Medicare Changes in 2026: What Lawrence Residents Need to Know

The Short Version

Medicare changed meaningfully in 2026. The standard Part B premium rose to $202.90 a month, the Part D out-of-pocket maximum held at $2,000, and a handful of smaller updates affect how Lawrence seniors pay for care this year. Here is what actually matters, in plain English.

If you want to skip the details and just talk through what the changes mean for your specific situation, call me at (785) 843-0288. No cost, no pressure.

What Changed in 2026

CMS released the 2026 Medicare figures in November 2025. Five changes are worth your attention.

1. The Part B Premium Went Up

The standard monthly Part B premium is now $202.90. That is a $17.90 increase from the 2025 premium of $185.00, or roughly a 9.7% jump.

Most Lawrence seniors have this premium deducted directly from their Social Security check. The 2.8% cost-of-living adjustment to Social Security will cover the Part B increase for most beneficiaries, but it does eat into the COLA. A Lawrence retiree getting the average Social Security check will see about $56 more per month from the COLA, and roughly $18 of that gets absorbed by the higher Part B premium.

Higher-income beneficiaries pay more. The Income-Related Monthly Adjustment Amount, or IRMAA, applies to individuals with modified adjusted gross income above $109,000 or married couples filing jointly above $218,000. The 2026 IRMAA tiers range from $284.10 up to $689.90 per month for Part B. These figures are based on your 2024 tax return.

2. The Part B Annual Deductible Increased

Your annual Part B deductible is now $283, up from $257 in 2025. This is the amount you pay out of pocket before Medicare starts sharing costs on outpatient services like doctor visits and lab work.

For most Lawrence residents this deductible gets hit quickly in the calendar year, especially if you have a chronic condition or see a specialist at LMH Health or KU Medical Center. If you carry a Medicare Supplement plan (Medigap Plan G, for example), the deductible is the only out-of-pocket cost you pay before the supplement covers the rest.

3. The $2,000 Part D Out-of-Pocket Cap Continues

The Inflation Reduction Act capped annual out-of-pocket prescription drug costs at $2,000 for 2026. This is the single biggest financial protection Medicare has added in years.

Before this cap, Lawrence seniors on expensive specialty medications could spend $10,000 or more per year out of pocket. Now, once your prescription spending reaches $2,000 in a calendar year, your Part D plan covers the rest for the remainder of the year.

The cap applies across all Part D plans, whether standalone or integrated into a Medicare Advantage plan. Insulin remains capped at $35 per month, and covered vaccines are still $0.

4. Part A Hospital Costs Rose Slightly

If you are hospitalized in 2026, the Part A inpatient deductible is now $1,736, an increase of $60 from 2025. Daily coinsurance for days 61 through 90 is $434, and lifetime reserve days cost $868 per day.

Most Lawrence seniors never pay the full Part A deductible because they are hospitalized rarely and for short stays. But if you have a serious hospitalization, a Medigap plan that covers Part A deductibles is worth a lot.

5. Medicare Advantage Plans Changed Benefits

Medicare Advantage plans operate on an annual contract cycle. Your plan sent you an Annual Notice of Change by September 30, 2025, outlining what would be different in 2026. Common changes include:

• Shifts in drug formularies (which medications are covered and at what tier)
• Network adjustments (which doctors, hospitals, and pharmacies are in-network)
• Benefit changes (dental, vision, hearing, over-the-counter allowances)
• Premium and copay updates

If you did not review your ANOC before Annual Enrollment Period closed on December 7, 2025, you may be on a plan that is slightly different from the one you signed up for. The Medicare Advantage Open Enrollment Period runs from January 1 through March 31 each year, giving you one opportunity to switch to a different Medicare Advantage plan or switch back to Original Medicare.

What These Changes Mean For Lawrence Seniors Specifically

The national averages matter less than what happens to your monthly budget in Lawrence, Kansas. Here are three specific situations worth thinking through.

If You Are On Original Medicare Plus Medigap

Your Part B premium just went up $17.90 per month. Your Medigap premium may have also increased at your plan's annual renewal. Together, you might be looking at $20 to $40 more per month in 2026 than you paid in 2025.

The good news is that your Medigap plan still covers most of what Medicare does not, and your out-of-pocket risk remains predictable. If your Medigap premium increase is larger than you expected, it is worth comparing rates across carriers. Under the Kansas Department of Insurance rules, all Medigap plans of the same letter (Plan G from Carrier A equals Plan G from Carrier B) cover the same benefits. The only difference is price.

Shopping Medigap often requires medical underwriting after your initial enrollment window, so it is worth having a real conversation before you switch.

If You Are On A Medicare Advantage Plan

Check your Annual Notice of Change. If your doctors at LMH Health or KU Med, your preferred pharmacy in Lawrence, or your prescription medications were affected, you have until March 31, 2026, to switch plans during the Medicare Advantage Open Enrollment Period.

The most common Lawrence scenario I see is a drug getting moved to a higher tier, which means it costs you more per fill. A quick review of your first 2026 pharmacy receipt versus your 2025 receipts tells you whether anything material changed.

If You Are Turning 65 In 2026

You are entering Medicare at a historically good moment. The $2,000 Part D out-of-pocket cap and expanded preventive care benefits make 2026 a better year to start Medicare than 2022 or 2023 was.

Your Initial Enrollment Period is a 7-month window around your 65th birthday. The enrollment timing calculator on our homepage shows your exact window. If you miss it without creditable employer coverage, the Part B late enrollment penalty adds 10% to your premium for every 12 months you delayed, and that penalty is permanent.

What Has NOT Changed

A few rules often confuse seniors, and these remained the same in 2026.

The Annual Enrollment Period is still October 15 through December 7. The Medicare Advantage Open Enrollment Period is still January 1 through March 31. The Initial Enrollment Period around your 65th birthday is still 7 months. The 6-month Medigap Open Enrollment Period after you first enroll in Part B at 65 is still 6 months.

The 10% Part B late enrollment penalty per 12 months delayed has not changed and is still permanent. The 1% Part D late enrollment penalty per month delayed, added to your premium for life, also has not changed.

The federal Extra Help program and Kansas Medicaid (KanCare) continue to assist low-income seniors with premiums and drug costs. Eligibility thresholds adjust annually but the programs themselves remain.

The Practical 2026 Checklist for Lawrence Seniors

1. Check your first 2026 Social Security deposit to confirm the new Part B premium is deducted correctly
2. Review your first pharmacy receipt of 2026 against your last 2025 receipt and note any cost changes
3. Verify your primary care doctor, specialists, and pharmacy are still in-network if you have Medicare Advantage
4. If you have Medigap, file any 2026 bills you receive from LMH Health or KU Med through your plan as usual
5. Put October 15 on your calendar for the next Annual Enrollment Period review
6. If you are turning 65 this year, start your Initial Enrollment Period planning at least 3 months before your birthday month

Questions I Hear Often

Should I switch from Original Medicare to Medicare Advantage because of the premium increase?

Probably not just because of that. Medicare Advantage and Original Medicare are different coverage structures with different trade-offs. The $17.90 monthly premium increase is the same on both paths, and the decision should come down to doctor access, drug coverage, and whether you want predictable costs. I walk through this with every client during a consultation.

Why did my Part D premium change?

Part D plan premiums are set by individual insurance companies, not by CMS. Your 2026 premium reflects the carrier's projected costs for the upcoming year. Some plans raised premiums, some lowered them. If your premium jumped significantly and you did not review your ANOC, you may want to use the Medicare Advantage Open Enrollment Period to reconsider.

What if I cannot afford the new Part B premium?

If your income is limited, the Medicare Savings Programs administered through Kansas Medicaid can pay all or part of your Part B premium. Douglas County seniors should contact KanCare or the Kansas Department for Aging and Disability Services to see if they qualify. The SHICK program provides free, unbiased counseling on these programs.

Do the 2026 changes affect Final Expense insurance or Medicare Supplement?

No. Final Expense is separate from Medicare. Medicare Supplement (Medigap) plans are standardized by the federal government, so the coverage itself does not change. Individual carrier premiums reset each year. Kansas Department of Insurance reviews and approves all Medigap rate filings.