Medicare Drug Savings Eclipsed by Part B Premiums, COLA Challenges and ACA’s Rising Costs

Published in RINewsToday on January 5, 2026

The official arrival of the New Year was marked by millions of viewers channel surfing between ABC, CBS, NBC, and CNN, eager to watch the ball drop in Times Square and ring in 2026. The iconic New York City ball—12,000 pounds and adorned with 5,280 Waterford Crystal discs and LED lights—descended a 139-foot flagpole atop One Times Square. In just 60 seconds, it reached the bottom at midnight on New Year’s Eve, signaling the beginning of 2026.

Just two days before January 1—when Medicare-negotiated prices for 10 prescription drugs take effect—AARP Executive Vice President and Chief Advocacy & Engagement Officer, Nancy LeaMond, shared good news. As the clock struck midnight, she announced that older Americans would see lower prices for the first 10 Medicare-negotiated drugs, which would take effect on January 1, 2026. AARP quickly issued a statement, celebrating the first-ever Medicare-negotiated drug prices and estimating a whopping 50% reduction in out-of-pocket costs for beneficiaries.

“For millions of older Americans managing chronic conditions, prescription drugs are not optional—they are a lifeline. But medicine doesn’t work if people can’t afford it,” said LeaMond in a Dec. 29 statement. She emphasized that AARP has been at the forefront of advocating for drug pricing reforms since 2022. The nation’s largest aging advocacy group, representing nearly 38 million members, shared their stories, conducted national research on drug costs, and urged lawmakers on both sides of the aisle to support legislative efforts to lower drug costs.

According to LeaMond, this advocacy has delivered significant progress. On January 1, negotiated prices will take effect for the first time, marking a major milestone for both patients and taxpayers. “Older Americans will see real results and billions in savings as the first Medicare-negotiated prices take effect,” she stated, pledging that “AARP won’t stop fighting to lower drug prices until every American can get the medications they need at a price they can afford.”

“These drugs are used by nearly 9 million Medicare beneficiaries and treat conditions such as diabetes, heart disease, autoimmune disorders, and cancer,” she noted.

While Medicare beneficiaries are set to see substantial savings, the Centers for Medicare and Medicaid Services (CMS) anticipates that the Medicare drug price negotiation program will save billions. CMS, a federal agency providing health coverage to over 160 million people through Medicare, Medicaid, the Children’s Health Insurance Program, and the Marketplace, expects the program to save enrollees roughly $1.5 billion in out-of-pocket costs in 2026 while saving the Medicare program $6 billion per year.  The negotiated prices are a minimum of 38% off the 2023 list price.

On the Other Hand

Though Medicare beneficiaries will benefit from lower out-of-pocket costs on 10 Medicare-negotiated drugs in the new year, the 2026 Social Security COLAs will barely cover Medicare Part B premiums and rising inflation.  Meanwhile, older Americans who are not eligible for Medicare coverage will face soaring health insurance premiums due to the Senate’s failure to extend the Affordable Care Act (ACA) Tax Credits.

Max Richtman, President and CEO of the National Committee to Preserve Social Security & Medicare, stressed the importance of ACA marketplace coverage for older adults, who often struggle to find affordable health insurance. “It’s not only cruel to let their premiums skyrocket; it costs everyone in the long run,” observes Richtman. “Older patients without insurance will be forced to use emergency rooms for care, which drives up costs for all healthcare consumers,” he says in a statement released on Dec. 11, 2026.

“They’ll also arrive at Medicare sicker or more disabled, which not only costs taxpayers more but raises premiums for all older Americans on Medicare,” warns Richtman.

Richtman pointed out that 40% of ACA enrollees are between the ages of 45 and 64. Without the extended tax credits, many of these individuals—including farmers, ranchers, entrepreneurs, and small business owners—will face unaffordable premium increases and may be forced to drop or downgrade their health care coverage. “Extending these tax credits to prevent premium hikes would have made simple common sense,” Richtman argued. “Why would Senators vote to push people off health insurance instead of widening the safety net when the ACA is so clearly beneficial, especially for older, vulnerable enrollees?,” he asked.

Additionally, this year’s premium increase for the standard Medicare Part B program, while not as high as originally projected, will still affect beneficiaries, too. They will face an increase of nearly $18 per month, marking roughly a 10% hike in 2026. In a statement on Nov. 17, 2025, Richtman said that this rise basically cancels out one-third of the average beneficiary’s cost-of-living adjustment (COLA) for 2026.

The standard Part B premium for 2026 will be $ 202.90 a month, which is $17.90 more than last year’s $ 186.  The average COLA will be $ 56 a month in 2026. After accounting for the $18 Part B premium increase, the average Social Security beneficiary will be left with an effective monthly increase of only $36 next year, notes Richtman.

Richtman pointed out that the 2.8% COLA for 2026, announced in October, was already modest before the Medicare premium hike. “In this economy, an extra $36 per month will provide only marginal relief for Social Security beneficiaries,” he said, stressing that seniors with below-average benefits will see even less of a benefit increase once Medicare Part B premiums are deducted.

“Some in lower-income brackets may experience an effective COLA of zero,” predicts Richtman.

A Final Note…

Yes, Medicare beneficiaries will see a decrease in Medicare-negotiated prices for 10 prescription drugs that took effect last week.  But, with inflation rising and older adults struggling to afford basic needs such as food, rent, utilities, and healthcare costs, aging advocates urge Congress to  take action to mitigate the negative impacts of HR 1, the 2025 budget reconciliation bill, on the Medicare drug price negotiation program.  It’s also crucial that Social Security COLAs accurately reflect the out-of-pocket expenses faced by beneficiaries, they say.

“Unfortunately, the 2025 budget reconciliation bill—HR 1—further limits the drugs that can be negotiated under the IRA’s negotiation program, reducing its effectiveness,” warns Julie Carter of the Medicare Rights Center in an October 9, 2025, blog post for Medicare Watch. “KFF, an independent health policy and research organization, estimates that this change will increase Medicare spending by at least $5 billion. As always, increases in Medicare spending lead to higher out-of-pocket costs for beneficiaries,” she says.

“At Medicare Rights, we strongly oppose efforts to scale back the IRA’s negotiation framework. We believe more drugs should be subject to negotiation, not fewer. We also advocate for expanding other cost-saving aspects of the law to reduce expenses for those covered by other forms of insurance,” Carter adds.

“Social Security COLAs are meant to offset the impact of inflation on beneficiaries. However, they are clearly insufficient for many seniors living on fixed incomes,” argues NCPSSM’s Richtman. He explains that this is why his organization has been pushing for an improved COLA formula—the CPI-E (Consumer Price Index for the Elderly). The CPI-E would more accurately reflect the inflationary effects on the goods and services seniors rely on, he says.

“We support legislation that would adopt the CPI-E for determining COLAs, but Congress has yet to take action. Adopting this formula would be a reasonable step toward expanding benefits and truly meeting the needs of 21st-century seniors,” Richtman concludes.

Aging Policy in 2025: Rhode Island Legislative Wins and What’s Missing

Published in RINewsToday.com, July 14, 2025 

On June 24, 2025, with a 35-2 vote in the Senate, the Rhode Island General Assembly has given its approval to a $13.963 billion budget for the 2026 fiscal year that directs additional funding toward addressing the state’s housing and homelessness crisis, improving access to health care, supporting municipalities through increased revenue sharing, more funding for the state’s Rhode Island Public Transit Authority, extending childcare subsidies for toddlers and infants, and increasing Medicaid reimbursement to primary care providers, nursing homes and hospitals, among its directives.

Faced with a slowing economy and impending federal budget cuts, lawmakers were tasked with closing a $250 million deficit without resorting to broad tax hikes or cuts to essential services. To generate revenue, they implemented new electric vehicle (EV) registration fees, adjustments to the gas tax, and increases in real estate conveyance and hotel taxes. Additionally, tolls on large trucks (18-wheelers), which were approved in 2016 but delayed due to litigation from the trucking industry, are now set to be implemented following the state’s legal victory. The FY 2026 budget includes revenue from these tolls, which are scheduled to take effect.

According to Larry Berman, House Director of Communications, when the dust settled at the conclusion of this year’s 164-day legislative session, lawmakers introduced 1,430 bills and resolutions in the House and 1,165 in the Senate. Of those, the Governor signed 384 House and Senate bills into law, while another 125 became law without his signature.

The Governor is not required to act on resolutions. During the session, the House passed 238 resolutions and the Senate passed 127, most of which expressed congratulations or condolences, says Berman.

As Rhode Island’s population continues to age, advocacy organizations urged lawmakers to consider an array of legislation aimed at enhancing the delivery of state programs and services for older residents—and strengthening protections for their health, safety, financial security, and overall well-being.

Below is a selection of key laws enacted, organized by category:

Healthcare and Insurance

Lawmakers increased insurance coverage for hearing aids from $1,500 to $1,750 per ear, applicable to all ages. Additionally, the new law allows for hearing aid purchases every year, rather than every three years. Sponsored by Rep. Carol Hagan McEntee (D-Dist. 33, South Kingstown, Narragansett), H 5218,  and Sen. Leonidas P. Raptakis (D-Dist. 33, Coventry, West Greenwich, S 0120, this legislation has been signed by the Governor.

The General Assembly passed S 0610B introduced by Senate President Valarie J. Lawson (D-Dist. 14, East Providence) and Rep. Kathleen A. Fogarty’s (D-Dist. 35, South Kingston), bill, H 5494A.  The new law provides new consumer protections for Medicare Supplement Insurance (Medigap) and aligns Rhode  Island’s market with neighboring states. Additionally, the budget expanded the Medicare Savings Program, helping more beneficiaries with premiums and co-pays.

With the passage of S 0169A  sponsored by Sen. Jacob E. Bissaillon (D-Dist. 1, Providence) and H 5184A by Rep. Mary Ann Shallcross Smith (D-Dist. 46, Lincoln, Pawtucket), the new law protects homeowners from medical debt-related liens on their primary residence. Medical bills are among the top reasons underlying bankruptcy among Americans. This law takes effect on Jan. 1.

Senate President Lawson and Rep. Joshua J. Giraldo (D-Dist. 56, Central Falls) sponsored S 0974aa and H 6066A to expand paid family leave under the Temporary Care Insurance (TCI) program. Starting in January 2027, the TCI wage replacement rate will increase from 60% to 70%, and then to 75% in January 2028. This expansion is funded through a modest increase in the payroll contribution cap, which will not impact the state budget.

Consumer Protections and Financial Legislation

The General Assembly passed S 0016A and H 5121A, introduced by Senate Artificial Intelligence & Emerging Technologies Committee Chairwoman Victoria Gu (D-Dist. 38, Westerly, Charlestown, South Kingstown) and Rep. Julie A. Casimiro (D-Dist. 31, North Kingston, Exeter). Signed by the Governor, the new law aims to prevent scams involving cryptocurrency ATMs, a growing fraud scheme in Rhode Island. 

According to AARP, recently 11 states have passed laws or regulations that put key consumer fraud protections on cryptocurrency ATMs in place. Americans lost more than $246 million to crypto ATM fraud and scams in 2024 alone, and older adults are disproportionately targeted by criminals.

With the passage of H 5042A and S 0229A, sponsored by Rep. Karen Alzate (D-Dist. 60, Pawtucket, Central Falls) and Sen. Ana B. Quezada (D-Dist. 2, Providence), a new law eliminates the special exemption that allowed payday lenders to charge exorbitant interest rates of up to 260% APR. This reform helps protect consumers from falling into predatory debt cycles.

Lawmakers passed H 5185A and S 0133A sponsored by Rep. Susan R. Donovan (D-Dist. 69, Bristol, Portsmouth) and Sen. Matthew L. LaMountain (D-Dist. 31, Warwick, Cranston).  Signed into law by Gov. Dan McKee, it prohibits predatory real estate practices that often target older homeowners, preventing them from facing liens or other issues related to their properties.  The bill is based on model legislation that has been adopted in 30 other states. The legislation was backed by AARP, the American Land Title Association and the National Association of Realtors.

Support for Vulnerable Populations

Rep. Tina L. Spears (D-Dist. 36, Charlestown, New Shoreham, South Kingstown, Westerly) and Sen. Todd M. Patalano (D-Dist. 26, Cranston) sponsored H 6165A and S 0983A to create the PURPLE Alert system. Signed into law, this new initiative is designed to quickly locate missing adults with serious disabilities whose health and safety are at risk.

Legislation (S 0381A / H 5833A), sponsored by Senate Majority Leader Frank A. Ciccone III (D-Dist. 7, Providence, Johnston) and Rep. Mary Ann Shallcross Smith, now law, allows licensed hairdressers to provide in-home services to individuals with special needs or sensory-related disorders. This new law ensures that such services are provided in accordance with individual care plans verified by a licensed healthcare professional.

Now law, (H 5017A/ S 0884), sponsored by Rep. Samuel A. Azzinaro (D-Dist. 37, Westerly),  and Sen. Walter S. Felag Jr. (D-Dist. 10, Warren, Bristol, Tiverton), protects veterans from improper conduct or excessive fees by individuals assisting them in filing disability claims with the Department of Veterans Affairs, except as authorized by federal law, and it imposes penalities under the deceptive trade practices provisions.

The General Assembly passed legislation (S 0884 / H 5017A) that grants people the right to repair their own complex power wheelchairs and mobility aids. Sponsored by Sen. Mark McKenney (D-Dist. 30, Warwick) and Rep. Grace Diaz (D-Dist. 11, Providence), this new law requires manufacturers to provide independent service providers with the necessary tools and repair information. Under the new law, manufacturers are prohibited from using parts that would prevent installation of any non-manufacturer-approved replacement part or component. Also, a health plan’s coverage and payment is not allowed to require any form of prior authorization or medical documentation to complete repairs for consumer-owned complex rehabilitation technology.

Deputy Majority Whip Mia A. Ackerman (D-Dist. 45, Cumberland, Lincoln) and Sen. Pamela J. Lauria (D-Dist. 32, Barrington, Bristol, East Providence) introduced H 5619 and S 0481, directing the Department of Health to collaborate with the state’s advisory council on Alzheimer’s to distribute educational materials. With the bill’s passage, signed into law, these resources will help  educate both the public and medical providers on prevention, early detection, and management of Alzheimer’s and dementia.

Legislative Changes and Reforms

Sen. Melissa Murray (D-Dist. 24, Woonsocket, North Smithfield) and Rep. Brandon Potter (D-Dist. 16, Cranston) sponsored legislation (S 0120, H 5218) to create a three-year pilot program to remove prior authorization requirements for medically necessary care ordered by primary care providers.  Now law, the program is designed to reduce administrative delays and improve patient access to timely care.

Two bills sponsored by Sen. Pamela Lauria and Rep. Michelle McGaw (D-Dist. 71, Portsmouth, Tiverton, Little Compton) improve pharmacy flexibility. The first (H 5633, S 0483aa) allows pharmacists to dispense a one-time refill for up to 100 days if the prescriber is unavailable. The second bill (S 0482A H 5855A) simplifies the process for substituting therapeutically equivalent prescription drugs or devises. Such substitutions typically occur at the request of an insurer, and the current process requires the pharmacist to contact the patient’s prescriber for approval before filling it.

Observations from Aging Advocates:

Lori Light, the state’s Long-Term Care Ombudsman, frequently observes that facility staff accused of abuse are often terminated from one facility only to be rehired by another, with the new administrator unaware of the prior allegations. “While it is important not to penalize individuals based on unproven claims, we believe that repeated allegations involving the same staff member across multiple facilities are unlikely to be coincidental and suggest a recurring issue,” she says.

To address this, H 5303 was introduced to make the complaint histories of licensed care staff accessible to prospective employers. Light expressed disappointment that this bill did not become law and hopes to work closely with the state’s Department of Health to revise and reintroduce it next year.

“We were pleased to see that the Safe Staffing and Quality Care Act, initially passed in 2021, was amended by the state budget to allow for enforcement,” says Light. While she acknowledges that the revised law may not provide the same level of benefit to nursing home residents as originally intended, she recognizes it as a step forward.

Light also expressed disappointment that the Assisted Living Resident Empowerment Act (H5169, S484) did not pass. “Assisted living facilities remain under-regulated, with fewer resident rights despite high monthly costs and regular rate increases,” she said. The unsuccessful legislative change would have strengthened resident and family councils and improved financial transparency within these facilities.

“It’s unclear why the Department of Health’s legislation (H5426, S789), which would have increased financial transparency in nursing homes and limited equity extraction, failed to advance this year, despite having the governor’s support,” says Light. She notes that this is the second year the bill has been introduced.

“With more out-of-state investor groups acquiring facilities, it is critical to ensure that public Medicaid dollars are spent on resident care, not diverted to investors,” she emphasizes, recognizing that the bill represented a modest but essential step in that direction. “We anticipate that RIDOH will reintroduce the bill next session, and we remain committed to supporting it,” she says.

Carol Anne Costa, executive director of the Senior Agenda Coalition of RI (SACRI), notes, “SACRI worked closely with many agencies and individuals in the aging network to advance our legislative agenda. Collaboration is always beneficial for passing good laws, and more importantly, it strengthens the fabric of the coalition,” she says.

Costa continues, “SACRI fully intends to resume pushing for the passage of unsuccessful legislation in the next session, including expanded accessibility in new housing, the development of more housing for older adults, nursing home patient welfare, and assisted living resident councils. Additionally, SACRI will be closely monitoring the impact of the Trump’s Reconciliation Bill on Rhode Island.”

SACRI Policy Advisor Maureen Maigret adds, “It was absolutely wonderful to see the FY 2026 bill include a provision to increase the income eligibility for the Medicare Savings Programs (MSP), which was SACRI’s top legislative priority for 2025.”

Maigret notes that SACRI has worked tirelessly since 2013 to expand the MSP program. “These efforts finally paid off, thanks to the incredible support from community partners and legislative champions, including House Speaker  K. Joseph Shekarchi (D-Dist. 23, Warwick), lead sponsors Sen. Louis DiPalma and Rep. Karen Alzate, and many legislative co-sponsors.”

“Once eligibility is increased, as called for in the budget, potentially several thousand current MSP participants will have their co-payments covered, and thousands more Medicare enrollees will no longer have to pay for their Part B premiums (currently $185/month). These savings will help pay for other basic needs, such as food,” says Maigret.

Rhode Island’s 2025 legislative session brought meaningful advances for older adults, including expanded healthcare coverage, stronger consumer protections, and new programs supporting vulnerable populations.  Despite these successes, important bills on long-term care staff accountability, assisted living oversight, and nursing home financial transparency did not pass, leaving critical issues unresolved.

Expect committed aging organizations and advocates to return next year to advance these and other unfinished legislative priorities including promoting development of accessible housing for those with mobility impairments and caregiver tax credits to help ease the financial burden on unpaid family caregivers.

For a reporting of the provisions in the FY 2026 Rhode Island budget, visit https://rinewstoday.com/house-finance-committees-fy-26-budget-boosts-support-for-older-rhode-islanders-herb-weiss/.