Medicare & Medigap
Medicare Changes for 2026: What to Expect
NHQC Editorial Team · Last updated April 14, 2026
For the first time, Part D enrollees have a hard annual out-of-pocket cap ($2,000 in 2025, adjusted thereafter). This especially benefits people on high-cost specialty drugs.
Thresholds adjust annually for inflation; check the Medicare.gov premium page each fall.
Permanent coverage for mental-health telehealth continues, including audio-only in many cases.
CMS continues tightening prior-authorization timeframes and supplemental-benefit accounting.
Disclaimer: This content is for educational purposes only and is not medical, legal, or financial advice. NHQualityCampaign.org is not affiliated with or endorsed by the U.S. government or the federal Medicare program.
Frequently Asked Questions
Is the Part D cap automatic?+
Yes — it applies to all Part D plans.
Do I need to switch plans?+
Use the Medicare Plan Finder during AEP to compare your current plan against 2026 alternatives.
Will premiums go up?+
Premiums are announced each fall; historically they rise modestly with inflation.
Where can I get help choosing a plan?+
Your free State Health Insurance Assistance Program (SHIP) counselors — unbiased and local.
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