Medicare Advantage and Part D in 2026: Aftershocks, and What You Need to Know.

2025 brought the biggest shift to Medicare’s prescription drug coverage in two decades. While the reforms were designed to lower out-of-pocket costs and add predictability, they also caused ripple effects in the Medicare Advantage Prescription Drug (MAPD) marketplace. Some carriers pulled out of certain regions, others restructured benefits, and many beneficiaries felt the disruption firsthand.

Now, as we look ahead to 2026, the Medicare landscape is settling into its “new normal”, but that doesn’t mean your coverage will look the same year to year.

What Changed in 2025 (in Brief)

• Medicare Part D enrollees saw a large reduction in the annual cap on out-of-pocket drug costs, giving more predictability for those on high-cost medications.

• The 5% coinsurance in catastrophic coverage was eliminated.

• Insulin and certain vaccines became more affordable.

  
  

While these were positive changes, the financial impact on carriers led to premium adjustments, tighter formularies, and disruption in MAPD availability in many areas.

What to Expect in 2026

1. Premiums Will Likely Continue to Rise

The federal premium stabilization measures that helped keep costs in check in 2025 are loosening. Many experts anticipate that Part D and MAPD premiums will climb in 2026 as carriers adjust to the new cost structure.

2. Plan Availability May Shift

Some insurers exited the MAPD market in 2025. In 2026, we may see additional adjustments as carriers re-evaluate participation and benefit design. The plan you had last year may not be available, or it may look different.

3. Formularies and Pharmacies Will Matter More

Even with an out-of-pocket cap, the specific drugs covered and where you can fill them will continue to vary by plan. Plan formularies (the lists of drugs they cover) may narrow, and preferred pharmacy networks may play a larger role in controlling costs.

4. Medicare Advantage Extras May Scale Back

Many people choose MAPD for the “extras”, including dental, vision, fitness programs, and more. These benefits can change from year to year. As carriers manage prescription drug expenses, it’s especially important to check how these extras look in 2026.

What Beneficiaries Should Do

1. Review your coverage annually. The Annual Enrollment Period (AEP) runs each year from October 15 through December 7. Even if your plan is still available, the benefits and costs can change. Keep in mind if you see premium and cost sharing go up with your plan, that is a predicted trend and likely not unique to your plan or carrier.

2. Compare MAPD vs. Medigap + Part D. With MAPD plan exits, you may have the opportunity to revisit whether Original Medicare with a Medigap policy might better fit your needs, with the benefit of Guaranteed Issue.

3. Look closely at your prescriptions. Make sure your medications are still covered on your chosen plan.

4. Don’t forget the network. Especially for MAPD, confirm your doctors, specialists, and preferred pharmacies continue to be in-network.

   
   

The Bottom Line

The reforms that started in 2025 reshaped how Medicare drug coverage works, and the aftershocks will still be felt in 2026. While the changes generally mean lower risk of catastrophic out-of-pocket drug costs, they also create uncertainty in plan pricing and availability. Your best strategy? Take the time to review your options carefully during the Annual Enrollment Period this fall.

Why Work With an Independent Medicare Specialist

Choosing the right Medicare coverage; whether MAPD or Medigap with a stand-alone Part D plan; depends on your prescriptions, your health, your providers, and your budget. An independent Medicare-focused agent can:

• Compare MAPD and Part D plans across multiple carriers and show you your options.

• Explain how Medigap works differently, and whether it’s an option for you and a fit for your needs.

• Make sure you’re not surprised by costs, provider access, or benefit changes in 2026.

• Provide support year after year as your needs change and as Medicare continues to evolve.

  
  

The bottom line: You don’t have to navigate Medicare’s changes alone. With the right guidance, you can remain confident that your coverage truly works for you. Milestone Medicare specializes in Medicare health care coverage, and best of all there is no cost to you for our services. Visit our website or contact us today!