The official handbook is out with this year’s numbers and a few important updates. Premiums moved. The drug spending limit changed. A new temporary program now affects certain weight-loss medications. These details shape real decisions about coverage and cost.
Here’s what this update covers:
• The official 2026 Part B premium and deductible
• The $2,100 Part D out-of-pocket maximum
• How the new GLP-1 Bridge program works
• Key enrollment dates and practical next steps
Every year the Centers for Medicare & Medicaid Services releases the Medicare & You handbook. It is the main public document that lays out what Medicare covers, what it costs, and what is changing. For 2026 the handbook and related fact sheets contain specific numbers and policy notes that affect household budgets and care choices.
A lot of people never open it. Others glance at it once and set it aside. That leaves important details unchecked, details that can influence whether a plan change makes sense, whether a new medication is newly available, and whether current coverage still fits. Taking a little time with the updates is one of the simplest ways to stay in control of the decisions Medicare requires.
The 2026 edition summarizes benefits, costs, enrollment windows, and several program updates. Here are the most relevant facts from the handbook and official CMS materials.
Part B (Medical Insurance)
The standard monthly premium is $202.90. The annual deductible is $283. These amounts apply to most people. Higher-income individuals may pay an additional Income-Related Monthly Adjustment Amount. The premium increase from 2025 reflects projected trends in outpatient services, physician care, and durable medical equipment.
Part A (Hospital Insurance)
Most people pay a $0 monthly premium because they or a spouse paid Medicare taxes long enough while working. Deductibles and coinsurance still apply for inpatient hospital stays, skilled nursing facility care, and related services. The Part A inpatient hospital deductible for 2026 is $1,736 per benefit period.
Part D (Prescription drugs)
The annual out-of-pocket maximum for covered Part D drugs is $2,100 in 2026. Once true out-of-pocket spending reaches this amount, the plan pays 100 percent of the cost of covered medications for the rest of the calendar year. This cap comes from the Inflation Reduction Act redesign that removed the coverage gap and put a hard ceiling on what beneficiaries pay.
Enrollment windows
The Initial Enrollment Period is still a seven-month window centered on the month a person turns 65. The Annual Enrollment Period runs from October 15 through December 7. During that time people can switch between Original Medicare and Medicare Advantage, change Part D plans, or join or drop drug coverage. A separate Medicare Advantage Open Enrollment Period runs from January 1 to March 31 for those already in an Advantage plan who want to make one change.
Coverage updates
The handbook materials include updated telehealth language and introduce the Medicare GLP-1 Bridge program. That program creates a temporary pathway for eligible people to access certain weight-loss medications at a fixed monthly cost.
These figures come directly from CMS and the Medicare & You 2026 materials. They matter because every dollar, every enrollment date, and every coverage rule affects real choices for individuals and families.
One of the biggest structural changes in recent years is the hard limit on what people pay for covered prescription drugs. In 2026 that limit is $2,100. Once true out-of-pocket costs for Part D-covered drugs reach this threshold, the person pays nothing more for those covered medications for the rest of the year.
This protection is useful, yet it is not automatic. Only spending on drugs that are on the plan’s formulary and that count toward true out-of-pocket costs applies. Drugs obtained outside the Part D benefit, certain non-covered items, and some forms of manufacturer assistance may not count. People still need to look at their specific plan’s formulary, preferred pharmacies, and prior authorization rules. The $2,100 ceiling offers a safety net. It does not remove the need to choose a plan that covers the medications someone actually takes.
For those who take multiple brand-name or specialty medications, reaching the $2,100 threshold earlier in the year can produce real savings later. For others with lower drug costs, the cap may never come into play. Either way, knowing the number exists and how it works is part of making an informed plan choice.
Starting July 1, 2026, CMS launched a short-term demonstration called the Medicare GLP-1 Bridge. The program gives eligible Part D beneficiaries access to certain GLP-1 medications used for weight management at a fixed cost of $50 per month. The covered products are Foundayo tablets, Wegovy (injection and tablets), and Zepbound (KwikPen only). Other formulations and other GLP-1 drugs are not included in this pathway.
The Bridge runs outside the regular Part D benefit. That means the $50 monthly payment does not count toward the Part D deductible or the $2,100 out-of-pocket maximum. Low-Income Subsidy cost-sharing reductions also do not apply to these fills. The program is set to continue through December 31, 2027.
Eligibility is limited. People must be enrolled in an eligible Part D plan type, must not already be receiving a GLP-1 through their regular Part D coverage for another reason, and must meet specific clinical criteria tied to body mass index and certain health conditions. A doctor must submit a prior authorization confirming the medication is being used for weight reduction and maintenance along with lifestyle changes. Those with type 2 diabetes, moderate-to-severe sleep apnea, or certain liver conditions are generally pointed toward regular Part D coverage instead.
This is a temporary demonstration, not a permanent change to Medicare’s long-standing limits on covering weight-loss drugs. Anyone considering these medications should talk with a physician about whether they make medical sense and then confirm the current eligibility rules before assuming coverage is available.
Premiums and deductibles set the baseline cost of staying enrolled in Medicare. A $17.90 rise in the standard Part B premium may look small on its own, yet it adds up with other costs and can affect monthly cash flow, especially for people on fixed incomes. The Part B deductible of $283 has to be met before most outpatient services begin sharing costs at the usual 20 percent coinsurance rate.
The $2,100 Part D out-of-pocket maximum creates a predictable ceiling that did not exist in earlier program designs. That predictability helps with financial planning for people who rely on expensive medications. At the same time, it does not remove the need to compare formularies, pharmacy networks, and utilization management rules across plans.
Enrollment windows decide when changes can be made without penalty. Missing the Annual Enrollment Period or waiting too long during an Initial Enrollment Period can lock someone into coverage that no longer fits or trigger late-enrollment penalties. The Medicare Advantage Open Enrollment Period gives a limited second chance for those already in Advantage plans, but the options are narrower.
Choice itself carries responsibility. Medicare Advantage plans often advertise extra benefits such as dental, vision, hearing, or fitness programs. Original Medicare paired with a Medigap policy generally offers broader provider access and more predictable cost-sharing once the Medigap plan is in place. Neither path is automatically better. Each involves trade-offs around network limits, prior authorization, referral rules, and the amount of out-of-pocket risk a person is willing to carry.
Small, deliberate actions reduce the chance of surprise bills and poorly timed decisions later. These steps are practical and can be handled in a short stretch of focused time.
1. Read the handbook summary.
Start with the official Medicare & You 2026 materials on Medicare.gov. Confirm the premium, deductible, and out-of-pocket figures that apply to your situation. Note any IRMAA notices if your income sits above the standard thresholds. The handbook is written for beneficiaries and is meant to be readable.
2. Put the enrollment dates on your calendar.
If you are approaching age 65, mark the exact start and end of your Initial Enrollment Period. If you are already enrolled and thinking about a change, mark October 15 through December 7 now. Write the dates down or set a digital reminder. Waiting until the final days of an enrollment window raises the chance of incomplete comparisons or rushed choices.
3. Check your current drug coverage.
Make a list of the medications you take regularly. Compare that list against the formulary of your current Part D or Medicare Advantage plan and against one or two alternatives. Confirm preferred pharmacies and any prior authorization or step-therapy requirements. The $2,100 out-of-pocket maximum is helpful, but only for drugs the plan actually covers.
4. Ask about new programs if they apply to you.
If GLP-1 medications for weight management are under consideration, talk with your physician about whether they make sense medically. Then confirm whether the Medicare GLP-1 Bridge criteria appear to be met. Eligibility is specific and requires prior authorization. Do not assume coverage simply because a drug is widely discussed.
5. Build a short comparison checklist.
When you look at plans, use the same five items each time: monthly premiums (including any IRMAA), deductibles and maximum out-of-pocket limits, network and referral rules, prior authorization practices, and telehealth access. Writing these five points down and filling them in side by side for two or three options reduces the chance that marketing language will overshadow the practical differences.
These steps are modest. Taken together they lower the odds of later stress, unexpected costs, and decisions made under time pressure. They also keep open the ability to choose coverage that matches actual health needs and financial circumstances rather than defaulting to whatever plan arrived in the mail.
The 2026 handbook materials include updated telehealth language. Certain temporary flexibilities were noted as running through January 30, 2026 in the printed documents available at the start of the year. Later legislative and regulatory actions have continued to shape what is available. It is wise to verify the current rules for the specific service and location in question, because originating-site requirements, provider types, and audio-only allowances can differ by service category and by whether the care is behavioral health or general medical.
Telehealth can be a convenient option for follow-up visits, medication management, and certain chronic-care check-ins. It is not a substitute for every in-person evaluation. Confirming coverage in advance helps avoid unexpected bills.
• The standard Part B premium for 2026 is $202.90 and the annual deductible is $283. Most people still pay $0 for Part A.
• The Part D out-of-pocket maximum is $2,100. Once that amount is reached for covered drugs, the plan pays 100 percent for the rest of the year.
• The Medicare GLP-1 Bridge is a temporary program that offers certain weight-loss medications for $50 a month to people who meet specific clinical and plan criteria.
• Enrollment timing still matters. The Annual Enrollment Period runs October 15 through December 7. Missing key windows can limit options or create penalties.
• The most useful Medicare decisions are usually the quiet ones made with accurate information and enough time to think.
2026 Medicare Parts A & B Premiums and Deductibles
https://www.cms.gov/newsroom/fact-sheets/2026-medicare-parts-b-premiums-deductibles
Medicare & You 2026 Handbook
https://www.medicare.gov/publications
Your Medicare in 2026 Fact Sheet
https://www.medicare.gov/publications/12229-your-medicare-in-2026-what-you-need-to-know.pdf
Medicare GLP-1 Bridge Program
https://www.cms.gov/medicare/coverage/prescription-drug-coverage/medicare-glp-1-bridge
For Journalists, Editors & Publishers
Everything you need for editorial reference is below. Use ready-to-quote expert commentary, key facts for reporting, and citation and source-reference tools related to this article.
These comments are available for editorial use with attribution to Matt Maresch, NSSA®, CLTC®, Senior Healthcare Planning. Each Copy Quote button includes the quote, attribution, and source link.
“Medicare is not a set-it-and-forget-it decision. Premiums, drug costs, formularies, and plan rules can change from year to year, so an annual review can help people avoid expensive surprises.”
Matt Maresch, NSSA®, CLTC® · Senior Healthcare Planning
“The $2,100 Part D out-of-pocket maximum gives Medicare beneficiaries a clearer ceiling on covered prescription drug spending, but it does not replace the need to check formularies, pharmacies, and prior authorization requirements.”
Matt Maresch, NSSA®, CLTC® · Senior Healthcare Planning
“There is no universally best Medicare path. The right choice depends on doctors, prescriptions, networks, prior authorization, expected costs, and how much out-of-pocket risk a person is comfortable taking.”
Matt Maresch, NSSA®, CLTC® · Senior Healthcare Planning
Quick reference points from the article for reporting and editorial research.
Use the citation below when referencing this article in published work.
Maresch, Matt, NSSA®, CLTC®. “Medicare and You 2026: What changed, what it costs, and what to do next” Senior Healthcare Planning. August 17, 2026. https://seniorhealthcareplanning.com/newsletter/medicare-and-you/
Editorial note: Please retain attribution when quoting expert commentary. Medicare premiums, deductibles, drug costs, enrollment rules, and program details can change, so time-sensitive information should be checked against current official guidance before publication.
Information current as of August 2026. Always verify details with Medicare.gov or 1-800-MEDICARE for your specific situation.
