1. Vaccines Will Be Free—Even Out of Network

Starting in 2026, Medicare Part D plans must cover all CDC-recommended adult vaccines with zero cost sharing. That means no copay, no deductible, and no out-of-pocket cost—even if you get the vaccine at a pharmacy or provider that’s out of network.

This includes vaccines like:
– Shingles (Shingrix)
– Tetanus and whooping cough (Tdap)
– RSV
– Hepatitis A & B
– Pneumococcal
– And others listed by the CDC’s Advisory Committee on Immunization Practices (ACIP)

What this means for you:
If your doctor or pharmacist recommends a vaccine, you can say yes without worrying about the cost—even if you’re not at your regular pharmacy.

💊 2. Insulin Copays Could Drop Below $35

Since 2023, insulin has been capped at $35/month for all Medicare Part D plans. But starting in 2026, it gets even better.

The new law says your monthly insulin copay will be the lowest of:
– $35,
– 25% of the drug’s negotiated price, or
– 25% of the new Medicare-negotiated Maximum Fair Price (MFP)

Why this matters:
If Medicare successfully negotiates lower prices for your insulin, you could pay less than $35.

📅 3. New Medicare Prescription Payment Plan: Spread Out Costs Monthly

Beginning in 2026, every Medicare drug plan (Part D and Medicare Advantage with drug coverage) will offer a new option called the Medicare Prescription Payment Plan.

Instead of paying large out-of-pocket drug costs all at once, you can:
– Elect to pay in monthly installments
– Avoid sticker shock at the pharmacy
– Still get the medications you need

This is especially helpful for:
– People on high-cost drugs (like cancer meds, injectables, or inhalers)
– Retirees on fixed incomes
– Those who hit the catastrophic coverage limit early in the year

Important: You must opt in to this plan—it won’t be automatic.

👀 What Should You Do Now?

If you:
– Take insulin or any brand-name drugs
– Are confused about which vaccines are covered
– Want to learn more about monthly payment options
– Just want to make sure your current plan is still your best option…

➡️ Now is the time to start planning.

Medicare’s Annual Enrollment Period runs from October 15 to December 7, but reviewing your options ahead of time can save you money and stress later.

📞 Let’s Talk

I help people navigate Medicare and make sense of changes like these every day. If you’re turning 65 soon—or already enrolled in Medicare—I’ll review your current plan and help you understand what’s changing for 2026.

Schedule a free consultation here.