With the routine annual changes to Medicare and Medicare Advantage plans, combined with the looming potential passage of sweeping federal spending cuts, 2026 is shaping up to be a turbulent year for the health insurance industry.
“We’ve got a lot of disruption coming,” says Jason Mackey, an author and advisor with Medicare Blueprint Advisors in Columbia and Charleston, South Carolina.
Medicare’s open enrollment period begins on October 7, 2025. Here’s what you need to know about what’s changing with Medicare as you review your current plan offerings and evaluate whether it’s time to modify your coverage for next year.
[READ: Find the Best Medicare Plan for You]
Medicare Changes in 2026
The following seven changes anticipated for 2026 could impact your Medicare coverage.
1. Continued growth of Medicare Advantage enrollment
In March 2025, KFF reported that since 2010, the share of Medicare beneficiaries enrolled in a private Medicare Advantage plan has more than doubled. Further, the Congressional Budget Office has projected that nearly two-thirds of all Medicare beneficiaries will be enrolled in Medicare Advantage plans rather than original Medicare by 2034.
This growth has been spurred by a range of factors, including potentially lower costs and the addition of dental coverage, Health Savings Accounts and prescription benefits that are often included in private plans.
With current trends expected to continue, KFF projects that the Trump administration might also pursue policies to encourage more private plan enrollment. Strategies that could be used to incentivize Medicare Advantage enrollment include:
— Easing restrictions on insurers and brokers who market Medicare Advantage plans
— Removing requirements that all TV ads be approved by the Centers for Medicare & Medicaid Services prior to airing
— Eliminating the requirement that brokers must provide certain information to potential beneficiaries before enrolling them in a plan
— Boosting payments to Medicare Advantage plans
— Making Medicare Advantage the default enrollment option for new beneficiaries
Simultaneously, it is likely that private carriers may begin trimming their extra benefits, such as dental and transportation options, to save money.
[READ: How to Manage Anxiety with Rising Medicare Costs and Potential Coverage Changes]
2. Changes to Medicare Advantage plans
In 2026, some of the perks, such as dental care and transportation, included in many Medicare Advantage plans could see cuts, as the companies that provide these plans look for cost savings to offset increases elsewhere.
Enrollees in Medicare Advantage plans may also encounter limits to Special Supplemental Benefits for the Chronically Ill, or SSBCI, which tailors special benefits for certain medical conditions. CMS has adopted a list of items and services that it won’t include or cover because they’re deemed non-health-related or don’t meet the standard of improving or maintaining health or function. Some examples include:
— Cannabis products
— Life insurance
— Funeral planning and expenses
3. Medicaid changes that could impact Medicare beneficiaries
While Medicare and Medicaid are two separate programs, there are some areas of overlap, which tend to be more pronounced in rural and underserved parts of the country, explains Barbara Hopkins, a licensed agent and Medicare educator based in Maine.
The changes sought under the “One Big Beautiful Bill Act,” a massive budget reconciliation bill, will not only alter who can access Medicaid, but could also have negative consequences on Medicare beneficiaries, Hopkins notes.
“Taking nondocumented people off Medicaid means you’ve got less population with health care to support rural hospitals across the country,” Hopkins explains. That’s because the payments those hospitals receive when they provide care to people on Medicaid help them stay open, pay health care providers and purchase diagnostic equipment and supplies.
In Maine, for example, 10 of 24 remaining rural hospitals are under significant threat of closing immediately, Hopkins explains. “That’s 42% of the rural hospitals.” Maine is a big, sparsely populated state that has a high proportion of low-income and older citizens, many of whom rely on Medicare and Medicaid for health care.
What’s more, the OBBBA as it’s currently written could trigger an automatic 4% reduction in most Medicare spending, including payments to hospitals, physicians and health care providers, KFF reports. Medicare Advantage plans, stand-alone prescription drug plans and hospitals are all likely to see cuts in reimbursements too.
While this situation is alarming, Hopkins notes, there is “room for innovation” in terms of finding better ways to improve elements of both Medicare and Medicaid to find efficiencies and cost savings in ways that don’t further threaten the sustainability of rural hospitals.
4. Delayed Medicare savings programs rollout
While Medicare has been a lifeline for many older adults since its establishment in 1965, it doesn’t cover all costs, and efforts to bridge gaps in coverage have taken a number of forms over the years.
In 2023, a new bill was passed reducing barriers to enrollment in Medicare Savings Programs, which help low-income Medicare beneficiaries (typically with incomes under $1,325 per month for an individual and $1,783 for a couple) afford their premiums and cost-sharing expenses, including deductibles, coinsurance and co-payments. MSP enrollees also receive assistance with Medicare prescription drug costs through the Low-Income Subsidy program.
These programs can help people on fixed incomes or those who’ve lost a spouse and are now trying to get by on a single Social Security income check, Hopkins says.
However, the implementation of some of those programs has been delayed until 2035 as part of the budget reconciliation bill, Hopkins says. And while this change might not be as obvious as some of the cuts the news has been reporting, Hopkins believes it’s a “big barrier” to people getting additional help to afford the care they need.
The CBO agrees, estimating that the consequences of halting implementation of the rule will mean 1.3 million Medicare enrollees would lose Medicaid coverage of Medicare costs. It sounds complicated, but these programs are designed for Medicare beneficiaries who are low-income and/or have a disability, which allows them to qualify for dual eligibility under Medicare and Medicaid.
5. Medicare Part D changes
The Part D Premium Stabilization Demonstration, a one-year program with an optional annual extension for up to two years, may also be going away in 2026. This program enabled beneficiaries to avoid an anticipated spike in Part D premiums for 2025, but so far, there’s been no mention of extending it in 2026, Mackey says.
If it’s not extended, the cost of Part D prescription drug coverage plans could soar, and some Part D plans may exit the market altogether, which also happened in 2025, Mackey says.
“We went from about two dozen prescription drug plans down to about a dozen depending on the area. And from what we’ve been told in our industry, they’re expecting another probably 50% to 70% reduction in the available plans for next year. That would mean we’re only going to have five or six available,” he says.
What’s worse, the plans that are expected to exit the market are the less expensive ones, while the ones that cost in excess of $100 per month are expected to survive.
“This really concerns me,” Mackey says, because in some cases, couples who have not had to pay any premium may suddenly have to pay $200 or more per month. “That’s a pretty big swing.”
Those price pressures may further push beneficiaries into Medicare Advantage plans, Mackey notes — not because they want to, but out of affordability. “That doesn’t necessarily mean that’s the best option for them, it’s just more affordable.”
Mackey also anticipates that some Part D plans may curtail their coverage of some of the more expensive medications currently on their formularies. While there are generic versions of a lot of medicines on the market, not every name-brand drug has a generic alternative, and sometimes an individual responds better to one medication than another. Limiting those options could have significant health consequences for certain individuals.
[READ: How Adults Can Get Free or Low-Cost Vaccines]
6. Access to free vaccines
Beginning in 2023, Medicare Part D plans have provided a limited number of free vaccines, a program that is expected to continue in 2026. Part D insurers must continue to waive deductibles and cost sharing for adult vaccines recommended by the Advisory Committee on Immunization Practices, a widely respected group of public health professionals who make annual recommendations about vaccines to the Centers for Disease Control and Prevention.
However, on June 9, 2025, Secretary of Health and Human Services Robert F. Kennedy Jr., a known vaccine skeptic, announced he had dismissed all 17 members of the ACIP. This move calls into question whether the new members of ACIP — some of whom also have histories of vaccine skepticism — will continue to recommend the same slate of vaccines going forward.
7. Out-of-pocket cap increase
The 2023 Inflation Reduction Act included a provision that capped the annual out-of-pocket costs for prescription drugs for Medicare beneficiaries at $2,000. That cap is rising to $2,100 in 2026 to keep in line with inflation.
You should be sure to verify that the medications you currently use will still be included in your Medicare Part D prescription drug formulary in 2026 and at a price you can afford.
[READ How Does GoodRx Work With Medicare?]
What You Can Do to Prepare for Medicare Changes in 2026
Open enrollment, which lasts from October 7 through December 15 each year, is your opportunity to review your coverage and make changes for the coming year.
Mackey says this year, more than any other of the 27 he’s been an advisor, it’s critical to review your Medicare or Medicare Advantage plan and options heading into 2026.
“When you get your Annual Notice of Change from your insurance company in the summer, you need to be really aware of what the changes are going to be and how they will affect your coverage.”
He recommends looking carefully at the prescription medications you’re currently taking and connecting with your health care provider to see whether they anticipate needing to make any changes to your medications in the coming year. That can be hard to ascertain, but looking ahead could help you save some money.
In addition, talking with a local, licensed insurance agent can help you find the best plan for you. You can also contact your State Health Insurance Assistance Program for more information about what’s available and what you may be eligible for. This is a free service offered by each state, and each SHIP office is staffed by highly trained, knowledgeable volunteers.
“Really good, ethical, hard-working insurance agents are the only walking, talking educational resource that people have,” Hopkins says. “And it takes a lot of time to help people figure out what’s going to work best for them and to really look at what array of products exist in a particular zip code.”
That kind of local expertise and unbiased insight can be harder to come by if you’re relying on “captive agents” who work directly for the insurance companies that are selling plans.
However, both Hopkins and Mackey note that commissions paid by insurance companies to independent brokers have been falling, making it increasingly difficult for these individuals to stay in business. “It’s been brutal to be an advisor the past few years,” Mackey says, as commissions have declined but the time needed to work with clients on annual reviews has only increased.
Uncertainty about the commission structure for licensed agents could also disrupt Medicare beneficiaries’ access to vital information to help them make informed choices during the annual open enrollment period.
“I want to stress the value of a local health insurance agent with boots on the ground, but I say that with caution, because there are good ones and there are bad ones,” Hopkins says. But she recommends asking friends, neighbors and loved ones for recommendations for a good local agent and begin establishing a relationship with them.
However, she warns against working with any agents who are seeking to charge you for this advice; licensed, independent agents should never charge the beneficiary for assistance in selecting a plan.
If you’re interested, you may also wish to ask prospective health insurance carriers if their company is embracing AI, and, if so, how your information might being used. Regarding the use of AI in determining whether a patient can get a requested procedure or treatment, 61% of physicians reported not trusting the judgment of machines and stated they fear an unnecessarily high number of denials might result, according to the American Medical Association.
The Centers for Medicare and Medicaid Services has said that Medicare Advantage companies may use AI-enabled technology to make coverage determinations, as long as these technologies adhere to rules, such as those used to determine whether a procedure or treatment is medically necessary.
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How Medicare Might Change for 2026 and How It Will Affect Your Coverage originally appeared on usnews.com
