What North Carolina Beneficiaries Need to Know About Costs, Coverage, and Network Updates
The 2026 Medicare insurance year brings a mix of welcome cost savings and important changes that beneficiaries need to understand. From lower prescription drug prices to updated premiums and significant network changes in North Carolina, this guide covers what you need to know to make informed decisions about your Medicare insurance coverage. At Broad River Insurance, we’re here to help Western North Carolina navigate these changes with confidence.
Lower Prescription Drug Costs
Negotiated Drug Prices Take Effect
For the first time, Medicare has negotiated directly with drug manufacturers to lower prices on 10 high-cost medications. These negotiated prices took effect January 1, 2026, and are expected to save Medicare beneficiaries an estimated $1.5 billion in out-of-pocket costs. The affected medications treat conditions including diabetes, heart disease, blood clots, and autoimmune diseases. Discounts range from 38% to 79% off previous list prices.
The 10 drugs with new negotiated prices include: Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, and Fiasp/NovoLog insulin products. If you take any of these medications, you may see significantly lower costs in 2026.
Part D Out-of-Pocket Cap: $2,100
The annual out-of-pocket spending cap for Part D prescription drugs continues in 2026 at $2,100 (increased from $2,000 in 2025 due to annual adjustments). Once you reach this limit, your Part D plan pays 100% of covered drug costs for the rest of the year. This cap provides meaningful protection for beneficiaries who take expensive medications.
$35 Insulin Cap Continues
The $35 per month cap on insulin costs remains in effect for 2026. This applies to all insulin products covered under Part D, providing continued relief for the millions of Medicare beneficiaries managing diabetes.
Medicare Prescription Payment Plan
The Medicare Prescription Payment Plan, which launched in 2025, continues in 2026. This program allows you to spread your out-of-pocket drug costs into monthly payments rather than paying large amounts upfront at the pharmacy. If you participated in 2025, you’re automatically re-enrolled unless you opt out. This can help with budgeting, especially for those with higher prescription costs early in the year.
Cost Increases to Be Aware Of
Part B Premium Increase
The standard monthly premium for Medicare Part B will be $202.90 in 2026, an increase of $17.90 from the $185.00 premium in 2025. The annual Part B deductible will also increase to $283 (up from $257 in 2025). These increases reflect rising healthcare costs and projected utilization changes.
For most beneficiaries, Part B premiums are automatically deducted from Social Security benefits. The 2026 Social Security cost-of-living adjustment will help offset some of this increase, but it’s important to factor the higher premium into your budget planning.
Part A Hospital Costs
For beneficiaries who need hospital care, the Part A inpatient deductible for each benefit period will be $1,676 in 2026.
Part D Deductible
The maximum Part D deductible for 2026 is $615, up from $590 in 2025. However, many Part D plans offer lower deductibles or no deductible at all, so your actual costs will depend on your specific plan.
Important Changes for North Carolina Beneficiaries
UNC Health Network Changes
One of the most significant changes for North Carolina Medicare beneficiaries in 2026 involves UNC Health. As of January 1, 2026, UNC Health is no longer in-network with several major Medicare Advantage plans. If you rely on UNC Health doctors and specialists, this change may directly affect your coverage and costs.
If your Medicare Advantage plan is affected and you did not make changes during the Annual Election Period (October 15 – December 7, 2025), you may now face higher out-of-network costs when using UNC Health facilities. However, options may still be available:
- Medicare Advantage Open Enrollment Period: Runs January 1 through March 31, 2026. During this time, you can switch from one Medicare Advantage plan to another, or switch from Medicare Advantage to Original Medicare (and add a Medicare Supplement and Part D plan).
- Special Election Periods: If you used inaccurate provider directory information from Medicare Plan Finder when making your enrollment decision, you may qualify for a special election period to change plans.
Medicare Advantage Supplemental Benefit Changes
CMS has finalized new restrictions on certain supplemental benefits that Medicare Advantage plans can offer. Starting in 2026, plans can no longer cover certain non-health-related items, including some cosmetic procedures and treatments. If you’ve relied on specific supplemental benefits through your Medicare Advantage plan, review your 2026 plan documents to confirm what’s still covered.
Improved Medicare Plan Finder
For the first time, the Medicare Plan Finder tool now includes provider directory information for Medicare Advantage plans. This means you can see which doctors, hospitals, and specialists are in a plan’s network without leaving the Plan Finder website. While this is a helpful improvement, directory information may not always be current, so it’s wise to verify directly with the plan or provider before making enrollment decisions.
Who Should Review Their Medicare Insurance Coverage?
You should schedule a consultation with our team if any of the following apply:
You use UNC Health providers and your Medicare Advantage plan’s network has changed.
You take one of the 10 negotiated drugs and want to understand how the new prices affect your specific plan.
You’re considering switching from Medicare Advantage to Original Medicare (or vice versa) during the Open Enrollment Period.
Your prescription costs are high and you want to explore whether the Medicare Prescription Payment Plan could help.
You’re turning 65 and need help understanding your Medicare insurance options.
You want to compare Medicare Supplement (Medigap) policies to find coverage that works for your healthcare needs and budget.
Key Medicare Insurance Dates for 2026
January 1 – March 31, 2026: Medicare Advantage Open Enrollment Period. Switch MA plans or move to Original Medicare.
October 15 – December 7, 2026: Annual Election Period for 2027 coverage. Compare and change Medicare Advantage and Part D plans.
Year-round: Special Election Periods may be available based on qualifying circumstances.
How Broad River Insurance Can Help
Since 2005, Broad River Insurance has been helping Western North Carolina residents navigate Medicare insurance decisions.
Our services are available at no obligation to you. We’re here to provide guidance and support as you make important decisions about your Medicare insurance coverage.
Schedule Your Consultation
Have questions about how 2026 Medicare insurance changes affect you? Contact Broad River Insurance today to schedule a no-obligation consultation with one of our licensed insurance agents.
Broad River Insurance is an independent authorized agency licensed to sell and promote Medicare insurance products from Blue Cross NC and other major carriers. We do not charge for our services. Blue Cross NC is an independent licensee of the Blue Cross and Blue Shield Association. The information provided here is for educational purposes and does not constitute legal or tax advice. Medicare insurance benefits, costs, and availability depend on individual circumstances and may vary by plan and location.