CQC raises alarm about higher costs coming in 2026 and educates Medicare beneficiaries on new protections to manage out-of-pocket expenses

WASHINGTON – This October, Consumers for Quality Care (CQC), a coalition of advocates and former policymakers, is marking Health Literacy Month by preparing consumers for significant changes impacting health insurance costs and coverage for 2026. As insurers raise premiums, deductibles, and cost-sharing in both ACA Marketplace and employer-sponsored plans, consumers will face new financial pressures. At the same time, Medicare beneficiaries will gain critical new protections that cap out-of-pocket prescription drug costs and allow them to spread those payments over the year.

“For years, families have told us that the cost of health care is one of their biggest financial worries and in 2026, that pressure is only going to grow,” said Honorable Donna Christensen, CQC board member, physician, and former Member of Congress. “Insurers are increasing costs across the board, leaving working families and small business owners paying more for less coverage. At the same time, Medicare Part D enrollees will see new, long-overdue protections, including a yearly cap and the ability to smooth costs over the year. This Health Literacy Month, Consumers for Quality Care is working to educate patients on what’s coming and equip them with the tools to make the best choices for their health and their financial well-being.”

During Health Literacy Month, CQC is promoting awareness around the following: 

• Rising Costs for Families: In 2026, ACA Marketplace premiums are projected to rise sharply. Employer-sponsored coverage costs are also expected to climb, as insurers shift more expenses to patients through higher deductibles, co-pays, and co-insurance.
• Medicare Part D Out-of-Pocket Cap: Beginning in 2026, Medicare Part D enrollees will pay no more than $2,100 per year for prescription drugs. Once this cap is reached, beneficiaries will not pay additional copays or coinsurance for covered medications for the rest of the calendar year.
• Growing Costs of Medicare Advantage (MA): In 2026, many Medicare Advantage plans are expected to increase premiums and out-of-pocket costs. During open enrollment, seniors should thoroughly go over the specifics of their plan to make sure they are aware of any changes to provider networks, co-pays, deductibles, and monthly premiums.
• Medicare Prescription Payment Plan (“Smoothing”): Beneficiaries may opt into the new payment plan, which spreads prescription drug costs into predictable monthly bills. This helps prevent seniors from facing large pharmacy bills up front and makes expenses more manageable.
• Vaccine Coverage Awareness: Consumers should review their insurance policies to understand what vaccines are covered. Preventive care, including vaccines, is an important part of maintaining health, and insurance companies should continue to make these protections accessible and affordable.
• Consumer Action is Essential: As coverage becomes costlier and more complicated, consumers should not “set it and forget it.” Reviewing options, updating information, and proactively choosing plans during open enrollment will be more important than ever.

With Open Enrollment for 2026 coverage beginning November 1, 2025, CQC is urging families to prepare now. Understanding plan changes and staying informed about new Medicare protections will be critical to avoiding surprise bills and safeguarding access to care.