Medicare’s Open Enrollment Period in 2024 saw big changes to the Medicare Advantage market for 2025. These Medicare Advantage 2026 plans may again experience notable changes. While you might see some good news, like lower plan costs and drug savings, you may also face tough choices as insurance companies cut back on supplemental benefits.

Since the OEP (also referred to as the Annual Enrollment Period) runs from October 15 to December 7, 2025, now is the time to understand the key shifts happening in the market.

I. Medicare Advantage 2026 Cost Changes: Why Your Bills Might Still Rise

The Centers for Medicare & Medicaid Services (CMS) has released its cost projections, and they show a mixed picture for your wallet:

*These are current projections. The updated Medicare costs for 2026 should be announced in October.

The Catch: Even though your MA plan premium might decrease, you must still pay the Medicare Part B premium. Because the Part B cost is increasing your total monthly bill for Medicare coverage may be higher in 2026.

II. Insurers Are Pulling Back: Check Your Plan

Insurance companies are changing their offerings to focus on profits, not just signing up new members. This will affect where and how many plans are available.

• Fewer Plans in Some Areas: Large insurers like Aetna (CVS Health) and UnitedHealthcare are dropping some of their MA plans in certain counties. UnitedHealthcare CEO Tim Noel said these plan exits may affect 600,000 members, “primarily in less managed products such as PPO offerings.” Basically, this is happening because those plans weren’t making enough money. Both sources cited above mentioned that PPO plans in general may be the most at risk for exits.
  • Action Needed: If your plan is one of the many being discontinued (potentially impacting over a million people), you must choose a new plan this fall. You should have received this news in your Annual Notice of Change letter (ANOC) which arrives in mid-September.
• Tighter Financial Restrictions for Insurers: This tightening from insurers is largely due to new rules from CMS. The government is finishing the three-year switch to a tougher payment model that better controls how plans are paid. This final stage puts more financial pressure on plans to prove that the care they provide is necessary and documented correctly.

III. Major Drug Savings Are Here to Stay (and Grow)

Because of the Inflation Reduction Act (IRA), new protections that started in 2025 are expanding in 2026, creating major savings for people with high prescription costs.

New for 2026: This is the first year that the prices for some expensive, brand-name drugs (like Eliquis, Jardiance, and Xarelto) will be lower because the government has directly negotiated them with drug manufacturers. If you take one of the affected medications, you should see a price drop.

IV. Benefits Are Shrinking, But Protections Are Growing

As insurers evaluate profitability, they are looking closely at the additional benefits they offer in Medicare Advantage plans.

• Cutting the Extras: Experts expect plans to continue cutting back on non-essential benefits like some dental work, vision allowances, or transportation services to offset rising medical costs. This occurred for 2025, and may continue when the 2026 plans are announced.

New Rules for “Special Benefits”: CMS is setting clear boundaries on the Special Supplemental Benefits for the Chronically Ill (SSBCI). They have now specifically outlawed things like paying for alcohol, tobacco, or general life insurance through these benefits, which limits the kind of non-medical perks plans can offer.

New Protections for You

CMS is also stepping in to protect you from unfair denials:

• Fewer Denials for Hospital Stays: CMS has created a new rule that makes it harder for MA plans to deny coverage for an inpatient hospital stay after they have already approved it. Once an admission is approved, the plan must generally honor that decision.

More Accurate Doctor Lists: New rules require MA plans to provide more accurate lists of doctors and hospitals for the official Medicare Plan Finder. This should make it easier for you to verify your provider network.

V. Your Action Plan for This Fall

The changes for 2026 make it vital that you review your plan during the AEP.

1. Read Your ANOC Letter: Do not ignore the Annual Notice of Change (ANOC) letter you receive in mid-September. It tells you exactly how your current plan will change for 2026.
2. Verify Your Doctors: Because major insurers are cutting plans, you must use the updated Medicare Plan Finder (available October 1, 2025) to confirm that your preferred doctors and hospitals are still in-network for your 2026 plan.
3. Check Your Drug Costs: If you have high drug spending, focus your research on a plan that gives you the best use of the $2,100 out-of-pocket cap and covers all your prescriptions correctly.
4. Don’t Go It Alone: If all these changes feel confusing, get help. You can call 1-800-MEDICARE or work with a licensed, independent insurance agent like SmartMatch who can compare plans from multiple companies to find the right fit for your health needs and budget.

The Bottom Line: The MA market is in a shakeup, but doesn’t mean it’s not a viable option. While you benefit greatly from the new drug savings, you must be careful to avoid surprise costs or losing access to your doctors because of plan changes. Get ahead by doing an early, thorough review of your current plan, and the plans available in 2026.