Medicare 2026

What's Already Locked In for Medicare in 2028, 2029 and 2030

A new federal law, the Consolidated Appropriations Act, 2026 (Public Law 119-75), was enacted on February 3, 2026. Tucked inside are several Medicare changes that don't kick in right away — they phase in over the next few years. If you're trying to plan ahead, here's a plain-English look at what Congress has already written into law for 2028, 2029 and 2030, plus a quick reminder of where things stand right now.

2028: directories, dual-eligible drug costs, telehealth and pharmacy middlemen

More accurate provider directories in Medicare Advantage. Starting with plan year 2028, Medicare Advantage organizations that use provider networks will have to maintain an accurate online directory. They'll need to verify most providers' information at least every 90 days, verify hospitals and certain facilities at least every 12 months, and remove a provider who has left the network within 5 business days. If you book an appointment with someone the directory shows as in-network and that turns out to be wrong, you'll owe only the lesser of the in-network cost-sharing or whatever cost-sharing would otherwise apply. That's a meaningful consumer protection for anyone who has ever been surprised by an out-of-network bill.

$0 generics for the lowest-income dual eligibles. Beginning with plan year 2028, the Part D copayment for generic drugs drops to $0 for full-benefit dual-eligible individuals — people who have full Medicaid along with Medicare — whose income is at or below 100% of the federal poverty line. Their copays for other drugs will then be adjusted each year by the Consumer Price Index. If you or a family member qualifies, this is worth knowing well before the change takes effect.

Telehealth rules revert on January 1, 2028 unless Congress acts. Medicare's pandemic-era telehealth flexibilities are authorized under current law only through December 31, 2027. And the long-standing requirement that mental health services delivered by telehealth be paired with an in-person visit applies again to services on or after January 1, 2028. Congress has extended these flexibilities before, but as of now the law says they expire — so if you rely on telehealth, keep an eye on this.

New rules for pharmacy benefit managers (PBMs). For plan years beginning on or after January 1, 2028, PBMs working for Part D plans (both stand-alone and Medicare Advantage drug plans) may receive only "bona fide" service fees — flat, fair-market-value payments for itemized services, as described by the Medicare Trustees. PBMs must also report drug data to the plan and to HHS by July 1 of each year, starting in 2028. This is a behind-the-scenes change, but it's intended to make Part D pricing more transparent.

2029: fairer pharmacy contracts and a new cancer-screening benefit

"Reasonable and relevant" pharmacy contract terms. Stand-alone Part D plans already have to let any pharmacy that meets their standard contract terms join their networks. For plan years beginning on or after January 1, 2029, the law requires those contract terms to be "reasonable and relevant" under standards HHS must set by the first Monday in April 2028. The goal is to make it easier for independent and community pharmacies to participate.

Multi-cancer early detection (MCED) blood tests. For tests furnished on or after January 1, 2029, Part B will cover FDA-cleared or FDA-approved multi-cancer early detection screening blood tests that HHS determines — through the national coverage determination process — to be reasonable and necessary. Until the U.S. Preventive Services Task Force gives such a test an A or B grade, Medicare cannot pay for it for people under 50, for people who have reached that year's age limit as of January 1 (65 for 2029, rising by one year each year after), or within 11 months of a previous test. This is a brand-new category of preventive benefit.

2030: hospital-at-home continues

The Acute Hospital Care at Home initiative — which lets certain hospitals deliver inpatient-level care in a patient's home — is extended through September 30, 2030 under the new law. Availability depends on participating hospitals, so this is something to ask about if you're facing a hospitalization.

Meanwhile, here's where 2027 stands

Even with 2028 on the horizon, the near-term numbers matter. For 2027, the Part D out-of-pocket cap rises to $2,400 (up from $2,100 in 2026), and the most any Part D plan may charge as a deductible is $700. The Part D base beneficiary premium — a national figure used to calculate the late-enrollment penalty — is $41.33 for 2027; individual plan premiums are set plan by plan. Annual Enrollment for 2027 coverage runs October 15 – December 7, 2026, with choices taking effect January 1, 2027. And Social Security announced a 3.6% COLA on October 14, 2026 for benefits payable starting January 2027.

Two important 2027 numbers are not yet announced: the Part B standard premium and deductible, and the IRMAA income brackets and surcharges. CMS typically announces these in the fall. Don't rely on estimates — wait for the official figures.

A quick note on choosing coverage

As you look ahead, remember there's no one-size-fits-all answer when comparing Medicare Advantage to Original Medicare paired with a Medigap policy and a stand-alone Part D plan. Each path has trade-offs around networks, out-of-pocket costs, extra benefits, and flexibility to see providers nationwide. What fits one person may not fit another.

If you have Medicaid or Extra Help: since 2025, you have a monthly Special Enrollment Period to move to Original Medicare with a stand-alone Part D plan or switch stand-alone Part D plans. If you're a full-benefit dual-eligible, you can also join an integrated D-SNP in any month.

Where to go for help

For official, up-to-date information — including the 2027 Part B and IRMAA figures when they're released — visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227), available 24 hours a day, 7 days a week. This article is educational only and is not affiliated with any government agency.