Content provided by Nick Byrd, Brady Insurance Group
In 2025, Medicare recipients experienced numerous changes — most of them not for the better. For example, the Medicare Part B premium rose by $10.30 from 2024, bringing it to $185 per month.
Another major change involved capping prescription costs at $2,000 per year. This shift pressured insurance companies, prompting them to raise premiums for Prescription Drug Plans, increase deductibles in Medicare Advantage prescription plans, and adjust co-pays for tier 3 drugs. For example, in 2024, some Aetna plans charged $47 for a tier 3 drug, but in 2025, beneficiaries paid 25% of the retail price. That means a prescription costing $1,000 rose from $47 to $250.
Many insurers also dropped popular benefits such as monthly food cards, co-pay assistance cards, and extra annual funds for vision, dental, and hearing. One popular UnitedHealthcare PPO, for example, dropped its comprehensive dental benefits, retaining only coverage for annual exams.
Looking ahead, there is optimism 2026 will bring fewer disruptions and more benefits for recipients.
A major change came when Dr. Mehmet Oz was confirmed as the new CMS director. He has publicly supported Medicare Advantage plans. On June 23, 2025, Dr. Oz joined HHS Secretary Robert F. Kennedy Jr. for a press conference with insurance executives. During the event, insurers committed to reducing prior authorization requirements, particularly for imaging, physical therapy, and outpatient surgeries.
To improve continuity of care, insurers also pledged to honor existing authorizations when patients switch plans. Additional commitments included real-time responses for prior authorizations, streamlined electronic submissions, and improved communication with patients. Most importantly, they promised that medical professionals — not administrative staff — will handle denial reviews to ensure evidence-based decisions.
These changes are welcome news for both patients and healthcare providers. As the rehabilitation director at a local assisted living facility, I frequently must inform residents we cannot begin their rehab programs without insurance approval. Some authorizations arrive quickly, but others take two to three weeks, which is incredibly frustrating for everyone involved.
More good news: CMS recently announced a 5.06% increase in federal payments to Medicare Advantage plans for 2026. According to Rebecca Pifer of “Healthcare Dive”, the actual increase could reach 7.2% due to risk scoring adjustments. This adds up to an additional $35 billion allocated to Medicare Advantage plans in 2026, compared to a 3.86% increase in 2025.
Signed into law in August 2022 as part of the Inflation Reduction Act, the federal government began negotiating with pharmaceutical companies to lower the prices of 10 high-cost prescription drugs. These reduced prices will take effect in 2026. Medications on the list include Eliquis, Xarelto, Januvia, Jardiance, and Farxiga — prescriptions I frequently see when reviewing clients’ medications. There is hope that these will see significant price drops.
The current administration is also negotiating for “most favored nation” drug pricing, which could further drive down costs in 2026 and beyond. What we do know is that the Medicare out-of-pocket maximum will increase by $100 to $2,100 in 2026.
In summary, Medicare Advantage and Prescription Drug Plans are expected to improve in 2026. Details of the plans will be released on Oct. 1, 2025. Beneficiaries will receive their Annual Notice of Change (ANOC) in September. Be sure to review it and feel free to call me to discuss your Medicare options during the Annual Enrollment Period, Oct. 15 through Dec. 7. You can reach me directly at 765-776-6309 or through Brady Insurance Group at 765-450-4661.
Nick Byrd is a health insurance agent with Brady Insurance Group, specializing in Medicare and Marketplace coverage. He offers in-person and scheduled phone consultations by request and will never call you unsolicited.
