What Big Medicare Changes Are Coming in 2026—And How You Can Prepare Now in Texas

Medicare may feel like alphabet soup sometimes—but 2026 is about to stir the pot in a big way.

Even if you’re happy with your Medicare plan now, new changes to prescription drug coverage, plan structure, and out-of-pocket costs could shake things up—especially for Texans who want to get ahead of rising healthcare costs.

Key Takeaway: Major Medicare changes in 2026 will affect drug prices, coverage caps, and plan options. Knowing what’s coming now helps you make smarter choices this AEP—and next year.

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What’s Actually Changing in 2026?

Here’s what’s already in motion (courtesy of the 2022 Inflation Reduction Act):

💊 1. A $2,000 Out-of-Pocket Maximum for Part D Drugs

Right now, some Texans are shelling out thousands every year for high-cost meds.
Starting in 2026, Medicare Part D will cap your yearly out-of-pocket drug costs at $2,000.

📌 If you’ve ever paid more than $166/month on medications, this will feel like a raise.

📉 2. Drug Price Negotiations—Finally!

For the first time, Medicare can negotiate directly with drug companies to lower prices for high-use medications.

  • Initial list includes drugs like Eliquis, Xarelto, Jardiance

  • More added annually after 2026

  • Could lead to lower premiums and copays for many Texans

🔁 3. Redesign of Part D Plan Structure

Say goodbye to the confusing donut hole, catastrophic coverage, and all those “phases” of Part D.

The new structure is simpler—but it also means plans will change, and not all existing options will stick around.

➡️ Translation: The plan you love now may not exist in 2026. You’ll want to review before it disappears.

Why This Matters for Texas Medicare Beneficiaries

Texas has one of the largest Medicare populations in the country, and we’re lucky to have a wide range of plan options. But with more options comes more complexity—and greater risk of missing out on new savings.

Here’s what makes this especially important:

  • Texas is seeing rising enrollment in Medicare Advantage

  • Prescription drug costs are higher in the South due to certain formularies

  • Many seniors in TX rely on Part D + Medigap combinations that will shift in 2026

What Can You Do Now to Prepare?

You don’t have to wait until 2026 to be proactive. In fact, the best time to prepare is now—before next year’s AEP even opens.

✅ 1. Get a Plan Review This AEP (Oct 15 – Dec 7)

Use this year’s election period to sit down with a local licensed broker (hi, that’s us!).
We’ll help you look at:

  • Your current plan’s 2025 coverage

  • Whether it’s likely to stay available after 2026

  • Ways to switch now to avoid disruption later

✅ 2. Make a Medication List

Let’s identify which drugs you take, and whether they’re on Medicare’s 2026 negotiation list.

This will give you a clearer picture of future savings—or what adjustments might be needed.

✅ 3. Ask About Locking in Rates or Coverage

Some Medigap and prescription plans in Texas offer guaranteed renewability or allow you to lock in lower rates now, before shifts happen in 2026.

People Also Asked

Will my drug prices go down in 2026?

If you take one of the medications on Medicare’s price negotiation list, yes! Plus, the $2,000 out-of-pocket cap will help thousands of Texans save on high-cost prescriptions.

Should I change my plan now to get ahead of 2026?

Maybe! It depends on what you take, what coverage you have now, and how your plan is expected to change. That’s why a quick review is smart during this year’s AEP.

Will all Medicare Part D plans change?

Yes, most plans will update their structure in response to the new law. Some may be discontinued or redesigned entirely. Don't assume your current plan will stay the same.

Let’s Plan Ahead—So 2026 Doesn’t Catch You Off Guard

At Gruene Insurance Group, we’re not just looking at what’s best today—we’re helping you plan for what’s coming.

We’ll keep your doctors, medications, and budget front and center, and help you stay ahead of the shifts. No guesswork. No fluff. Just local Medicare help that makes sense.

📞 Schedule your free Medicare plan review today. We’ll help you prepare for 2026—and feel confident all the way there.

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