What Changes to Expect for Medicare Recipients in 2026
- John Schmidt
- Sep 10
- 4 min read
As we approach 2026, Medicare recipients can look forward to important changes that may significantly affect their healthcare coverage and costs. Grasping these changes is essential for beneficiaries, as it empowers them to make sound decisions about their health and financial well-being. This blog post will outline the expected modifications to Medicare, including new coverage options, cost adjustments, and innovative programs designed to enhance care.
The Value Based Insurance Design
The Centers for Medicare & Medicaid Services (CMS) is terminating the Medicare Advantage (MA) Value-Based Insurance Design (VBID) model at the end of 2025 due to the model’s substantial and unmitigable costs to the Medicare Trust Funds. Excess costs to the Medicare Trust Funds of this magnitude — $2.3 billion in Calendar Year (CY) 2021 and $2.2 billion in CY 2022 associated with the VBID model, based on the prior and forthcoming evaluation reports, respectively — are unprecedented in CMS Innovation Center models. Additional analyses of model performance and policy options demonstrated that these substantial costs were driven in part by increased risk score growth and Part D expenditures and that no viable policy modifications could address these excess costs. As such, the model must be terminated at the end of 2025 to meet the CMS Innovation Center’s statutory requirements.
This includes extra benefit food cards as well as "0" dollar co-pays for Dual Eligible plans.
Changes to Coverage
One of the largest anticipated changes for 2026 is the expansion of coverage options under Medicare. The Centers for Medicare & Medicaid Services (CMS) is likely to roll out new services and benefits aimed at promoting better patient care and outcomes.
For example, there is an expectation of increased access to preventive health services. This may include more comprehensive screenings for conditions such as cancer and diabetes. Recent studies suggest that preventive care can reduce healthcare costs by up to 30% in the long run, as catching conditions early often leads to less complicated and less costly treatments.
Medicare is also likely to broaden its telehealth services, which have surged in popularity since the COVID-19 pandemic. A survey from the Pew Research Center highlighted that 76% of older adults who used telehealth found it convenient. With expanded telehealth options, beneficiaries will have easier access to healthcare, especially those with mobility issues or those residing in rural regions.
Cost Adjustments for Medicare Recipients
Cost changes for Medicare recipients in 2026 are also on the horizon. While exact figures are not finalized, it is projected that premiums, deductibles, and out-of-pocket expenses could change.
Beneficiaries may face increased premiums for Medicare Part B, which covers outpatient services. For instance, the average monthly premium for 2025 was approximately $185, and this may rise. However, positive developments are also expected, particularly in prescription drug costs. The Inflation Reduction Act aims to lower these costs, and its continued influence might mean reduced prices for essential medications in 2026. A report showed that nearly 1 in 4 seniors struggle to afford their prescriptions, so this could significantly alleviate their financial burden.
Introduction of New Programs
Beyond changes in coverage and costs, Medicare recipients can look forward to new programs that aim to enhance care quality. One potential program may target chronic disease management and deliver additional resources for individuals with conditions like diabetes, heart disease, and arthritis.
Chronic condition SNPs (C-SNPs) are SNPs that restrict enrollment to individuals with certain chronic or disabling chronic conditions, specified in CMS regulations. Those conditions include, but are not limited to diabetes, stroke, certain cardiovascular disorders, cancer, certain chronic lung disorders, HIV, dementia, chronic kidney disease, certain mental health disorders, drug or alcohol dependence, or certain neurological disorders like epilepsy or Parkinson’s disease.
These programs could offer personalized care plans and access to health coaches, making a marked difference in patient experiences. A study from the National Institutes of Health revealed that chronic disease management programs could reduce hospital readmissions by 25%, demonstrating their effectiveness in supporting patient health.
Enhanced Support for Mental Health Services
Mental health is increasingly recognized as a critical area of healthcare, and Medicare is expected to expand its offerings in this domain by 2026. Expectations include broader coverage for therapy sessions and counseling services.
This change is particularly salient given the rising recognition of mental health issues among seniors. According to the National Alliance on Mental Illness, nearly 20% of adults aged 65 and older experience mental health challenges. By enhancing access to mental healthcare, Medicare aims to help recipients maintain both their emotional wellness and overall quality of life.
Standard Part D Benefits for 2026
For 2026, the standard benefit requires the beneficiary to pay:
• A $615 deductible
• 25% of prescription drug costs during the initial coverage phase.
Once beneficiary out-of-pocket costs reach a total of $2,100, the beneficiary is through the initial coverage phase and reaches catastrophic coverage.
• The out-of-pocket costs that count toward reaching the catastrophic limit are known as true out-of-pocket costs or TrOOP. In some instances, amounts not directly paid by the beneficiary count toward TrOOP. After reaching the annual out-of-pocket threshold, the beneficiary pays nothing.
Looking Forward
As 2026 approaches, Medicare recipients should remain vigilant about the changes that could affect their healthcare coverage and costs. The anticipated expansions in coverage, adjustments in costs, and new programs present numerous considerations for beneficiaries.
By staying informed about these changes, Medicare recipients can navigate their options effectively and make well-considered decisions regarding their healthcare. Being proactive and engaged with Medicare updates will be crucial in ensuring individuals receive the highest quality care in the future.
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