Year-End Medicare Strategy: Reviewing Your Drug List, Coverage Gaps & Costs Before 2026 Kicks In

As 2025 draws to a close, it’s crucial for Connecticut residents to review their Medicare plans and prepare for significant changes coming in 2026. Whether you’re already enrolled or planning to sign up, a proactive approach—guided by a trusted medicare insurance agent CT residents trust—can help you avoid coverage gaps, manage costs, and ensure your prescriptions remain affordable.

Medicare undergoes annual updates that can impact your premiums, deductibles, and drug coverage. For 2026, several key changes will affect both Original Medicare and Medicare Advantage plans, especially regarding prescription drug costs and coverage limits.

Key Medicare Changes for 2026

• Prescription Drug Cost Cap: Out-of-pocket costs for Medicare Part D drugs will be capped at $2,100 in 2026, up from $2,000 in 2025. This cap helps limit your annual spending on covered medications.
• Lower Prices for High-Cost Drugs: Medicare will begin offering negotiated lower prices on 10 widely used, high-cost prescription drugs, making these medications more accessible and affordable for beneficiaries.
• Part D Deductible Increase: The maximum deductible for Part D plans will rise to $615 in 2026.
• Medicare Part B Deductible: The Part B deductible increases to $283 in 2026.
• Medicare Advantage Out-of-Pocket Limit: The in-network maximum out-of-pocket limit for Medicare Advantage plans will decrease slightly to $9,250.
• Automatic Plan Renewal: If you participate in certain payment plans, you’ll be automatically re-enrolled unless you opt out, streamlining plan management.

Medicare Part D plans update their formularies (covered drug lists) annually. Medications you rely on today may change tiers, require prior authorization, or be dropped from coverage in 2026. Review your current prescriptions and compare them against your plan’s 2026 formulary. A medicare insurance agent in CT can help you:

• Identify if your medications remain covered.
• Find alternatives if your drugs are no longer included.
• Estimate your out-of-pocket costs under the new cap.

Coverage gaps can lead to unexpected expenses. Evaluate:

• Network Changes: Providers and pharmacies may change networks each year.
• Plan Benefits: Some Medicare Advantage plans may add or drop benefits, such as dental, vision, or hearing coverage.
• Special Needs Plans: If you’re eligible for both Medicare and Medicaid, new streamlined plans may offer better support starting in 2026.

With new caps and deductibles, it’s important to estimate your total healthcare spending for the year:

• Add up expected premiums, deductibles, and copays.
• Factor in the new $2,100 Part D cap and any changes to your medication costs.
• Consider supplemental coverage (Medigap) to help with out-of-pocket expenses not covered by Original Medicare.

Navigating these changes can be complex. A licensed medicare insurance agent in CT can:

• Compare all available plans for 2026.
• Help you avoid coverage gaps and minimize costs.
• Ensure your plan aligns with your health needs and budget.

• Medicare Open Enrollment: October 15 – December 7, 2025.
• During this period, you can switch plans, add or drop coverage, and update your drug list.

CT Insurance Agency is here to help Connecticut residents make informed decisions about their Medicare coverage. Contact a knowledgeable medicare insurance agent in CT today to review your options and secure the best plan for 2026.

Disclaimer: This blog is for informational purposes only. For personalized advice, consult a licensed Medicare insurance agent in Connecticut.