.

The maximum Part D deductible, which is adjusted each year, also increased for 2026. It’s $615 this year, up from $590 in 2025. Some Part D plans will have lower deductibles or none at all.

5. No reenrolling in Medicare drug payment plan needed

In 2025, original Medicare enrollees in Part D prescription plans and Medicare Advantage plans with prescription coverage had the option to pay out-of-pocket costs in monthly installments rather than all at once at a pharmacy. Paired with the $2,000 cap on out-of-pocket prescription costs, that might have meant that a $2,000 bill in January became a $167-a-month payment through the Medicare Prescription Payment Plan.

To make enrollment in the program easier in 2026, those who participated in 2025 were reenrolled automatically unless they opted out or changed to a new Part D or Medicare Advantage plan. If you did change plans and want to continue on a payment plan, just contact your new drug plan.

“Automatic renewal eases burden for both participants and plan sponsors,” CMS said last year. For participants who decide not to stay, Part D plans must process their opt-out request within three days.

6. Original Medicare begins prior authorization test

In a six-year experiment that began Jan. 1, millions of original Medicare beneficiaries in six states could be required to get advance approval, called prior authorization, before certain medical services, procedures or devices are covered.

If successful, the pilot project could lead to wider use of prior authorization in original Medicare, possibly using artificial intelligence (AI). The practice is already widely used in Medicare Advantage, with some plans using AI and algorithmic software to help make coverage decisions.

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The experiment runs through December 2031 and could involve up to 6.4 million original Medicare beneficiaries in parts of Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington, according to estimates from McDermott+, a health care consulting firm in Washington, D.C.

It’s designed to speed up coverage decisions and cut wasteful spending on at least 16 devices, procedures and services that are “particularly vulnerable to fraud, waste and abuse or inappropriate use,” according to CMS. Technology companies that participate will be paid based on savings from denied medical claims, which has drawn the ire of the American Medical Association and consumer organizations.

The pilot project comes amid concerns from lawmakers, government watchdogs and others that Medicare Advantage plans’ prior authorization procedures can create burdens for caregivers, who have to figure out how to appeal, and risk the health of patients by delaying or denying care that would otherwise be covered under original Medicare.

7. Medicare shutters supplemental benefits pilot

More than 7 million people enrolled in Medicare Advantage plans, including many who are chronically ill and have limited incomes, are no longer eligible for an array of extra benefits after a pilot project was terminated Jan. 1 because of excessive costs.

The Medicare Advantage Value-Based Insurance Design Model, which started in 2017, was developed to remove obstacles to care for vulnerable Medicare beneficiaries. The 62 plan sponsors participating in 2025 provide tailored benefits, such as lower prescription drug costs, food assistance, transportation to medical appointments and support to help manage chronic health conditions.

It targeted low-income beneficiaries. Those include people dually eligible for Medicare and Medicaid and those who qualify for Medicare’s Extra Help program, which lowers prescription drug prices for struggling enrollees.

The pilot program was designed to modernize Medicare Advantage and test whether the additional benefits improved health and lowered costs, according to CMS. But its cost — $2.3 billion in 2021 and $2.2 billion in 2022 — caused CMS to end it.

8. Medicare Advantage plans limit nonmedical benefits

The Bipartisan Budget Act of 2018 expanded the types of supplemental benefits that Medicare Advantage plans could offer to chronically ill enrollees. In 2026, CMS has limited the types of allowable coverage.

This assistance, called Special Supplemental Benefits for the Chronically Ill, doesn’t have to be health related. But it must have a reasonable expectation of improving or maintaining the health or function of someone who has a persistent medical condition, according to CMS.

Benefits and treatments not permitted in 2026 include:

• Alcohol, cannabis and tobacco products
• Certain cosmetic surgeries and procedures, such as facelifts, treatment for facial lines and remedies for atrophy of collagen and fat
• Funeral planning and expenses
• Life insurance and hospital indemnity insurance
• Unhealthy foods

“We believe that codifying a nonexhaustive list of examples of items or services that do not meet these standards will provide transparency and greater certainty for MA organizations and enrollees about the rules that govern these benefits,” CMS says in the rule.