2026 Medicare Changes in Indiana: What Seniors Need to Know
- Eric Han
- Jan 12
- 3 min read
As we move into 2026, several important Medicare changes are taking effect that will impact healthcare costs, prescription coverage, and plan flexibility for seniors across Indiana. Staying informed about these updates can help you avoid unnecessary expenses and make the most of your Medicare benefits this year.
At Woodside Internal Medicine, we believe understanding how Medicare works alongside your medical care is an important part of staying healthy and financially protected.
1. Indiana’s New Medigap “Birthday Rule”
One of the most significant updates for Indiana residents is the launch of the Medigap Birthday Rule, effective January 1, 2026.
If you already have a Medicare Supplement (Medigap) plan, you now have a 60-day window starting on your birthday to switch insurance companies for the same lettered plan (for example, Plan G to Plan G).
Why this matters
Previously, switching Medigap plans often required medical underwriting, which could lead to denial or higher premiums based on health history. Under the Birthday Rule:
You can switch to a lower-cost insurer
No medical underwriting is required
Your existing health conditions cannot be used against you
Practical tip
Review your Medigap premium about 30 days before your birthday to see if a comparable plan is available at a lower cost.
2. New $2,100 Annual Cap on Prescription Drug Costs
Another major change comes from updates to Medicare Part D prescription coverage.
For 2026, there is a hard cap of $2,100 on annual out-of-pocket prescription drug costs.
How this works
Your deductible, copays, and coinsurance all count toward the $2,100 limit
Once you reach that amount, you pay $0 for covered medications for the rest of the year
Important consideration
The standard Part D deductible has increased to $615, meaning some patients may notice higher medication costs early in the year before reaching the cap.
If you take multiple or high-cost medications, this change can offer substantial financial protection over the course of the year.
3. Lower Costs for Certain High-Cost Medications
For the first time, Medicare has negotiated lower prices on several commonly prescribed, high-cost medications. If you take one of these drugs, you may notice reduced out-of-pocket costs in 2026.
Affected medications include:
Blood thinners
Eliquis
Xarelto
Diabetes and heart medications
Jardiance
Januvia
Farxiga
Entresto
Fiasp / NovoLog
Arthritis and autoimmune conditions
Enbrel
Stelara
Blood cancers
Imbruvica
If you’re on any of these medications, it’s worth reviewing your Part D coverage and discussing medication planning during your visit.
4. Medicare Part B Premium and Deductible Updates
Medicare Part B, which covers office visits, outpatient services, and preventive care, has also been adjusted for 2026.
Standard monthly premium: $202.90
Annual deductible: $283
Most preventive services, including annual wellness visits and many recommended screenings, continue to be covered with no out-of-pocket cost when Medicare guidelines are followed.
How to Prepare for 2026 at Woodside Internal Medicine
With these Medicare changes, a plan that worked well in 2025 may not be the best fit in 2026. We recommend:
Confirming provider access: Make sure your preferred physicians and specialists remain in-network
Using the Medigap Birthday Rule if applicable to reassess premiums
Reviewing medications annually to understand cost changes and alternatives
Staying up to date on preventive care, which remains a key benefit of Medicare
The Bottom Line
Medicare changes in 2026 bring new opportunities to reduce prescription costs and gain flexibility with supplemental coverage — especially for Indiana seniors. Staying proactive and informed can help you avoid surprises and focus on what matters most: your health.
If you have questions about preventive care, medications, or how these Medicare updates affect your healthcare, we’re happy to discuss them during your visit.
Woodside Internal Medicine proudly serves patients throughout Carmel, Zionsville, Westfield, Fishers, and the northern Indianapolis area, providing personalized primary care with a strong focus on prevention, chronic disease management, and long-term health planning. Whether you’re preparing for your annual Medicare wellness visit or have questions about how your coverage fits into your care, our team is here to help.
Contact Woodside Internal Medicine today to schedule your annual wellness visit and stay proactive about your health in 2026.
This article is for educational purposes only and is not intended to provide insurance or financial advice. Medicare coverage and costs vary by individual plan. Please consult your insurance provider or a licensed Medicare advisor for plan-specific guidance.