What's new for 2026
A short list of the Medicare, Medicaid, and ACA Marketplace changes that take effect this year and actually matter to Wisconsin enrollees. Sources cited inline.
Part D out-of-pocket cap rises to $2,100
The Inflation Reduction Act's hard cap on Part D out-of-pocket drug spending was $2,000 in 2025; for 2026 it's indexed up to $2,100. Once you hit the cap, your Part D plan covers 100% of further drug costs for the rest of the calendar year.
What this means in practice: for anyone on expensive drugs (specialty tier, biologics, multi-thousand-dollar per-month therapies), the Part D math changes dramatically. Pre-IRA, hitting the donut hole could cost $7,000–$10,000+/yr for high-utilizers; post-IRA it caps at $2,100. More on the IRA.
Part B premium $206.50/month, deductible $283
CMS announced the 2026 Part B standard premium at $206.50/month (up from $185 in 2025) and the annual deductible at $283 (up from $257). Higher-income enrollees pay an IRMAA surcharge on top.
If you're on a Medicare Savings Program (QMB / SLMB / QI), Medicaid pays this premium for you. Worth checking — ~6 million Americans qualify for an MSP and aren't enrolled. Our WI Medicaid screener checks all three MSP tiers.
ACA Marketplace: enhanced subsidies expired Dec 31, 2025
The ARPA / IRA-enhanced ACA subsidy schedule expired at the end of 2025. For 2026, the Marketplace reverted to the pre-ARPA schedule with a 400% FPL cliff.
Practical impact: a 60-year-old earning $62,000 (just over 400% FPL for a household of one) saw average premium go from ~$888/mo with subsidy in 2025 to ~$1,904/mo with no subsidy in 2026 — a $1,000+/mo increase. Anyone in the 150–400% FPL band still gets subsidies, but they're smaller than 2021–2025.
Our Marketplace screener uses the reverted schedule, so the premiums you see are the 2026 reality.
Insulin still capped at $35/month copay
The IRA's $35/month insulin copay cap continues for 2026. Applies to every Medicare Part D plan and to every insulin product. If your plan is charging more, ask for a coverage determination — see our appeals helper.
Wisconsin Medicaid unwinding: still happening
Wisconsin began the federally-required Medicaid unwinding (post-pandemic eligibility redeterminations) in 2023. Nearly 400,000 people have been disenrolled — most for procedural reasons (paperwork), not actual income changes. Renewals continue throughout 2026.
Watch your ACCESS inbox and your physical mail. If you get a renewal packet, return it within the deadline — usually 30 days. If you've already lost coverage, our unwinding helper walks you through reinstatement or moving to the Marketplace.
WI 2026 Federal Poverty Levels
HHS published 2026 FPL guidelines in January. Single person: $15,960/yr (up from $15,650 in 2025). Two-person household: $21,640/yr (up from $21,150). Add ~$5,680 per additional person. BadgerCare Plus (adult) caps at 100% FPL; the WI Marketplace subsidy band runs 100–400%.
Ready to act on what's changed?
The fastest way to see how 2026 affects you is to run the relevant screener.