What Seniors Need to Know—Medicare Advantage Plans 2026

Significant changes are coming to Medicare Advantage plans in 2026, including increased payments, updates to Part D coverage, and new regulations aimed at improving benefits. As demand for medical services continues to increase, Medicare Advantage plans must carefully align benefits with this increased demand to support members’ health needs today and in the future. 

The actions taken by the Centers for Medicare & Medicaid Services (CMS) help protect beneficiaries and taxpayers from waste, fraud, and abuse, while also providing access to high-quality, affordable health care through Medicare Advantage. By finalizing these payment policies, CMS is ensuring that Medicare Advantage continues to offer access to critical services in an efficient, accountable manner, further strengthening the program’s ability to serve beneficiaries.

CMS is maintaining its withdrawal of a previous proposal to expand coverage for obesity medications, limiting these drugs to specific scenarios. While disappointing for those needing this coverage, it is a move to prevent resources from being diverted from broader Medicare needs. With the new maximum out-of-pocket for prescriptions in 2025 to $2000, in 2026 to $2100, many carriers may impose a Part D deductible on prescription plans.

Last year, major insurers began withdrawing Medicare Advantage plans from certain markets due to federal cost-containment measures and rising medical expenses, which reduced profitability. UnitedHealthcare, Humana, and Aetna were among the largest carriers that acknowledged the growing financial pressures the industry has faced for nearly two years, and are cutting supplemental benefits, exiting unprofitable markets, and dropping entire product lines ahead of the upcoming annual enrollment period. This change can result in current members being moved to another plan or having to find another plan option.  Keep in mind, this may be an opportunity to switch to a Medigap plan.

CMS continues to clamp down on aggressive billing practices by Medicare Advantage insurers. New policies phasing in through 2026 are intended to curb “upcoding”—in which plans use complex billing codes to maximize reimbursements. This aims to limit unnecessary Medicare spending and ensure fairness across all plans.

Additionally, CMS is ending the VBID (Value-Based Insurance Design) program for 2026 due to excessive costs. That means D-SNP plans will need new ways to offer the extra benefits members depend on.

Medicare Advantage plans are expected to undergo significant changes from 2025 to 2026, impacting plan availability, benefits, costs, and federal funding. As the full effect of those changes will not be announced until early October, Medicare-eligible individuals should begin planning for the decisions they will need to make during the 2026 open enrollment period (October 15 – December 7), including the following considerations: 

Open Enrollment Checklist

• Review your current plan’s Annual Notice of Change letter.

• Compare 2026 plan premiums and out-of-pocket maximums.

• Confirm your primary care doctor and specialists are still in-network.

• Check the drug formulary for your medications.

• Evaluate extra benefits (dental, vision, hearing, fitness, etc.).

•  Consider your travel needs—does the plan offer coverage outside your area?

• Make a list of your must-have benefits and compare plans side-by-side.

• Mark important deadlines for enrollment and plan changes.

Tips & Pitfalls to Avoid

• Tip: Always check the plan’s provider directory and call your doctor’s office to confirm. Networks can change each year.

• Tip: Always double-check your prescription coverage, as formularies can change even if your plan name stays the same.

• Tip: Don’t assume your favorite extra benefits (like dental or vision) will stay the same—read the fine print every year. 

This open enrollment season is an opportunity to review any changes to current plans and switch if necessary.  With the anticipated changes, beneficiaries should stay informed and consult licensed advisors or local health insurance assistance programs to understand their options.  For guidance, contact Crystal Manning (412-716-4942, crystalmanning33@gmail.com) or her daughter, Dvonya Sedlacko-Stephens (412-657-3889, djsedlacko@gmail.com).