Medicare 2026: What FQHCs Need to Know and How to Prepare Now

As the healthcare landscape continues to evolve, federally qualified health centers (FQHCs) are once again at the crossroads of change. The 2026 Medicare updates—ranging from premium adjustments to prescription coverage and telehealth access—will have ripple effects on patients, providers, and operational planning.

For FQHC leaders, understanding these shifts early is the key to staying compliant, maintaining access to care, and strengthening financial stability in the year ahead.

The Big Picture: What’s Changing in 2026

Medicare’s Annual Enrollment Period (AEP) for 2026 will run from October 15 through December 7, 2025, giving patients a window to enroll or make plan changes before updates take effect January 1, 2026.

Here are some key updates likely to affect FQHCs:

• Premium and deductible adjustments

  • Average Part B premiums are expected to rise roughly 12%, from $185 to $206.

  • Annual deductibles for Part B coverage could increase to $288, while the out-of-pocket cap for Medicare Advantage plans will decrease slightly to $9,250.

• Part D changes and prescription coverage

  • Standalone Part D plans will decrease from 464 to about 360 nationwide.

  • Monthly Part D premiums may drop slightly to an average of $34, but insurers can now raise them as high as $50 per month.

  • CMS continues to negotiate lower drug prices, including for medications such as Eliquis, Jardiance, and Farxiga—potentially offering up to 79% price reductions.

• Telehealth uncertainties

  • If the government shutdown continues, telehealth reimbursements and approvals could be delayed. This poses challenges for FQHCs that serve rural and mobility-limited patients who rely heavily on remote care options.

What This Means for FQHCs

While Medicare changes are often viewed through the lens of seniors, they directly impact FQHC operations, revenue cycles, and community outreach. Here’s how these updates could affect your center:

1. Revenue Planning and Reimbursement Models
With fluctuating premiums and out-of-pocket costs, patients may delay or forgo visits, leading to unpredictable appointment volumes. FQHCs should review their Medicare payer mix and model how potential changes in reimbursement could affect 2026 budgets.

2. Patient Education and Communication
Older patients often struggle to navigate new Medicare terms or plan adjustments. Proactive outreach—through newsletters, front-desk scripts, and digital reminders—can help patients understand their options and stay engaged with your center for care continuity.

3. Access and Scheduling Coordination
As patients face new cost structures, FQHCs may see scheduling fluctuations. Aligning marketing, patient services, and billing teams ensures the front desk is prepared for questions and that campaigns don’t outpace capacity.

4. Telehealth Strategy Review
If federal support for telehealth remains uncertain, evaluate your virtual visit infrastructure. Identify patients most affected by possible limitations and explore hybrid visit models that minimize care gaps.

5 Steps to Prepare Before the 2026 Enrollment Period

1. Audit your Medicare patient population.
   Review how many of your active patients are 65+ or dual-eligible for Medicare and Medicaid.

2. Educate your teams early.
   Host staff training sessions to review 2026 plan changes, including updated copays and drug tiers.

3. Strengthen partnerships.
   Coordinate with local aging councils, insurance navigators, and outreach programs to simplify patient education and enrollment support.

4. Reassess telehealth readiness.
   Update workflows, evaluate broadband access, and document any reimbursement changes from CMS.

5. Communicate transparently.
   Keep patients informed with plain-language updates through social media, appointment reminders, and print materials. Clear communication builds trust and reduces confusion during open enrollment.

The Bottom Line

Medicare’s 2026 updates bring both challenges and opportunities for FQHCs. Those who prepare now—by aligning outreach, operations, and financial planning—will be best positioned to maintain access, improve patient satisfaction, and sustain growth.

Metric helps FQHCs align marketing, patient services, and strategic planning to navigate policy shifts like these with confidence.
Let’s work together to ensure your health center and patients are ready for what’s next.