2026 Medicare Changes in California: What's New (and What It Costs)

The headline change: a $2,100 cap on Part D drug costs

The most meaningful 2026 change for many people is in Part D prescription drug coverage. There is now an annual cap of $2,100 on what you pay out of pocket for covered drugs. Once your true out-of-pocket spending reaches that amount, your Part D plan covers 100% of your covered prescription costs for the remainder of the year. For Californians who take expensive or specialty medications, this can make yearly drug costs far more predictable than in the past. Separately from the cap, adult vaccines like shingles remain $0 under Part D, with no copay or deductible.

If even the capped amount is hard to manage all at once, the Medicare Prescription Payment Plan lets you spread your out-of-pocket Part D costs across the year in monthly payments instead of paying large amounts at the pharmacy counter. It does not lower your total cost, but it can smooth out the timing. Any Part D or Medicare Advantage plan with drug coverage must offer this option.

2026 Medicare costs at a glance

Most people pay the standard Part B premium, and many have it deducted directly from their Social Security benefit. The figures above are the national amounts that apply in California just as they do everywhere else.

Higher-income beneficiaries: IRMAA in 2026

If your income is above certain levels, you pay an extra amount on top of the standard Part B and Part D premiums. This surcharge is called the Income-Related Monthly Adjustment Amount, or IRMAA. In 2026, the surcharge begins to apply once income is above $109,000 for a single filer or $218,000 for a married couple filing jointly. The exact amount you pay increases in steps as income rises.

IRMAA in 2026 is based on the income reported on your 2024 tax return, since Social Security looks back two years. If your income has dropped since then because of a life event such as retirement, you can ask Social Security to reconsider using a more recent year.

What's specific to California

The federal cost changes above are the same across the country, but a few things work differently for California residents:

• The Birthday Rule: California gives Medicare Supplement (Medigap) policyholders a 60-day window each year, starting on your birthday, to switch to another Medigap plan with equal or lesser benefits without medical underwriting.
• Medi-Cal: Californians who qualify for both Medicare and Medi-Cal may have additional help with costs, and may be eligible for Dual Eligible Special Needs Plans (D-SNPs).
• HICAP counseling: California's Health Insurance Counseling and Advocacy Program (the State Health Insurance Assistance Program, or SHIP) offers free, unbiased Medicare counseling statewide.
• Local plan availability: Medicare Advantage and Part D plan choices and provider networks vary by California ZIP code, so the right plan in Los Angeles may differ from the right plan in the Inland Empire or the Central Coast.

What to do during the 2026 Annual Enrollment Period

Medicare plans can change their costs, drug formularies, and provider networks each year, so it is worth reviewing your coverage even if you are happy with it. The Annual Enrollment Period runs October 15 to December 7, when you can join, switch, or drop a Medicare Advantage or Part D plan. A good yearly checklist:

• Read your plan's Annual Notice of Change, which arrives in the fall and lists what is changing for next year.
• Confirm your prescriptions are still covered and your pharmacy is still preferred under the plan.
• Check that your doctors and hospitals remain in network.
• Compare your current plan against other options for your ZIP code before deciding.