Medicare Changes for 2026: What Every Florida Senior Needs to Know

If you're on Medicare — or about to turn 65 — 2026 brings some of the most significant changes to the program in years. Some of them will save you real money. Others could catch you off guard if you're not paying attention.

I've been helping Florida seniors navigate Medicare for years, and I want to cut through the noise and tell you exactly what changed, what it means for your wallet, and what you should do about it.

This is the headline change for 2026, and it's genuinely good news.

For the first time ever, Medicare Part D (prescription drug coverage) has a hard out-of-pocket cap of $2,000 per year. Before this change, there was no true ceiling — seniors in the "catastrophic" phase of coverage could theoretically spend thousands more.

• Once you've paid $2,000 in covered drug costs in 2026, your plan pays 100% for the rest of the year
• The old "donut hole" (coverage gap) is effectively eliminated
• If you take expensive specialty medications, this could save you thousands annually

The $2,000 cap applies to covered drugs on your plan's formulary. If your medication isn't covered, it doesn't count toward the cap. This is why reviewing your formulary every year during Open Enrollment (October 15 – December 7) is so important.

2026 has seen more Medicare Advantage plan exits and network changes than we've seen in recent years. Several major carriers reduced their service areas or pulled out of certain Florida counties entirely.

• Some plans that were available in 2025 are no longer offered in 2026
• Network rosters changed — doctors and hospitals that were in-network last year may not be this year
• Out-of-pocket maximums shifted on many plans

If you stayed on your 2025 Medicare Advantage plan without reviewing it during Open Enrollment, you may be on a plan with a higher out-of-pocket maximum, a narrower network, or a formulary that no longer covers your medications at the same tier.

If you didn't review your plan last fall, it's not too late to act. The Medicare Advantage Disenrollment Period runs January 1 – March 31 each year, allowing you to switch to Original Medicare (and add a Medigap plan) or switch to a different Medicare Advantage plan.

The standard Medicare Part B premium for 2026 is $202.90 per month — up from $174.70 in 2025. The Part B annual deductible is $283.

Higher-income beneficiaries pay more through IRMAA (Income-Related Monthly Adjustment Amount). If your income was above $106,000 (individual) or $212,000 (joint) in 2023, you're paying a surcharge on top of the standard premium.

If your income dropped significantly since 2023 (retirement, loss of a spouse, etc.), you can appeal your IRMAA surcharge using Form SSA-44. I help clients with this regularly — it's worth doing.

Most people don't pay a Part A premium (you earned it through work history), but the cost-sharing changed:

• Inpatient hospital deductible: $1,736 per benefit period (up from $1,632 in 2025)
• Days 1–60: $0 coinsurance
• Days 61–90: $419/day coinsurance
• Lifetime reserve days: $838/day

This is why having a Medigap plan or Medicare Advantage with a low out-of-pocket maximum matters so much — a long hospital stay can be financially devastating without supplemental coverage.

Medigap (Medicare Supplement) plans themselves haven't changed structurally — Plans G, N, and others cover the same benefits they always have. But premiums have increased for most carriers in Florida.

If you've been on a Medigap plan for several years, your premium has likely gone up 5–15% or more. Many of my clients are surprised to learn they can shop for a lower rate with a different carrier for the same Plan G coverage — the benefits are standardized by law.

The catch: Switching Medigap plans typically requires medical underwriting (health questions). If you have significant health conditions, you may not qualify for a new plan. The time to shop is when you're healthy.

One of the most common questions I'm getting in 2026: "Does Medicare cover Ozempic or Wegovy?"

Here's where things stand:

• For Type 2 diabetes: GLP-1 drugs like Ozempic and Mounjaro are typically covered under Part D (check your plan's formulary and tier)
• For weight loss only: Medicare Part D still does not cover GLP-1 drugs prescribed solely for obesity/weight management — though this may change in future years
• Medicare Advantage: Some plans have added limited GLP-1 coverage for weight management as an extra benefit — check your specific plan

If you're paying out of pocket for a GLP-1 drug, ask your doctor about manufacturer savings programs, which can significantly reduce costs for Medicare beneficiaries.

Even with all these changes, the enrollment windows haven't changed:

• Initial Enrollment Period: 7-month window around your 65th birthday (3 months before, month of, 3 months after)
• Annual Enrollment Period (AEP): October 15 – December 7 each year (changes take effect January 1)
• Medicare Advantage Open Enrollment: January 1 – March 31 (switch MA plans or return to Original Medicare)
• Special Enrollment Periods: Triggered by life events (losing employer coverage, moving, etc.)

Missing your Initial Enrollment Period can result in permanent late enrollment penalties on Part B and Part D. These penalties follow you for life — don't let that happen.

Here's my practical checklist for 2026:

1. Review your current plan's formulary Log in to your plan's website or call member services. Make sure your medications are still covered at the same tier. If they moved to a higher tier, you may be paying significantly more.

2. Check your network Confirm your primary care doctor, specialists, and preferred hospital are still in-network. This is especially important if you have a Medicare Advantage HMO.

3. If you're on Medigap, shop your rate If you're healthy and your premium has increased substantially, it may be worth applying for a new plan with a different carrier. The benefits are identical — only the price and company differ.

4. If you missed Open Enrollment, you still have options The Medicare Advantage Open Enrollment Period (January 1 – March 31) lets you make one switch. If you're outside that window, a Special Enrollment Period may apply depending on your situation.

5. Talk to an independent broker I'm not captive to any insurance company. I represent all the major carriers in Florida and can compare every plan available in your county — at no cost to you. My fee comes from the insurance company, not from you.

2026 brings real improvements (the $2,000 Part D cap is a genuine win for people on expensive medications) alongside real risks (Medicare Advantage network changes, rising premiums). The seniors who come out ahead are the ones who review their coverage every year and don't assume last year's plan is still the best fit.

If you have questions about your specific situation, I'm here to help. There's no pressure, no sales pitch — just straight answers from someone who does this every day in Northeast Florida.

Schedule a free Medicare review →

Related guides:

• Medicare Advantage plans in Florida
• Medicare Supplement (Medigap) plans in Florida
• Medicare Part D prescription drug plans
• Turning 65 in Florida — enrollment guide
• Medicare resources for Palm Coast seniors
• Medicare resources for Daytona Beach seniors
• Medicare resources for Jacksonville seniors
• Medicare resources for St. Augustine seniors

William Gray is an independent Medicare broker serving Northeast Florida, including Palm Coast, Flagler County, Volusia County, St. Johns County, Duval County, and Putnam County. He is not affiliated with or endorsed by Medicare or any government agency.