Changes Are Coming To Medicare Advantage Plans In 2026

Regardless of where you stand politically, there's a lot of uncertainty currently surrounding the U.S. healthcare system. Affordable healthcare plans have been an extra-hot topic this year, with a series of Medicare cuts already taking place in 2025 and further policy changes coming thanks to the "One Big Beautiful Bill" Act (OBBBA). Medicare Advantage (MA) plans are now under threat as well, with notable changes like coverage loss and increased prices looming for 2026. 

Also known as Medicare Part C, Medicare Advantage was established back in 1997 to cover the costs regular Medicare plans don't. It's offered by Medicare-approved private companies and essentially bundles all three types of traditional Medicare plans into one: Part A (hospital), Part B (medical), and Part D (prescription drug) coverage. Additional benefits may include dental, vision, or hearing coverage, but these can vary by company and location. Nevertheless, this robust coverage could be at risk, especially since multiple healthcare companies have already announced they are reducing Medicare Advantage coverage for 2026.

The main causes of concern revolve around potential coverage losses, with UnitedHealthcare, Humana, and Aetna (CVS Health) all stating they would scale back on both Part D prescription coverage and Medicare Advantage plans in general. Citing government funding losses combined with rising healthcare costs, these companies are reducing coverage availability in some states and hundreds of counties across the nation, likely impacting hundreds of thousands of people. For those who will keep their MA plans, maximum out-of-pocket costs for drug coverage are estimated to increase to $2,100 in 2026, up $100 from the cap in 2025, while it looks like maximum drug deductibles will be raised by $25.

Although reviewing upcoming changes to either Medicaid or Medicare can be scary, knowing what's coming your way as well as what alternatives you may have is key to avoiding unpleasant surprises. While MA is run by private companies that have contracts with Medicare, these plans are still subject to federal rules, which is why government healthcare coverage decisions still affect them. And, because Medicare Advantage restricts patients to a network like other insurers, coverage can be further reduced or eliminated when relationships between the insurer and hospitals change.

Although the prospect of coverage loss can be concerning, at least some of the upcoming changes are less alarming. The Centers for Medicare & Medicaid Services (CMS) announced in late September that MA enrollments were projected to decrease in 2026, but, on a more positive note, access to coverage would remain relatively stable for most people. In the same announcement, the CMS also said premiums were projected to go down. AI usage in MA healthcare was addressed in late 2024, with the CMS outlining stricter guidelines for its usage in healthcare to be implemented in 2026.

Regardless, with open enrollment for healthcare plans coming up swiftly, it's important to know your options as well as which changes may affect your current coverage. Especially if you're a retiree, there are already various Medicare mistakes you should avoid making that could threaten your benefits. While you should receive a notice if your MA coverage is going to be cut or reduced, you should still check with your specific provider if you have not already. In the meantime, now's a great time to schedule appointments through the end of the year and take advantage of your current Medicare benefits before any changes set in.