Week of November 9–16, 2025
Medicare continues to shift quickly as Washington ends the shutdown, finalizes 2026 costs, and rolls out major changes to prescription drug coverage. This weekly roundup collects the biggest Medicare stories from trusted sources over the last seven days and breaks down what each update means for your coverage — and your wallet. Read our comprehensive overview of what's ahead for Medicare in 2026.
1. Government Shutdown Deal Extends Medicare Telehealth — For Now
A major part of the agreement to end the federal shutdown includes a short-term extension of Medicare telehealth flexibilities through January 30, 2026. Several outlets including Axios reported that the deal:
- Extends Medicare's ability to pay for telehealth visits outside rural areas
- Allows patients to receive telehealth services from home
- Authorizes retroactive payment for virtual care delivered during the shutdown
- Extends the "hospital-at-home" program
Meanwhile, the Medicare Rights Center and American Medical Association warn that many telehealth claims remain unpaid from the shutdown period, creating uncertainty for both doctors and patients.
What this means for you
- Telehealth remains available, but the extension is temporary.
- Expect more congressional debate about making these flexibilities permanent.
- If you notice delayed billing on recent telehealth visits, it may be tied to the shutdown backlog.
2. CMS Releases Official 2026 Medicare Part A & B Costs
On November 14, 2025, CMS published the official costs for Medicare Parts A and B for 2026.
Key numbers:
- Standard Part B premium (2026): $202.90/month
- Part B deductible (2026): $283
- Updated Part D IRMAA brackets, which now begin at $109,000 (single) and $218,000 (married filing jointly)
What this means for you
- Most beneficiaries will see higher premiums and deductibles in 2026.
- If you are near an IRMAA threshold, even a small increase in taxable income could trigger significant surcharges.
- These numbers matter when evaluating 2026 Advantage and Medigap options.
Related Medicare Updates
3. Major Deal Brings Medicare Coverage for GLP-1 Weight-Loss Drugs
A widely reported White House agreement with Eli Lilly and Novo Nordisk will significantly expand Medicare coverage for GLP-1 medications (Ozempic, Wegovy, Mounjaro, Zepbound).
Key takeaways:
- Medicare will cover GLP-1 drugs prescribed for obesity plus related conditions, not only diabetes.
- Negotiated prices bring the Medicare cost to about $245/month, with beneficiary copays around $50.
- A parallel "TrumpRx" program will offer lower direct-to-consumer pricing for people outside Medicare.
What this means for you
- GLP-1 access may become dramatically more affordable under Medicare starting in 2026.
- Expect heavy plan management (prior authorization, step therapy).
- Over 30% of seniors meet clinical obesity criteria — meaning this could affect millions.
4. "9 Medicare Changes Coming in 2026" — Consumer Overview
A popular Kiplinger breakdown this week highlighted the biggest changes seniors can expect in 2026:
- Part D annual out-of-pocket cap rises to $2,100
- Part D deductible maximum increases to $615
- "Medicare Prescription Payment Plan" becomes automatic re-enrollment
- Medicare Advantage supplemental benefits face tighter restrictions
- Maximum out-of-pocket (MOOP) for Medicare Advantage drops to $9,250
- GLP-1 coverage changes factored into the 2026 landscape
What this means for you
- Even with small increases, 2026 Part D protections remain far better than pre-IRA rules.
- Some non-medical MA perks may scale back.
- 2026 will be a defining year for drug cost reform.
5. Renewed Focus on 2025 IRMAA Brackets
Kiplinger's updated overview of 2025 IRMAA brackets resurfaced this week as CMS finalized 2026 numbers. Highlights for 2025:
- Part B premium: $185/month
- Average Part D premium: $46.50/month
- IRMAA surcharges range from $74 to $443.90 for Part B
- Surcharges begin when income exceeds $106,000 (single) or $212,000 (joint) based on 2023 income
What this means for you
- 2025 IRMAA is already locked in using 2023 income.
- Planning for 2026 IRMAA now (based on 2024 income) may save thousands.
6. Physician Fee Schedule & Provider Participation Changes
The California Medical Association and Ropes & Gray published several updates this week on Medicare physician payment for 2026:
- CMS finalized a 3.26% increase in physician payment rates
- Clarified rules for digital mental health technologies
- Set the Dec. 31, 2025 deadline for physicians to update participation status
What this means for you
- Payment increases may stabilize some access issues but likely don't solve ongoing rate pressures.
- Some specialists may re-evaluate whether they accept Medicare assignment for 2026.
- If access is already tight in your area, it's worth checking your providers' plans.
7. Preparing for the Next Round of Medicare Drug Price Negotiations
New analyses from the Medicare Rights Center and the Journal of Managed Care & Specialty Pharmacy reviewed which drugs are most likely to be chosen in the next wave of Medicare price negotiations.
Highlights:
- Negotiated prices for the first 10 drugs take effect in 2026
- Additional drug rounds will follow in 2027 and beyond
- Researchers expect more high-cost brand-name drugs to enter negotiation next
What this means for you
- If you take an expensive brand-name drug, negotiation could significantly lower costs in coming years.
- Even if your medication isn't negotiated, overall Part D pricing is expected to shift.
Also This Week in Related Healthcare News
- Medicaid enrollment & spending continue to rise post-unwinding, which affects dual-eligible seniors and state budgets.
- ACA marketplace news highlights rising premiums and the eventual expiration of enhanced subsidies — important for people approaching Medicare eligibility.
✅What This Means for You
This was one of the busiest weeks in Medicare news in months, with major developments on telehealth access, 2026 costs, and prescription drug coverage. The common thread: Medicare policy is shifting fast, and staying informed is essential.
Whether you're preparing for 2026 enrollment, managing IRMAA surcharges, or tracking new drug coverage options, understanding these updates helps you make confident decisions about your healthcare.
Bottom line: Bookmark this weekly recap series and check back each week for the latest Medicare developments from trusted sources — all in one place.
Explore Further
References
Telehealth & Shutdown Coverage
- Axios — Healthcare Coverage
- Medicare Rights Center — Newsletter & Updates
- American Medical Association — Telehealth Resources
