New for 2026

Plan Design Changes

In 2026 the maximum out of pocket will be $2100, an increase of $100 over the $2000 limit in 2025. The annual deductible will increase $25 to $615 from $590 in 2025. 

Medicare Prescription Payment Plan

Introduced in 2025 the Medicare Prescription Payment Plan will undergo very minimal changes in 2026. If you elected to participate in the plan in 2025 your enrollment will continue over in 2026 unless you opt out. CMS will require plan sponsors to process opt-out requests within 3 days, instead of the 24 hour turn around time in 2025.

Maximum Fair Price

Beginning January 1, 2026, Medicare will implement the Maximum Fair Price (MFP) program. Under this program, the federal government negotiates lower prices directly with drug manufacturers for a small number of high-cost medications. 

• In 2026, 10 drugs will be subject to MFP.
• MFP replaces privately negotiated rebates with federally set prices.
• Instead of plans paying the full price and waiting months for rebate checks, the savings will now be applied right away—showing up as a lower cost at the pharmacy counter (point-of-sale) for members and as reduced claim      costs for groups.
• The federally negotiated prices will benefit members who pay co-insurance, since their cost is based on a percentage     of the drug’s price. Members who pay a flat co-pay will not see a change.
   

Insulin Costs

For 2026 the $35 insulin cap will change to the lesser of $35 or 25% of the drug’s Maximum Fair Price (MFP) established by the Medicare Drug Price Negotiation Program. This means you will still pay a maximum of $35 per month for your insulin, but you cost may be less if Medicare negotiates a lower price for your specific insulin. 

Adult Vaccine Coverage 

In 2026 Medicare Part D plans must continue to waive deductibles and cost sharing for adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP). The list of vaccines covered will be updated annually. 

Helpful Links

Inflation Reduction Act - Click to leave site

Medicare Prescription Payment Plan (M3P)- Click to leave site