Medicare Changes 2026: How Trump Policies Impact Illinois Beneficiaries
A Shifting Landscape
Medicare is evolving in 2026. After landmark reforms under the Inflation Reduction Act (IRA) of 2022, a new administration is modifying how far these changes go. While many reforms still move forward, the pace and scope have been rebalanced.
1. Drug Price Negotiation: Which Drugs & What Changed
➡ What’s Coming:
For 2026, Medicare will negotiate prices for 10 high-cost Part D drugs, including Eliquis, Jardiance, Xarelto, Entresto, Januvia, Imbruvica, Stelara, Enbrel, Farxiga, and NovoLog/Fiasp—saving an estimated $8 billion in 2026.
➡ Trump-Era Revisions:
Delay or label tweaks: While the negotiation program remains, expansion to more drugs (15 for 2027+) may be slowed.
Market-indexing approaches: Instead of directly setting lower prices, CMS under the new administration may tie prices to foreign markets or rely more on PBM rebates.
Legal pressure: Pharma companies challenged the program in court—such battles could slow implementation even more.
Bottom line: The initial drug list stays, but future expansion may take longer and rely on indirect pricing methods.
2. Part D Out-of-Pocket Cap—Still There (But Indexed)
Thanks to the IRA, Part D will cap out-of-pocket prescription costs at $2,000 for 2026, benefiting over 11 million enrollees. However, under new rules, this cap will be indexed to annual Part D cost growth, meaning it could climb slightly each year.
3. Extra Help (LIS) Expansion—with Added Checks
Expanded Extra Help continues into 2026, giving full premium and copay assistance to those earning up to 150% of the federal poverty line. But new identity and income verification rules may make the application process a bit tougher.
4. Medicare Advantage (MA) Ratings & Payments Shifting
➡ Bonus Payment Changes:
CMS projects a 5.06% increase in Medicare Advantage payments ($25 billion total increase) for 2026.
➡ Star Ratings Outlook:
Despite expanding plan choices, overall quality bonus payments may drop slightly due to recalibrated rating metrics.
5. Obesity Drug Coverage Left Out
Though the Biden-era CMS proposed Medicare coverage for GLP‑1 anti-obesity drugs—like Wegovy and Zepbound—starting in 2026, the new administration removed this benefit, restricting coverage to diabetes or cardiovascular cases.
✅ What Illinois Beneficiaries Should Do Now
| Action | Why It Matters |
|---|---|
| Review your Part D plan | Especially if you use any of the 10 drugs included in the 2026 negotiations |
| Monitor annual cap changes | The $2,000 limit may rise slightly each year |
| Reapply for Extra Help early | Watch for new verification requirements |
| Compare Medicare Advantage and Original plans | Changes in bonuses and ratings could affect your coverage cost and quality |
| Consult local SHIP counselors | They can guide you through the new rules and tools come October 2025 |
🎯 Final Takeaway
Thanks to the IRA, Medicare in 2026 offers real benefits like negotiated drug prices and capped prescription costs. Still, changes from a new administration—especially around drug coverage and plan criteria—mean Illinois seniors must stay informed. By reviewing plans early, verifying eligibility, and getting help when needed, you can continue to make Medicare work for you.
