What To Know About Medicare Advantage In 2026
If you’re enrolled in Medicare Advantage — or considering it for the future — 2026 could bring some important changes you’ll want to understand now.
Why Are Changes Happening?
Several factors are driving reform:
Rising enrollment — as baby boomers age in, demand is surging.
Spending pressure — Medicare wants to rein in long-term costs.
New oversight rules — aimed at improving transparency and care quality.
The 2026 updates are part of a broader plan to make Advantage plans more accountable, less confusing, and better aligned with actual care outcomes.
What’s Changing in 2026?
While details may vary by provider, here are the biggest shifts expected:
🏥 1. New Star Rating Weighting
Plans will be scored more heavily based on actual health outcomes (e.g., hospital readmission rates), not just member satisfaction. Poor performers could face penalties or lose eligibility.
💳 2. Out-of-Pocket Maximum Standardization
Federal caps may be tightened, meaning less variation between plans — and clearer expectations for members.
🦷 3. Expanded Dental, Vision & Hearing Rules
More plans may be required to offer baseline coverage in these areas — no longer just optional perks.
💊 4. Drug Pricing & Transparency
Plans will need to offer more upfront clarity on formularies, drug tier pricing, and cost-sharing for prescriptions.
Will It Cost Me More or Less?
It depends on your plan.
Some members could see lower out-of-pocket costs as a result of standardized benefits. Others may see minor premium increases, especially if their plan currently offers extras that aren't federally mandated.
The good news? More oversight = fewer hidden costs.
What to Watch For During Open Enrollment
The Annual Enrollment Period (AEP) still runs from October 15 to December 7.
Before then, you should:
Review your current plan’s 2026 changes (check your ANOC letter)
Compare other available plans — especially if you're in a high-cost zip code
Look closely at drug coverage, provider networks, and star ratings
Online tools like Medicare.gov’s plan finder can help simplify your decision.
Why It’s Worth Reviewing — Even If You’re Happy With Your Plan
Every year, plans can and do change:
Doctors drop out of networks
Drugs move to higher tiers
Benefits shift or disappear
In 2026, more changes are expected than usual, so even loyal members should double-check the fine print.
