As retirement trends shift and health care evolves, Medicare is undergoing significant changes in 2025 and 2026 that will impact millions of Americans. From adjustments to Social Security’s full retirement age and cost of living to new cost-saving measures in Medicare coverage, here’s what you need to know to stay informed and be well prepared.
As of May 2025, Americans born in 1960 or later must wait until age 67 for full Social Security Administration (SSA) retirement benefits. This completes a gradual shift from age 65, which was started by the 1983 amendments to reflect longer lifespans and support program solvency. While no new legislation is pending to raise the age further, future changes remain possible.
Benefits can still be claimed at 62, but with a permanent 30% reduction. For instance, a $1,000 monthly benefit at 67 drops to $700 at 62. Waiting until 70 boosts it to $1,240 — a 24% increase.
This change impacts 4.2 million Americans turning 65 in 2025, marking the peak year for retiring Baby Boomers, known as "peak 65."
The cost-of-living adjustment (COLA) is one of SSA's most anticipated annual changes. The 2026 numbers were originally expected on Oct. 15. But the government shutdown that began on Oct. 1 has impacted staffing at the Bureau of Labor Statistics, the agency responsible for releasing key data needed to calculate the COLA, so this year's announcement has been delayed.
The SSA is required to announce the COLA by Nov. 1, but the data used to calculate it will be announced on Oct. 24.
Despite the shift in Social Security’s full retirement age, Medicare eligibility still begins at age 65. Retirees are encouraged to apply for Medicare within three months of their 65th birthday — even if they plan to delay Social Security — to avoid late enrollment penalties.
According to the official U.S. government handbook, Medicare & You 2026, Medicare will focus on affordability and preventive care in the new year.
Medicare will begin covering monthly Advanced Primary Care Management services. These include personalized care coordination and 24/7 access to a care team or provider, helping patients manage chronic conditions and improve overall wellness.
Medicare will also cover a broader range of colorectal cancer screenings, including computed tomography (CT) colonography, supporting early cancer detection and prevention.
In 2026, the annual out-of-pocket cap for individual Part D drugs will be $2,100. After reaching this limit, enrollees pay no copays or coinsurance for covered drugs for the rest of the year.
According to data from the Centers for Medicare & Medicaid Services (CMS), analyzed by Health Payer Specialist, Medicare Advantage Part D premiums will drop 4.5% to $13.22/month, while standalone plans fall 2.2% to $62.86. However, deductibles are rising 38% to $434.47, meaning enrollees will save about $7.56 on premiums but will pay roughly $120 more before coverage begins.
Also, 92.8% of Medicare Advantage plans will include Part D, up slightly from 2025, but plans offering “enhanced” drug benefits — those with better coverage and fewer restrictions — have dropped from 89% to 80%.
You can visit Medicare.gov to get specific costs for original Medicare and Medicare Advantage plans. You can also call the plans you’re interested in to get more details. For help comparing plan costs, contact your State Health Insurance Assistance Program (SHIP). The list of phone numbers in each state is in Medicare & You 2026.
“Original Medicare is covering these 2026 changes at 100%, but if there is any coinsurance, a Medicare Supplement policy would help with the cost share,” says Erin Bueltel, Director of Product Solutions at Wellabe. “A Medicare Supplement plan can help fill gaps between what’s paid by original Medicare and the overall cost of health care treatments. It also helps with charges like copays, deductibles, and coinsurance.”
Other supplemental health insurance plans that can help fill Medicare gaps are Hospital Indemnity, Critical Illness, Short-term Care, and Dental insurance.
“Hospital Indemnity insurance plans are designed to help ease out-of-pocket costs for consumers,” says Ed Croushore, Wellabe’s VP of Product Solutions. “Wellabe has one of the best plans available because its guaranteed issue for anyone aged 60 to 79 years old, and now we’ve made it better by adding our Outpatient Rx rider, which addresses those rising drug costs. It’s another way we’re helping customers be well prepared.”
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Wellabe offers life and supplemental health insurance plans to help you prepare for good days and bad. We’ll always be here to empower you to be well — well prepared, well protected, and well loved.
