2026 Medicare changes — what's new this year
Medicare changes every year — premiums, deductibles, plan structures, benefits, and rules all get updated. This guide covers what changed for 2026 and what it means for Hawaii Medicare beneficiaries. Most of the 2026 news is mixed: standard premiums went up, but the Medicare Advantage out-of-pocket maximum actually decreased for the first time in years, and average Part D premiums dropped too.
Quick navigation: The big changes · Full 2026 cost reference · IRMAA brackets · Part D specifics · Telehealth & mental health · D-SNP changes coming in 2027 · Action items for Hawaii beneficiaries
Three big changes worth knowing about
1. The Medicare Advantage out-of-pocket max went DOWN
This is unusual and worth flagging. For years the MA in-network maximum out-of-pocket (MOOP) has crept upward annually. For 2026, CMS lowered the federal cap by $100:
- 2025 MA MOOP maximum: $9,350
- 2026 MA MOOP maximum: $9,250
That's a real improvement for beneficiaries — your worst-case year just got slightly less expensive. Most plans set their MOOP well below the federal max anyway (typical MA MOOPs in Hawaii range $3,000–$7,500), but if you're shopping plans this AEP, you'll see slightly lower ceilings across the board. Note: Part D drug costs do not count toward your MA medical MOOP — those have their own separate $2,100 cap.
2. The $2,100 Part D out-of-pocket cap (up only $100)
The Part D hard cap that started at $2,000 in 2025 ticked up to $2,100 for 2026 — a modest $100 inflation adjustment, not a meaningful cost increase. Once you reach $2,100 in out-of-pocket Part D spending, you pay $0 for covered medications the rest of the year. This is still a transformative change for beneficiaries on expensive medications (cancer drugs, biologics, specialty drugs) — three years ago they would have spent $8,000+ before catastrophic coverage kicked in.
3. Average Part D premiums actually decreased
While individual plan premiums vary widely, CMS projects 2026 averages came down compared to 2025:
- Average stand-alone Part D plan total premium: $34.50/month in 2026 (down $3.81 from 2025)
- Average Part D premium within Medicare Advantage plans: $11.50/month in 2026 (down $1.82 from 2025)
- Part D national base premium (used for late-enrollment penalty calculations): $38.99
Take these as benchmarks, not guarantees — your specific plan's premium depends on the carrier and benefit design. But the trend is unusually positive.
Full 2026 Medicare cost reference
| Cost | 2026 amount | Change from 2025 |
|---|---|---|
| Part B standard premium | $202.90/month | Up $17.90 from $185.00 |
| Part B annual deductible | $283 | Up $26 from $257 |
| Part B IRMAA starts at | $109,000 single / $218,000 joint | Up from $106,000 / $212,000 |
| Part B immunosuppressive drug premium | $121.60/month | Standard |
| Part A hospital deductible | $1,736 per benefit period | Up $60 |
| Part A days 61–90 coinsurance | $434/day | Up $15 from $419 |
| Part A lifetime reserve days (91+) | $868/day | Up $30 from $838 |
| SNF days 21–100 coinsurance | $217/day | Up $7.50 |
| Voluntary Part A — full premium | $565/month | Up $47 |
| Voluntary Part A — reduced premium (30+ quarters) | $311/month | Up $26 |
| Part D max deductible | $615 | Up from $590 |
| Part D out-of-pocket cap (catastrophic) | $2,100 | Up $100 from $2,000 |
| Insulin cap (per 30-day supply) | $35 | Unchanged |
| ACIP-recommended adult vaccines | $0 | Unchanged |
| Average stand-alone Part D premium | $34.50/month | Down $3.81 ▼ |
| Average MA-PD Part D premium | $11.50/month | Down $1.82 ▼ |
| Medicare Advantage in-network MOOP cap | $9,250 | Down $100 ▼ |
| Medigap Plan K out-of-pocket limit | $8,000 | Up |
| Medigap Plan L out-of-pocket limit | $4,000 | Up |
| Medigap high-deductible Plan F/G amount | $2,950 | Up $80 from $2,870 |
Sources: CMS 2026 Parts A & B Premiums and Deductibles announcement (Nov 14, 2025); CMS Final CY 2026 Part D Redesign Program Instructions; CMS K&L Out-of-Pocket Limits Announcement; CMS CY 2026 Rate Announcement.
2026 IRMAA brackets — important if you're higher-income
If your modified adjusted gross income (MAGI) exceeds certain thresholds — based on your tax return from two years prior — you pay an Income-Related Monthly Adjustment Amount on top of the standard Part B and Part D premiums. The 2026 income thresholds increased modestly from 2025, so some beneficiaries who paid IRMAA in 2025 may not in 2026.
| Single MAGI | Joint MAGI | Total Part B premium | Part D IRMAA add-on |
|---|---|---|---|
| $109,000 or less | $218,000 or less | $202.90 | $0 |
| $109,000 – $137,000 | $218,000 – $274,000 | $284.10 | $14.50 |
| $137,000 – $171,000 | $274,000 – $342,000 | $405.80 | $37.50 |
| $171,000 – $205,000 | $342,000 – $410,000 | $527.50 | $60.40 |
| $205,000 – $500,000 | $410,000 – $750,000 | $649.20 | $83.30 |
| Above $500,000 | Above $750,000 | $689.90 | $91.00 |
Roughly 8% of Medicare beneficiaries pay IRMAA. If your income dropped recently — retirement, loss of spouse, work stoppage — you can request an IRMAA reconsideration from Social Security using Form SSA-44.
Hawaii context: EUTF state retirees, federal FEHB retirees, and military retirees with substantial pensions or large RMDs from retirement accounts often hit IRMAA. EUTF reimburses only the standard $202.90 — IRMAA surcharges are paid by the retiree.
Part D in 2026 — what specifically changed
- $2,100 hard cap on out-of-pocket spending — once reached, you pay $0 for covered drugs the rest of the year
- $615 max deductible — many plans charge less, some charge $0 for generics
- $35 insulin cap continues — applies even before you meet the deductible
- $0 ACIP-recommended vaccines — including shingles (Shingrix), RSV, Tdap
- Drug Price Negotiation Program prices take effect — first 10 negotiated drugs (Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, Fiasp/NovoLog insulins) have new "Maximum Fair Prices" in 2026
- Medicare Prescription Payment Plan continues — you can spread Part D out-of-pocket costs in monthly installments instead of paying at the pharmacy. New for 2026: enrollees from 2025 are auto-renewed unless they opt out
For Hawaii residents on multiple medications, the combination of the $2,100 cap and the new negotiated prices could mean substantial savings. Run your specific medication list through Medicare's Plan Finder during AEP — the best plan for you may have changed.
Mental health and telehealth in 2026
Recent expansions in Medicare mental health coverage continue in 2026:
- Marriage and family therapists (MFTs) and licensed mental health counselors (LMHCs) can bill Medicare directly
- Telehealth for behavioral health permanently covered, including audio-only phone visits
- No geographic restrictions on mental health telehealth
- Substance use disorder telehealth permanently covered
Many other COVID-era telehealth flexibilities have been extended through 2026 but require Congressional renewal beyond:
- Home as an originating site for non-mental-health telehealth
- Audio-only telehealth for many services beyond behavioral health
- FQHCs and Rural Health Clinics as distant-site providers
- Expanded list of telehealth-eligible services
For Hawaii's neighbor-island residents who rely on telehealth for specialty care access, watch for late-2026 Congressional action affecting 2027.
D-SNP integration rule — looming 2027 change
Important for dual-eligibles: Starting January 1, 2027, dual-eligible beneficiaries (those with both Medicare and Med-QUEST) must enroll in their D-SNP and their Med-QUEST plan with the same insurer. Hawaii is rolling this out through 2026 — affected beneficiaries should review their plan options before AEP. Carriers will also be required to issue integrated Medicare/Medicaid ID cards and conduct integrated health risk assessments. See our D-SNP guide.
Medicare Advantage marketing rules tightened
Recent CMS rules continue to tighten Medicare Advantage and Part D marketing in 2026:
- Stricter prohibitions on misleading advertisements
- Tighter restrictions on third-party marketing organizations (TPMOs)
- Required scope of appointment forms before sales discussions
- Recording requirements for telephone enrollment
- Limits on cold-calling and unsolicited contact
If you receive Medicare marketing that feels aggressive or misleading, report it to Sage PLUS Hawaii at 1-888-875-9229 or 1-800-MEDICARE.
Immigration and Medicare eligibility — October 2026 change
Federal Medicare eligibility rules narrow starting October 2026. The new rules limit Medicare eligibility for noncitizens to:
- Lawful permanent residents (green card holders)
- Cuban and Haitian entrants
- Citizens of COFA nations (Marshall Islands, Federated States of Micronesia, Palau)
For most Hawaii Medicare beneficiaries — including all U.S. citizens and most lawfully present immigrants — this change has no effect. COFA migrants, a significant population in Hawaii, are explicitly preserved in the new rules. See our COFA migrants guide.
Hawaii Med-QUEST changes affecting dual-eligibles
- February 2026 income limit update — Hawaii updates Med-QUEST limits in February (not January like most states); 2026 limits reflect roughly a 3% increase from 2025
- OBBBA work requirements — Possible eligibility check changes for Medicaid expansion adults; may begin late 2026
- D-SNP / Med-QUEST alignment — Rolling out through 2026 ahead of mandatory 2027 alignment
What hasn't changed but remains important
- The structure of Original Medicare (Parts A and B), Medigap, Medicare Advantage, and Part D remains the same
- Annual Enrollment Period — October 15 through December 7
- Medicare Advantage Open Enrollment Period — January 1 through March 31
- Initial Enrollment Period rules at age 65 — same 7-month window
- Special Enrollment Periods triggered by life events
- Hawaii's Sage PLUS SHIP program for free counseling at 1-888-875-9229
- The 24-month SSDI waiting period for under-65 Medicare (immediate for ALS and ESRD)
Action items for Hawaii Medicare beneficiaries in 2026
- Review your Annual Notice of Change (ANOC) from your current plan — premium, formulary, network changes for 2026
- Use Plan Finder during AEP with your specific medications to compare 2026 plans
- If you have expensive medications, recalculate costs under the $2,100 cap — your best plan may have changed, especially if your medications are now on the negotiated list
- If your income dropped recently, file Form SSA-44 with Social Security to request an IRMAA reconsideration
- If you're dual-eligible, prepare for 2027 D-SNP / Med-QUEST alignment — your insurer for both plans will need to match
- If you use telehealth heavily, watch for late-2026 Congressional action that could affect non-behavioral-health telehealth in 2027
- If you're a COFA migrant or know one, confirm Med-QUEST and Medicare access — 2026 federal changes preserve eligibility but require documentation
- If you're an EUTF retiree, remember EUTF reimburses only the standard Part B premium ($202.90); you absorb any IRMAA surcharge personally
Where to get help in Hawaii
| Resource | Contact |
|---|---|
| Sage PLUS Hawaii (free Medicare counseling) | 1-888-875-9229 |
| 1-800-MEDICARE (federal) | 1-800-633-4227 |
| Med-QUEST eligibility | 1-800-316-8005 |
| Hawaii ADRC (statewide aging) | 643-ADRC (808-643-2372) |
| Find a licensed agent | MedicareAgents.com |
| Compare 2026 plans | PlanMatch.com |
Frequently asked questions
It's a tie between two: the $2,100 Part D out-of-pocket cap continuing (up from $2,000 in 2025) and — unusually — the Medicare Advantage maximum out-of-pocket actually decreasing for the first time in years, from $9,350 to $9,250. Both are beneficiary-friendly.
Mixed. Standard Part B premiums rose nearly 10% to $202.90/month and Part B and A deductibles increased. But the Medicare Advantage MOOP decreased, average Part D premiums actually dropped, and IRMAA income thresholds rose modestly — meaning some higher-income retirees who paid IRMAA in 2025 won't in 2026.
The standard Part B premium is $202.90/month in 2026 — up $17.90 from 2025's $185.00. Higher-income beneficiaries pay IRMAA surcharges on top, ranging from $284.10 to $689.90 depending on income. The Part B annual deductible is $283 for 2026.
IRMAA surcharges begin at $109,000 modified adjusted gross income for individuals and $218,000 for joint filers in 2026 — both up from 2025 thresholds of $106,000 and $212,000. This means some beneficiaries who paid IRMAA in 2025 may not in 2026.
Most plans change benefits, premiums, networks, or formularies year over year. Read your Annual Notice of Change (ANOC) — it lists all 2026 changes for your specific plan. Then compare with new 2026 options during AEP.
The big near-term change is preparing for January 1, 2027, when dual-eligibles must have their D-SNP and Med-QUEST plan with the same insurer. Hawaii is rolling this out through 2026. Talk to Sage PLUS or a licensed agent about whether your plans need to be aligned.
Yes. COFA migrants — citizens of the Marshall Islands, Federated States of Micronesia, and Palau — are explicitly preserved in the October 2026 federal eligibility narrowing. Many other lawfully present immigrant groups lose federal eligibility in October 2026, but COFA migrants remain eligible for both Medicare and Med-QUEST.