2026 MEDICARE CHANGES
- Ben Murray
- Aug 28, 2025
- 4 min read
Updated: Aug 28, 2025
What every Hoosier on Medicare should know before this year's
AEP - Annual Enrollment Period - Oct 15- Dec 7
Starting in January 2026, a new federal law changes some parts of Medicare. These updates affect who can get Medicare, how doctors are paid, rules for nursing homes, and how the government can negotiate drug prices. None of these changes will take away your Medicare if you are a U.S. citizen or permanent resident, but there are things every Hoosier on Medicare should know.
Why does Medicare change? Medicare isn’t set in stone. Because it’s a federal program, Congress can pass new laws that change who qualifies, how much is paid, and what rules apply. These laws usually move through both the House and Senate, and then the President signs them into law. After that, the Centers for Medicare & Medicaid Services (CMS) writes the detailed rules to put the law into action. That’s why every year, especially after big budget bills, Medicare can look a little different — and why it’s important to check in each fall during Open Enrollment to see what’s new.
1. Who Can Get Medicare (Eligibility Changes)
What’s changing:
Medicare will now only cover:
U.S. citizens and U.S. nationals
Green card holders (lawful permanent residents)
Cuban–Haitian entrants
People from certain Pacific island nations with special U.S. agreements (COFA migrants)
People in other immigration categories (like refugees, asylees, or temporary protected status) will no longer be eligible.
What this means: If you’re already on Medicare and don’t fall into one of those groups, you will get a notice in 2026. Your Medicare will end by January 4, 2027 unless your status changes.
Why it matters for Indiana: This doesn’t affect most Hoosiers, but it’s important to know in case you’re helping a neighbor or family member who immigrated later in life.
2. Doctor Pay Gets a Boost in 2026
What’s changing: Medicare will pay doctors and other clinicians 2.5% more for one year (Jan 1–Dec 31, 2026).
What this means: This helps keep doctors’ offices open and encourages more providers to keep seeing Medicare patients, especially in small towns and rural parts of Indiana.
What you’ll see: Your costs won’t go up from this. But it may make it a little easier to find and keep your doctor in 2026.
3. Medicare Drug Price Negotiation (Orphan Drug Rule)
What’s changing: Medicare is negotiating drug prices for the first time. But under the new law, some rare-disease drugs will be exempt from negotiation as long as they are only approved for those rare conditions.
What this means:
This change starts with the drug list published in 2026, but the new prices from those negotiations won’t show up until 2028.
For now, your drug prices in 2026 stay the same, but fewer drugs may be subject to lower negotiated prices down the road.
Plain talk: If you’re on expensive specialty medications, this might delay savings. It makes it even more important to check your drug plan every fall during Open Enrollment to be sure you’re getting the best deal.
4. Help for Low-Income Medicare Beneficiaries (MSPs)
What’s changing: A rule that was supposed to make it easier for low-income seniors to get help paying for Medicare premiums and copays has been put on hold until 2034.
What this means: The Medicare Savings Programs (MSPs) and Extra Help (for prescriptions) are still available. They’re just not easier to sign up for yet.
Plain talk: If money is tight, you should still APPLY FOR HELP through the state of Indiana— but you’ll likely need someone to walk you through the forms, or ask Ben at Just North of 65 for guidance.
5. Nursing Home Staffing Rules Paused
What’s changing: A federal rule that would have required nursing homes to have more nurses on staff, including a 24/7 registered nurse, is on hold until 2034.
What this means: Nursing homes won’t have to meet those higher standards for many years.
Plain talk: If you or a loved one might need nursing home care, don’t assume staffing levels will improve. Do your homework: check inspection reports, visit the facility, and ask about staffing before making a decision.
Quick Checklist for Indiana Medicare Beneficiaries
This Fall (Oct 15–Dec 7, 2025) – Re-check your Part D or Medicare Advantage plan for 2026. Drug formularies and networks can change every year.
Low-Income? Apply anyway – Even though enrollment isn’t simplified yet, you may still qualify for programs that pay your Part B premium or help with drug costs. Call SHIP (1-800-452-4800).
Ask your pharmacy about payment plans – If you face big drug bills in January, Medicare now allows you to spread them into monthly payments.
If you’re a non-citizen on Medicare – Double-check your status now. You may get a letter in 2026 if you’re affected by the new rule.
If you’re considering nursing home care – Look closely at staffing reports and facility ratings since new federal minimums won’t apply for many years.
Final Word
Medicare is still here for Hoosier seniors and people with disabilities. Most of these changes don’t affect your daily coverage in 2026, but they do shape the future.
The biggest takeaways:
Doctor access may improve in 2026.
Low-income help is still there but not easier to get yet.
Drug price relief for some medicines will come later, not sooner.
Nursing homes won’t see higher staffing rules anytime soon.
At Just North of 65, we’ll keep watching these changes so you don’t have to. If you’d like me to help you or someone you care about figure out the best Medicare route, please reach out to me TODAY! -> CONTACT BEN <-
