Newsletter

MEDICARE & YOU 2026

You can learn more about Medicare at www.medicare.gov, which is the official site of CMS. Medicare & You 2026 is the official government handbook with information about Medicare. This handbook is mailed to all Medicare households each fall, and Medicare beneficiaries should already have received their copy or will shortly. The handbook  includes a summary of Medicare benefits, rights, and protections and answers to frequently asked questions about Medicare. The copy mailed to beneficiaries contains an abbreviated list of available health and drug plans in your geographic area. (The copy that is linked in this article does not include this list.)

2026 ANNUAL ENROLLMENT

Marketing of 2026 Medicare Advantage, Medicare Advantage Prescription Drug, and stand-alone Prescription Drug Plans begins today. Beneficiaries can change plans (or enroll for the first time if they have not previously enrolled) and this must be done between October 15 and December 7 for a January 1, 2026 effective date.

If you’re enrolled in one of the plan types mentioned in the first paragraph, you should have received an Annual Notice of Change (ANOC) which describes changes to your plan for next year.

If your plan is terminating or you are affected by a service area reduction, you will have or shortly will be receiving a letter informing you of the termination. If you do receive a termination letter you have a special enrollment period to enroll in a new plan by February 28. HOWEVER, you need to enroll in a new plan by December 31 to have a plan effective date of January 1, 2026 for your new plan and thereby not incur a gap in coverage. If you receive one of these letters please retain it because it will give you the right to enroll in a Medicare Supplement plan without answering health questions; if you apply for such a plan the carrier will request a copy of the termination letter before they’ll issue a policy.

If you’ve received an ANOC it’s more important than ever to read that carefully, as it will explain how your plan is changing. To our knowledge there will be more changes to Medicare Advantage plans than in any previous Annual Enrollment Period.

In 2026, Medicare Advantage (MA) and outpatient drug plans (Part D) are undergoing significant shifts that will reshape how beneficiaries access care and manage costs. Many Medicare Advantage plans (particularly PPO’s) are being scaled back or restructured and in some cases terminated.

CMS is tightening rules around prior authorization—requiring approvals for inpatient care to last through discharge (this means pre-authorization must remain valid throughout the entire admission and can’t be revoked or re-reviewed mid-stay unless there is a significant change in clinical status) and mandating faster response times. Insurers must now provide clearer clinical reasons for denials and offer expanded appeal rights, including independent external reviews. These changes aim to reduce red tape and improve transparency, but they also signal a more regulated environment that may limit plan flexibility.

Meanwhile, some “extras” — for example, grocery cards--are being capped and standardized. Plans must now clearly document which chronic conditions qualify for these benefits and ensure they don’t overshadow core medical coverage. Grocery cards are being eliminated from most non-special needs plan like core HMOs where they existed in modest amounts. Those who qualified for grocery cards in these core HMO plans were required to have a verifiable chronic condition and did not automatically qualify.

On the drug side, 2026 brings a $100 increase (to $2,100) to the annual out-of-pocket catastrophic cap which offers relief for high-cost medication users. The standard drug deductible increases to $615, but many plans continue to have lower deductibles or to have deductibles for only some drug tiers. Because carrier costs for medications have increased over what they were under previous law prior to 2025, some carriers are substituting coinsurance for copays in higher drug tiers. Drug formularies and tier placement of certain drugs are changing in some plans. Insulin remains capped at $35/month, and adult vaccines recommended by ACIP continue to be free. These changes reflect a broader push toward affordability and consistency—but they also mean beneficiaries will need to scrutinize plan details more closely during open enrollment.

This evolving landscape presents both a challenge and an opportunity. With fewer bells and whistles and more regulatory guardrails, the emphasis shifts toward clarity, empowerment, and strategic plan selection. Beneficiaries will need to rely heavily on trusted guidance to navigate shrinking service areas, rising premiums, and shifting benefit structures. The message for 2026? Simplicity is out; informed decision-making is in.

Please call us on 561-734-3884 for expert help in guiding you with your benefits decision for next year.

MEDICARE SUPPLEMENTS

At least one major Medicare Supplement carrier has already seen a substantial increase in enrollments and expects to have a record enrollment year during the Annual and Open Enrollment periods.

Medicare Supplement carriers are reframing their messaging to emphasize:

• Freedom from networks
• Stability in coverage
• Long-term cost predictability
• Protection from unexpected medical bills

Many of those who are affected by the changes affecting Medicare Advantage PPOs will look at Medicare Supplement plans as an alternative this year. Those who have a one year “trial right” are considering changing to Medicare Supplement plans within that one- year period that starts with the 65^th birthday month because they aren’t subject to underwriting during their trial right period.



“Snowbirds” will need to have coverage both in their home states as well as where they winter, and those who are affected by termination or curtailment of PPO plans by necessity will need to consider Medicare Supplements as an option. However, unless these individuals have a guaranteed issue right because of a plan termination, trail right, or have recently terminated from employer group coverage they’ll need to pass medical underwriting to be able to enroll in a Medicare Supplement plan.

About Paul Cholak

Paul is a licensed, independent health and life insurance agent and has over forty years of benefits experience and specializes in helping Medicare beneficiaries obtain health insurance. However, he offers a complete array of life and health insurance products to individuals of all ages.

He guides Medicare beneficiaries through the steps of getting insurance and is available to help clients both BEFORE and AFTER they've made their purchase decision.

Disclaimer for Part C and D plans: "We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY: 1-877-2048) to get information on all your options."

Contact Us

Local: 561-734-3884 (TTY: 711)

Toll-free: 877-734-3884 (TTY:711)