By Katie Ostini, State Health Insurance Program Coordinator
In 2026, Medicare’s Part D Prescription Payment Plan will feature automatic renewal, meaning participants will be re-enrolled each year unless they actively opt out. The Medicare Part D Prescription Payment Plan allows beneficiaries to spread the cost of prescription drugs over the year, rather than paying the full cost when filling a prescription.
The chart below outlines the 2026 changes to deductibles, premiums, and out-of-pocket caps.
| Medicare Component | 2025 Cost | 2026 Cost | Change |
|---|---|---|---|
| Part A Hospital Deductible (per benefit period) | $1,676 | $1,736 | +3.5% |
| Part A In Patient Hospital Coinsurance (Days 61-90) | $419 | $434 | +4.7% |
| Part A In Patient Hospital Coinsurance (Lifetime Reserve Days) | $838 | $868 | +3.5% |
| Part A Skilled Nursing Facility Co-Insurance (Days 21-100) | $209.50 | $217 | +3.5% |
| Part B Premium (monthly) | $185 | $202.90 | +9.6% |
| Part B Deductible (annual) | $257 | $288 | +12% |
| Part D Out-of-Pocket Cap (annual) | $2,000 | $2,100 | +5% |
| Part D Deductible (annual) | $590 | $615 | +4.2% |
| Medicare Advantage Plan In-Network Out-of-Pocket Cap (annual) | $9,350 | $9,250 | -1.1% |
Beginning in 2026, for the first time, Medicare has negotiated lower prices for 10 high-cost drugs intended to treat various medical conditions. All Part D plans must offer these drugs at the new, lower prices. This means guaranteed savings for beneficiaries taking these specific medications.
| Name of Medication & Condition(s) Treated | 2023 Cost | 2026 Cost | Cost Savings |
|---|---|---|---|
| Enbrel: Autoimmune Conditions | $7,106 | $2,355 | 67% |
| Eliquis: Blood Clots | $521 | $231 | 56% |
| Entresto: Heart Failure | $628 | $295 | 53% |
| Farxiga: Diabetes, Heart Failure, Kidney Disease | $556 | $178 | 68% |
| Imbruvica: Blood Cancers | $14,934 | $9,319 | 38% |
| Januvia: Diabetes | $527 | $113 | 79% |
| Jardiance: Diabetes, Heart Failure, Kidney Disease | $573 | $197 | 66% |
| NovoLog: Diabetes | $495 | $119 | 76% |
| Stelara: Autoimmune Conditions | $13,386 | $4,695 | 66% |
| Xarelto: Blood Clots | $517 | $197 | 62% |
Your State Health Insurance Program at the Pikes Peak Area Agency on Aging is here for you. You can contact the Pikes Peak Area Agency on Aging for any Medicare-related questions or concerns you have. SHIP counselors are government funded to provide trusted, unbiased Medicare counseling at no cost to you. Call (719) 471-2096 to schedule an appointment.