Last year, seniors picking Medicare coverage faced some tough choices. This year might be even worse.
The enrollment period for 2026 Medicare coverage starts Wednesday, and it is likely to be a difficult one for many enrollees. For the second year in a row, big Medicare insurers are getting rid of some plans, trimming popular benefits and increasing out-of-pocket costs such as deductibles.
Seniors have to be careful, or they might end up with a bad surprise, such as higher drug costs or the loss of a favorite doctor.
Ty Pitman, MRA’s Director of Insurance Solutions, has 16 years of experience in his field and specializes in Health Insurance Benefits and ancillary plans for small, mid-sized, and large groups, as well as supplemental Medicare coverage, and Life & Disability Insurance for both Groups & Individuals. Ty is available to help you navigate this year’s Medicare changes. Learn more about him and schedule a meeting here:
This year, there will be a lot of changes; Medicare enrollees have to know more than they ever have had before, as some new changes are hidden.
Behind the turmoil are business realities. Medicare insurers have seen their profits squeezed by higher-than-expected medical spending and regulatory changes. Now, some of the biggest are trying to improve their margins by dumping unprofitable products and by controlling costs better.
The moves might make their products less appealing. The industry is projecting that enrollment in private Medicare plans, known as Medicare Advantage, will shrink in 2026. That would be the first time in 15 years, according to the health researcher KFF.
What many companies have discussed is pricing for profitability rather than growth.
Here’s what you need to know about navigating this year’s Medicare enrollment pitfalls.
Higher costs
To reduce their costs, Medicare insurers might be raising yours.
Medicare Advantage companies are increasing the maximum out-of-pocket cost in many of their plans. This figure is supposed to represent the total amount you could pay toward your care over the year, in the form of copayments and other charges. It is an important number to watch.
Wall Street analysts found that Medicare insurers, including Elevance Health, UnitedHealthcare, and CVS Health’s Aetna, were raising their average out-of-pocket caps. But Humana’s is actually going down.
To figure out where the bite will come, you want to focus on the documents that describe each plan. For your current plan, you should have received an Annual Notice of Change, describing next year’s tweaks. For other products you are considering, you will want to dig into the Summary of Benefits and the more in-depth Evidence of Coverage.
Some changes one might see in the annual notice for the Medicare Advantage plan are, the fee for the first five days of a hospital stay will increase to $550 a day from $395 this year. And, in 2026, the plan will have a $48 monthly premium, up from zero.
Loss of doctors and hospitals
At least 1.2 million Medicare Advantage enrollees are likely to lose their current plans next year because the plans are being eliminated, according to Healthpilot, a brokerage that offers Medicare plans.
Big Medicare insurers are paring back their preferred provider organization designs, known as PPOs, while bolstering their more-restrictive health maintenance organization plans, known as HMOs.
HMOs often don’t pay for care you get from doctors and hospitals outside their approved networks, which can be limited. PPOs typically give patients more freedom.
If you are looking at an HMO, you should also check the plan documents for other constraints, such as requirements that you get a referral from your primary-care physician to see a specialist.
You should always check if the doctors and hospitals you like are included, because a growing number of hospitals are leaving Medicare Advantage networks. You may want to reach out directly to healthcare providers because insurer directories aren’t always accurate or up-to-date.
If unfettered access to healthcare providers is important to you, consider opting for traditional Medicare, which tends to include nearly every hospital and doctor. But if you do, you will likely need a special product called a Medicare supplement, or Medigap, and that can be expensive, or even impossible, to get.
If you don’t get a Medigap soon after you first age into Medicare at 65, you might be refused, or pay higher rates, based on your pre-existing health conditions.
Fewer drug plans
Many of the biggest changes this year are affecting Medicare drug coverage.
For the second year in a row, the number of stand-alone Medicare drug-benefit plans, known as Part D plans, is dropping sharply. The 2026 offerings will include 360, down from 464 currently and 709 in 2024, according to Avalere Health, a consulting firm.
Both the stand-alone plans and the drug benefits offered through Medicare Advantage are also hitting patients with higher charges.
Drug deductibles, the amount you pay up front before coverage kicks in, are mushrooming for many. Also, in a number of plans, medications that now come with a flat copayment will next year require “coinsurance,” a charge that represents a percentage of the medication’s total cost.
To protect yourself, be sure to run your medications through the Medicare.gov site when you are shopping for next year’s plan. The government’s tool can give you a sense of what you might pay for those medicines under each plan.
When you do that, try out every option you have, and also check different forms of your drugs, such as the generics and original brand.
Reduced perks
Over the past several years, Medicare insurers layered on perks designed to lure seniors, including money for fun extras such as pickleball paddles. Some of those are now being dialed back.
UnitedHealthcare, Aetna, and Elevance will be trimming some extra coverage that seniors can use for a variety of needs, sometimes including items such as healthy food and home repairs. Their rival Humana wasn’t doing so, on average.
Elevance, Aetna and Humana said they were updating their offerings and stressing their enrollees’ needs and wants in designing their plans. UnitedHealthcare, a unit of UnitedHealth Group, said it is “preserving access to affordable plans.”
Broker incentives
Medicare insurers are also making hidden changes that might have a big impact on your Medicare shopping. The companies are cutting back on commissions that they pay insurance agents, generally for less-profitable plans that they don’t want to grow.
These changes don’t hit seniors directly, of course. But agents and brokers have no incentive to steer clients to plans that don’t pay.
Agents said that commissions for many stand-alone Part D plans have vanished. And they see a pattern of lower and fewer payments tied to many PPOs.
Seniors need to do their own homework to ensure they are seeing all the options, including those that don’t pay commissions. Start with the plan finder tool at Medicare.gov, which should list everything available in your area.
You can find unbiased Medicare advice from the State Health Insurance Assistance Program (SHIP) in every state (New Jersey SHIP), and the nonprofit Medicare Rights Center maintains a national helpline.
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