A new year often brings fresh routines, new goals, and sometimes even a new Medicare plan. While much of the world continues to change, one thing stays the same: understanding your Medicare coverage can help you start the year with confidence and avoid unexpected costs.
Whether you stayed in the same plan or made a change during the Annual Enrollment Period, here are a few important reminders and helpful tips to keep in mind as we move into the new year.
You May Experience Cost Changes in January
One of the most important things to remember is that Medicare Advantage plans reset many cost-sharing limits at the start of the year.
Medical Maximum Out-of-Pocket (MOOP) amounts reset on January 1
This means that if you have copays and/or coinsurance on your Medicare Advantage plan, your costs for services at the hospital, on doctor’s visits, for outpatient care, and other medically covered services may be higher than what you were paying in January.
Prescription Drug Plan Maximum Out-of-Pocket amounts reset on January 1
The Medicare Part D prescription drug maximum out-of-pocket also resets each January. In 2026, your costs for plan covered drugs are capped at $2,100 for the year. In most cases, once you’ve paid that amount towards your covered drug costs, your plan will pay 100% of covered prescriptions for the rest of the year.
If You Remained on the Same Plan, Your Plan’s Benefits May Have Changed
Each new year, Medicare plans may update their provider networks, prescription formularies, and drug pricing tiers, which can change what medications and doctors are covered—and may result in different out-of-pocket costs than last year.
Planning appointments early in the year can help you manage healthcare expenses more predictably.
Don’t Forget to Use Your Over-the-Counter (OTC) Benefits
If your plan includes over-the-counter (OTC) benefits, now is the time to use them.
Many plans offer allowances for items such as:
• Pain relievers
• Cold and allergy medications
• First-aid supplies
• Dental care items
• Vitamins and wellness products
These benefits are often use-it-or-lose-it, so it’s a good idea to review your plan materials and take advantage of what’s available to you.
Thinking About Changing Plans in January, February, or March?
From January 1 through March 31, Medicare members enrolled in a Medicare Advantage plan have access to the Medicare Advantage Open Enrollment Period.
Here’s an important detail many people don’t realize:
• If you change Medicare Advantage plans during this period, your
medical maximum out-of-pocket amount will start over under the new plan
• However, any prescription drug costs you’ve already paid will carry over
• This helps ensure you don’t lose progress toward prescription coverage thresholds
Because of this reset, it’s especially important to talk through timing and cost considerations before making a change.
Start the Year Informed and Supported
The beginning of the year is a great time to:
• Review your plan benefits. Make sure to read through your plan coverage resources like your Summary of Benefits, Explanation of Benefits, Network Directory, and Formulary Lists.
• Schedule preventive care visits
• Confirm your doctors and prescriptions are still covered
• Ask questions about anything that seems unclear
Medicare rules and benefits can be confusing, but you don’t have to navigate them alone.
We’re Here When You Need Us
If you have questions about your current plan, or just want help understanding your benefits for the year ahead, we’re here to help. A quick conversation now can prevent surprises later.
Here’s to a healthy, informed, and confident start to the new year.