Every year, Medicare updates bring new costs, benefits, and opportunities for enrollees. For 2026, there are several important changes that will affect premiums, drug costs, and plan options here in San Diego County. Here’s a clear breakdown of what you need to know before the Annual Enrollment Period (October 15 to December 7, 2025).
Medicare Part B Premiums and Deductible Are Rising
The standard Medicare Part B premium is expected to increase to $206.50 per month in 2026 up from $185.00 in 2025. That’s roughly an 11.6% increase from the 2025 premium. Additionally, the Part B annual deductible will increase from $257 to $288. These changes affect everyone on Original Medicare (Parts A & B) and those with Medicare Supplement plans.
Part D Prescription Drug Costs Are Changing
Several adjustments are coming to Medicare Part D:
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The out-of-pocket cap for prescription drugs is increasing to $2,100 in 2026 (up from $2,000 in 2025).
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If your plan has a deductible, the maximum allowed will rise to $615 for the year.
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The $35/month cap on insulin remains in place, and plans cannot apply a deductible to covered insulin products.
- Members who qualify for the Low-Income-Subsidy (LIS) will pay up to $5.10 for generic or preferred drugs and up to $12.65 for brand-name drugs during the initial coverage phase.
- Members enrolled in the Medicare Prescription Payment Plan will be automatically re-enrolled for 2026, provided they remain on the same plan.
These changes are part of the continued rollout of the Inflation Reduction Act, which aims to lower drug costs and make spending more predictable for beneficiaries.
Enhanced Medicare Advantage Options in San Diego
Every year, Medicare Advantage (MA or MAPD) plans adjust their benefits, provider networks, and pricing. For 2026:
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New or enhanced MA/MAPD plans are expected in San Diego County, including some with lower costs for key services or more generous supplemental benefits (like dental, vision, hearing, or transportation).
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Supplemental benefits can change year to year so it’s essential to review your plan’s Annual Notice of Change (ANOC) carefully to understand what’s being added, removed, or adjusted for 2026. You can always ask our HealthyMarks team about any changes to your plan.
Medi-Medi Program Expansion Continues
San Diego County remains part of California’s Medi-Medi Plan Expansion for individuals eligible for both Medicare and Medi-Cal. This includes a Default Enrollment Pilot, which automatically enrolls some full-benefit dual eligibles into aligned Medicare Advantage plans to streamline coverage. This can simplify care for many dual-eligible beneficiaries but it’s important to understand your options and ensure the plan fits your needs. HealthyMarks Medicare is licensed to offer Medi-Medi plans to those who qualify.
How Do I Prepare for my 2026 Medicare Plan?
The Annual Open Enrollment period is the best time to evaluate your options for the coming year. HealthyMarks Medicare is a great resource if you are not sure whether your current plan will meet your needs for 2026. Our team takes the time to reach out to each of our clients to confirm their needs have not changed. For example, if you are taking new medications or you expect major medical needs in the coming year, this is a great opportunity to share these details with your broker and confirm which plans will work for you. Part D Prescription Drug Plans change ever year, so be sure to take advantage of this Open Enrollment Period.
Keaton Marks is the owner and CEO at HealthyMarks including the medicare team. Keaton was born and raised in Encinitas. He often rode his bike through town and to the local beaches like Moonlight. Keaton knows it is important to have a local resource, someone who understands the area, the hospitals and networks of doctors. Keaton is proud to be a local Medicare broker who is able to assist the people in his town when selecting medicare plans.
Keaton believes one thing above all else: “Medicare is confusing… but it doesn’t have to be! That is where HealthyMarks Medicare comes in” Please contact me with any questions.