Another year brings significant updates to Medicare, and 2026 is no exception.
From proposed compliance relief like eliminating the 48-hour SOA rule to a groundbreaking weight loss drug pilot program, understanding these updates is key to guiding your clients through their options.
2026 Medicare Costs
As always, Medicare costs are changing in 2026.
Related: 2026 Medicare Parts A & B Premiums and Deductibles
Part B Premium & Deductible Increases
In 2026, the standard Medicare Part B premium is $202.90, an increase of $17.90 from $185 in 2025. This represents a nearly 10% increase and marks the first time the standard premium has exceeded $200.
The Part B deductible is also going up to $283 in 2026, a $26 increase from 2025.
Note: to easily show these costs to your clients, you can download our customizable 2026 Medicare Costs handout:
Part B IRMAA
For about 8% of people with Medicare Part B that have a high income, their Part B premiums will range from $284.10-$689.90 per month.
Part A Costs
Here are some quick Part A cost highlights for 2026:
- 2026 Part A premium: up to $565 per month
- 2026 Part A deductible: $1,736 (increase of $60 from 2025)
- 2026 Part A coinsurance for Days 1-60: $0
- 2026 Part A coinsurance for Days 61-90: $434 per day
- 2026 Part A coinsurance for lifetime reserve days: $868 per day
- Skilled nursing facility daily coinsurance for days 21-100: $217 per day
Most people don't pay a monthly premium for Part A.
For those that paid Medicare taxes for less than 30 quarters, the standard Part A premium is $565 in 2026 (a $47 increase from 2025). And for those that paid Medicare taxes for 30-39 quarters, the standard Part A premium is $295 in 2026.
GLP-1 Weight Loss Drug Coverage Pilot Program
One of the most significant changes for 2026 is the new pilot program that expands Medicare coverage for GLP-1 medications (like Ozempic, Wegovy, Mounjaro, and Zepbound) beyond diabetes and cardiovascular indications.
In November 2025, the Trump administration announced manufacturer agreements that enable Medicare to cover these medications for weight loss at dramatically reduced prices (White House Fact Sheet).
Get all the details here: Wegovy, Ozempic & Medicare: What Agents Need to Know Now
What It Costs
Beneficiaries who qualify will pay a $50 monthly copay for GLP-1 medications, a significant savings from the $900-$1,300 monthly cost without coverage.
Medicare will pay $245 per month for these drugs, down from list prices exceeding $1,000.
Medicare Technology
Integrity has made serious investments in technology to help you produce more and serve your clients more efficiently.
IntegrityCONNECT is an all-in-one platform designed by agents, for agents. This comprehensive platform connects you with your clients and carriers, streamlining every aspect of your workflow from initial contact to application submission.
Agents using IntegrityCONNECT are submitting up to 79% more applications.
Key features include:
- Industry-leading CRM system
- Instant quoting for multiple carriers and products
- Direct eApplication submission
- Mobile app access
- Ask Integrity® AI-powered assistant with voice activation
- Automated marketing tools (emails and texts)
- Built-in compliance protocols
IntegrityCONNECT is available at no cost to all Integrity agents, including New Horizons agents.
Learn more and get started here: 10 Reasons Every Agent Should Start Using IntegrityCONNECT
2026 PDP Changes
Here's what you need to know about the key changes to stand-alone Prescription Drug Plans (PDPs) in 2026 and how they might impact your clients.
Premium Trends
Despite concerns about market stability following the Inflation Reduction Act changes, stand-alone Part D plan premiums are generally decreasing for 2026 (KFF Analysis):
- Average PDP premium: $34.50/month (down $3.81 from 2025)
- MA-PD premium: $11.50/month (down $1.82 from 2025)
CMS took unprecedented action during the 2026 bidding cycle to negotiate with plan sponsors and reject bids with unacceptable premium increases.
The voluntary Part D Premium Stabilization Demonstration continues in 2026, capping premium increases at $50/month for participating plans.
Multiple zero-premium PDPs are available, with beneficiaries having access to up to 6 $0 premium plans depending on location.
Market Consolidation Continues
The number of stand-alone PDPs continues to decline as the market consolidates:
- 2026: 360 plans nationwide (22% reduction)
- 2025: 464 plans
Several major developments shaped the 2026 PDP market:
- Centene discontinued one of three Wellcare PDP options
- Health Care Service Corporation discontinued one of three Cigna PDP options and withdrew from several regions
- Elevance exited the PDP market entirely with Anthem PDPs
Despite this consolidation, beneficiaries in each state still have 8-12 PDP options available, plus Medicare Advantage plans with drug coverage.
Inflation Reduction Act Impact
The Inflation Reduction Act continues to reshape the Part D landscape.
While the $2,100 out-of-pocket maximum (up from $2,000 in 2025) provides meaningful protection for high-cost medication users, it has led to higher premiums across all plans as costs are redistributed among all beneficiaries.
Check out our updated 2026 IRA resources to help you educate consumers on the impacts of the Inflation Reduction Act (IRA) on their Medicare coverage in 2026 and beyond.
2026 Medicare Advantage Changes
Medicare Advantage is always evolving, and 2026 is no different! Here's a quick look at a few of those changes.
Overall Enrollment Expected to Decrease
According to KFF's August 2025 analysis, more than half (54%) of eligible Medicare beneficiaries are enrolled in Medicare Advantage in 2025 (KFF).
However, CMS projects this to decrease to approximately 48% in 2026 (CMS).
Related: Medicare Advantage Highlights For the 2026CY AEP
Premium Trends
The average monthly MA plan premium (including plans with prescription drug coverage and SNPs) is projected to decrease from $16.40 in 2025 to $14.00 in 2026 (CMS).
Even better news: in 2025, three-quarters (76%) of MA enrollees were in plans charging no additional premium beyond the Part B premium (KFF), and this trend is expected to continue in 2026.
New Mid-Year Statement
Starting in 2026, Medicare Advantage plans must send enrollees a "Mid-Year Enrollee Notification of Unused Supplemental Benefits" annually between June 30 and July 31 (Federal Registrar).
This personalized statement lists supplemental benefits each enrollee hasn't used during the first half of the year, including:
- List of unused benefits
- Benefit scope and cost-sharing details
- Instructions for accessing benefits
- Customer service contact information
This creates a perfect opportunity to reconnect with existing clients, help them maximize their plan benefits, and strengthen relationships throughout the year.
Learn more: How to Maximize the New Medicare Advantage Midyear Statement (2025)
Compliance and Market Changes
Looking ahead to 2027, CMS has proposed significant compliance relief for Medicare agents that could take effect October 1, 2026 if finalized (Federal Register CMS-4212-P).
These proposed changes represent some of the most significant regulatory relief agents have seen in years.
Key proposed changes:
- 48-hour SOA rule eliminated - Just need SOA before discussing benefits, not 48 hours in advance; can collect at educational events
- Call recording retention - Drops from 10 years to 6 years
- Educational/marketing separation - 12-hour wait between events eliminated
- Streamlined disclaimers - Not required within 1 minute; SHIP referral language removed
- New SEP - When provider leaves network, beneficiaries can change plans through agents directly
Important Note: These are proposed changes and not yet final. CMS is accepting public comments for 60 days. We'll keep you updated as CMS reviews comments and moves toward final rules.
Learn more: CMS Proposes Major Medicare Compliance Relief for 2027
Indiana Medigap Birthday Rule
Starting January 1, 2026, Indiana joins the growing number of states offering a Medigap birthday rule.
Indiana Medicare Supplement policyholders age 65 and older get an annual 60-day guaranteed issue period beginning on their birthday.
- Guaranteed issue: No medical underwriting required
- Plan type restrictions: Must keep the same plan letter (Plan G to Plan G, Plan N to Plan N)
- Effective date: First day of the month following the member's birthday
- Application timing: Can be signed starting January 1, 2026
This creates an annual opportunity for Indiana seniors to shop for better rates or service without health questions. Clients can switch carriers to reduce premiums while maintaining their existing coverage level.
Get carrier-specific details on our announcement page, which we are updating as new information becomes available.
Medicare Benefit Changes
We have several benefit updates from the 2026 Medicare & You handbook (Medicare.gov):
- Advanced Primary Care Management Services: Medicare now pays for monthly advanced primary care management services where providers coordinate and tailor care to individual needs. Requirements include 24/7 access to care team, comprehensive care management, and management of care transitions. Beneficiaries pay 20% of the Medicare-approved amount (Part B deductible applies).
- Expanded Colorectal Cancer Screenings: Medicare now covers CT colonography (virtual colonoscopy) as a screening option – once every 24 months for high-risk individuals age 45+, or once every 60 months for average risk. No cost-sharing if provider accepts assignment.
- Blood-Based Biomarker Tests: Medicare covers new blood-based biomarker tests for colorectal cancer screening for beneficiaries ages 45-85 who meet specific average-risk criteria. Tests are covered once every 3 years with no cost-sharing.
Conclusion
Medicare continues to evolve, and it's important that we stay on top of those updates so we can educate our clients.
From the new weight loss drug pilot program to rising costs across Parts A, B, and D, 2026 brings significant changes that will impact your clients' healthcare decisions and budgets.
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