All the Big Medicare Changes Coming in 2026—From Record-Breaking Premium Hikes to New $50 Drug Savings
Costs are climbing, but major prescription savings are coming too—here's how to prepare
Next year will bring big changes for people on Medicare, from increased premium prices to new technology and some price-saving drug deals. And while some of these changes will help people actually save money, others could impact who gets what type of medical care. To learn more about what’s changing with Medicare in 2026, keep reading.
Medicare changes in 2026: what every retiree and caregiver needs to know
From new monthly premiums to cheaper prescription costs, here are the most important 2026 Medicare changes to be aware of.
Premium costs are rising
In 2026, Medicare Parts A, B and D costs will increase by a record-breaking amount.
For people enrolled in Part A:
- Hospital deductibles rise from $1,676 to $1,736.
- The coinsurance amount for one’s hospital stay goes from $419 to $434.
- Lifetime reserve day costs go from $838 to $868.
- The daily coinsurance for beneficiaries in skilled nursing facilities for days 21 through 100 of extended care will go from $209.50 a day to $217.00 a day.
For people enrolled in Part B:
- The annual deductible goes from $257 to $283.
- The monthly cost goes from $185 a month to $202.90 a month on average.
For people enrolled in Part D:
- Monthly premiums will go from $35 to $50.
- The annual cap on out-of-pocket expenses will go from $2,000 to $2,100.
Six states will begin using the Wasteful and Inappropriate Service Reduction (WISeR) Model
Starting on January 1, 2026, Arizona, New Jersey, Oklahoma, Ohio, Texas and Washington will launch the Wasteful and Inappropriate Service Reduction (WISeR) Model. It’s an artificial intelligence (AI) tool that is going to help determine whether or not Medicare users qualify for certain outpatient procedures. This model is mandatory for people enrolled in Medicare Parts A/B in the states mentioned above, and according to experts, could harm patient care.
“For the first time, seniors will need prior approval from private contractors (paid based on how many claims they deny) before accessing certain treatments,” Michael Ryan, a finance expert and the founder of MichaelRyanMoney.com, told Newsweek. “Traditional Medicare has operated without prior authorization for 60 years. This pilot introduces it.
Center for Medicare and Medicaid Innovation (CMS) administrator Mehmet Oz, MD, denied these claims, telling Morning in America, “The purpose of these is not to deny care. It’s to make sure you get the care you need and deserve, not the care that some unscrupulous doctor wants to use on you because he can talk you into having spine surgery or knee surgery.”
As of publication, there is no news on whether the WISeR Model is expected to be tested in other states as well.
Ten drugs will be cheaper
Thanks to the Inflation Reduction Act, 11 drugs are dropping in cost come 2026. These include:
- Fiasp and NovoLog, two diabetes drugs, will go from $495 to $119.
- Stelara, a drug for psoriasis and Crohn’s disease, will go from $13,836 to $4,695.
- Xarelto, a blood thinner, will go from $517 to $197.
- Enbrel, a rheumatoid arthritis drug, will go from $7,106 to $2,355.
- Januvia, a diabetes drug, will go from $527 to $113.
- Farxiga, a drug for diabetes, heart failure and chronic kidney disease, will go from $556 to $178.
- Imbruvica, a drug for blood cancers, will go from $14,934 to $9,319.
- Jardiance, a diabetes drug, will go from $573 to $197.
- Entresto, a heart failure drug, will go from $628 to $295.
- Eliquis, a blood thinner, will go from $521 to $231.
“It is a historic moment,” former White House domestic policy adviser Neera Tanden said in 2024, per NBC. “Millions of seniors and others on Medicare will soon see their drug costs go down on some of the most common and expensive drugs that treat heart disease, cancer, diabetes…and more.”
A new Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model is going to launch
In July of 2026 the CMS will launch their new Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model, which will help manage and prevent chronic conditions such as musculoskeletal pain, behavioral health issues, early cardio-kidney-metabolic (CKM) conditions like prediabetes and obesity and established CKM conditions such as chronic kidney disease through the use of apps, wearable devices and telehealth software. Applications are open from January 1 to April 1, 2026, and anyone enrolled in Medicare Part B and getting government approval is welcome to apply.
“ACCESS introduces a way of paying for care that focuses on results. It offers clinicians a new predictable payment option, giving them the flexibility to use digital tools that help people take charge of their health,” Dr. Oz said during the press conference.
Several drugs will be available for cheap on TrumpRX
In 2026, President Donald Trump is expected to launch TrumpRx, a direct-to-consumer sales program that will offer the following drugs for cheap to people on Medicare
- Amgen’s cholesterol-lowering drug Repatha will go from $573 to $239 on TrumpRx.
- Bristol Myers Squibb’s HIV medication Reyataz will go from $1,449 to $217 on TrumpRX.
- Genentech’s flu medication, Xofluza, will go from $168 to $50 on TrumpRx.
- Gilead Sciences’ Hepatitis C medication Epclusa will go from $24,920 to $2,425 on TrumpRx.
- GSK’s inhaler Advair Diskus 500/50 will go from $265 to $89 on TrumpRx.
- Merck’s diabetes medication Januvia will go from $330 to $100 on TrumpRx.
- Novartis’ Multiple Sclerosis medication Mayzent will go from $9,987 to $1,137 on TrumpRx.
- Sanofi’s prescription blood thinner Plavix will go from $756 to $16 on TrumpRx.
- Wegovy will cost around $50 to $350, depending on dosage.
Cannabis will be covered
President Trump also recently announced that he would be reclassifying cannabis as a Schedule 3 drug as opposed to a Schedule I drug, which will allow people on Medicare to receive medical marijuana (cannabis) and CBD (a chemical derived from the hemp plant or the cannabis sativa) when it’s needed.
“The innovation center models are going to allow millions of Americans on Medicare to become eligible to receive CBD as early as April of next year and at no charge, if their doctors recommend them,” Dr. Oz said in a statement.
There will be a new ID verification
In 2026, people wanting to log into the Medicare site will have to use ID.me to verify their identity. By doing so, the CMS hopes to lower the risk of fraudulent logins and give users an easier sign-in experience.
“Healthcare access should be simple, secure and trustworthy for every American. By extending ID.me’s high-assurance identity capabilities across CMS and Medicare.gov, we’re creating a more unified patient experience while strengthening overall program integrity,” Blake Hall, Founder & CEO of ID.me, said in a statement. “This collaboration demonstrates what’s possible when government and technology work together to protect sensitive data at a national scale.”
The Global Benchmark for Efficient Drug Pricing (GLOBE) pilot program will help with drug costs
On October 1, 2026, the CMS will launch its new Global Benchmark Efficient Drug Pricing (GLOBE) pilot program, which will use global price data to set out-of-pocket costs for patients or certain drugs covered by Medicare Part B. It will primarily be used for “drugs that are administered in a clinical setting, such as cancer therapies or drugs used to treat autoimmune conditions and arthritis,” according to the CMS, and will run until 2031.
“For too long, the patients who use Medicare Part B and the taxpayers who fund it have been paying far more than people from comparable countries for the exact same drugs,” Dr. Oz said in a statement. “The proposed GLOBE Model will reduce costs and improve the quality of care without slowing down medical innovation. At CMS, we’re not just talking about making life more affordable. We’re delivering results.”
The Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth (BALANCE) model can help with GLP-1 costs
Beginning in 2026, the CMS will launch its new Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth (BALANCE) model, which will lower the costs of GLP-1 medications for people in Medicare and Medicaid. It will launch in May 2026 for Medicare users and in January 2027 for Medicare users.
“The BALANCE Model will empower more Americans to live healthier lives by expanding access to GLP-1s that have shown to be a powerful tool against the development of diseases, such as diabetes, cardiovascular disease, and other metabolic conditions, which can negatively affect a person’s long-term health,” CMS Innovation Center Director Abe Sutton said in a statement. “Through this model, CMS will make GLP-1s more accessible for people with Medicare and Medicaid.”
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