What changes in Medicare coverage mean for your 2026 health plan | Hindustan Times

What changes in Medicare coverage mean for your 2026 health plan

Published on: Oct 21, 2025 04:33 PM IST

Changes in various factors such as medical services coverage and out-of-pocket might lead to rising premium costs in 2026

This year's open enrollment period is already underway, and medicare experts are urging recipients to choose their options for the upcoming year carefully. Experts suggest that changes in premiums, government shutdowns, and other factors might lead to a rise in current medicare premium costs. “Millions of Medicare beneficiaries will face higher out-of-pockets costs and reduced benefits in 2026, so comparing Medicare coverage options is especially crucial this year", vice-president of consumer enablement at ehealth, Whitney Stidom told Medical News Today.

Medicare Changes 2026 price increase: Experts urge seniors to compare plans as open enrollment period begins(Unsplash)
Medicare Changes 2026 price increase: Experts urge seniors to compare plans as open enrollment period begins(Unsplash)

Why are medicare premiums increasing?

Basic medicare coverage is divided into parts A and B. Medicare trustees suggest that part B premiums might rise from $21.50 to $206.50, according to The Hill. The reasons stated for the increased costs include low profits for companies as well as higher costs of hospitalization and outpatient care, all of which are included in Part B of the medicare premium. Experts suggest that medicare recipients might feel the effect of an increase in premium costs.

The monthly premium for medicare advantage plans with drug prescription will also decrease from $16 to $14. While premiums for Part D plans (which are included in Medicare Advantage) will dip slightly, insurance companies will raise the premiums to $50, which was around $35 earlier.

Experts mention that people could also feel an increase in out-of-pocket deductibles. The annual cap for Part D on out-of-pocket expenses will decrease from $9350 to $9250 in 2025. While most vaccines and drugs are covered under Part D, last year, authorities decided that GLP-1 weight loss drugs like Ozempic would not be covered under Part B.

There are also assumptions that telehealth services could be reduced, as many previous telehealth plans expired on October 01 and were not renewed by the Trump administration.

Also read: What stays open and what closes during a government shutdown: Social security, medicare, USPS & more

Melinda Caughill, co-founder of 65 Incorporated, which offers Medicare guidance, told The Hill, “This is the most important open enrollment period in Medicare’s 60-year history. Everybody should be reviewing their plan.”

Eligibility and expert advice

The open enrollment period has already begun on October 15 and will close on December 7. The period opens every year and allows residents to make changes to their medicare plans, which come into effect from January 1, next year. Residents who are 65 years of age or above can sign up for government health programs or make changes to the existing ones.

Experts suggest that on receiving their notice of change letter, medicare recipients should research their available medicare plans and pick which one is the best as per their needs. Recipients suggest that Part D and Part B plans should be read thoroughly before making a decision. Instead of looking for low-cost premiums, recipients should focus on health benefits and long-term financial security.

FAQs

Do all US citizens get medicare in the US?

People who are 65 or above or permanent residents of the USA are eligible for Part A of Medicare.

Is there a rule for Medicare in the US?

Yes, one must be above 65 to get free Medicare in the US.

Is there a limit for Medicare in the US?

No, there is no income limit for Medicare in the USA.

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