What is Ahead for Medicare in 2026
AIS Medicare & More
For more information about the author, click to view their website: AIS Medicare & More
Mar 19, 2025
Colorado - Southern Colorado
Medicare has been changing yearly and 2026 will be no
exception. What is ahead for Medicare this fall and why?
Carriers are still feeling the effects of the Inflation
Reduction Act, which passed in 2022, but just took full effect in January of
2025.
Beginning January 1, 2025, people with Part D plans through
traditional Medicare and Medicare Advantage plans with prescription drug
coverage, won't pay more than $2,000 over the calendar year in out-of-pocket
costs for their prescription medications, the donut hole or coverage gap is
eliminated and there is a new payment plan to spread drug costs through the
year. Those changes came at a cost to other benefits.
The Inflation Reduction Act significantly increased the
carriers’ expenses and in response benefit cuts occurred for 2025 and will
continue for 2026.
Carriers had to absorb the steep cost increase for the
mandatory prescription drug plan changes by balancing the budget, which
included increases in beneficiaries’ copays, deductibles added to plans, the
plan maximum out of pocket increased, non-medical benefits were reduced, a
prescription drug deductible was added, and prescriptions were re-tiered or
eliminated from the list of covered drugs.
2026 will see further adjustments as the carriers remove
most benefits deemed non-medical. Seniors who have grown accustomed to benefits
such as an over-the-counter allowance or food subsidy may see those benefits
sharply reduced or eliminated this fall.
Plans must be submitted to Centers for Medicare &
Medicaid Services for approval in early spring to be ready for the enrollment
period in fall to be active for the following calendar year, so carriers have had
little time to study the impact of the Inflation Reduction Act on overall
costs. Insurance moves slowly. The changes we are feeling in 2025 are the
result of a bill passed in 2022 and will continue to affect plans in 2026.
This fall will feel like a continuation of the benefit cuts seniors
faced in the fall of 2024 as carriers work to balance the budget while considering
the increased prescription costs and trying to maintain the plan benefits seniors
rely on. For more information visit: aismedicareandmore.com
Editor’s Note: This article was submitted by Jolynn Allen with AIS Medicare & More. Jolynn is the owner of AIS Medicare &
More and may be reached at: 719-404-3202
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Medicare Advantage Plans 3030 North Hancock Avenue, Colorado Springs, Colorado, 80907AIS Medicare & More has been serving Southern Colorado seniors since 2008. We have started to spread all throughout Colorado, to broaden our reach and help more Colorado seniors. Our complimentary Medicare appointments are available in office, at your home, by phone or by computer. We believe in educating you about your Medicare options and both Medicare systems, so you can make an educated and informed decision that meets both your health insurance needs and fits your budget. Our agents are with you for life. We provide annual policy reviews, lifetime claims service, account management and prefer if you call us not the carriers. We want to know what is going on in order to better assist you with any of your needs in the future. We help you with State and Federal programs, Medicare Savings Reimbursement, Extra Help, Pharmaceutical Assistance Programs, Veterans Programs, Long Term Care Medicaid and more. By combining all of the programs available to you with your Medicare plan benefits, we can improve your overall coverage and reduce your out of pocket expenses. We are on your team! We want to ensure that you are taking advantage of all of the benefits available for you.