As 2026 approaches, Medicare beneficiaries need to stay informed about the latest changes in Medicare Advantage (MA) plans. With recent updates from the Centers for Medicare & Medicaid Services (CMS), understanding how to compare plans effectively can help you make informed decisions about your healthcare coverage.
Key Updates for 2026
Payment Increases
CMS has proposed a 4.3% payment increase to MA plans for calendar year 2026, amounting to approximately $21 billion. citeturn0search0 This increase is expected to impact premiums, benefits, and plan availability, making it crucial to review how these changes affect your options.
Risk Adjustment Model
The three-year phase-in of the updated MA Risk Adjustment Model, known as the 2024 CMS-HCC model, is set to be completed in 2026. citeturn0search0 This model aims to improve payment accuracy by better predicting healthcare costs based on enrollees’ health status.
Out-of-Pocket Prescription Drug Costs
Under the Inflation Reduction Act of 2022, annual out-of-pocket prescription drug costs for Medicare Part D enrollees will be capped at $2,100 in 2026, up from $2,000 in 2025. citeturn0search7 This change provides greater financial predictability for those with significant medication needs.
Comparing Medicare Advantage Plans
When evaluating MA plans for 2026, consider the following factors:
Coverage and Benefits
● Medical Services: Ensure the plan covers the medical services you require, including doctor visits, hospital stays, and specialized care.
● Prescription Drugs: Verify that your medications are included in the plan’s formulary and understand any associated costs.
● Additional Benefits: Many MA plans offer extra benefits such as dental, vision, hearing, and wellness programs. Assess the value of these benefits based on your personal needs.
Provider Networks
● In-Network Providers: Check if your preferred doctors, hospitals, and specialists are within the plan’s network to avoid higher out-of-pocket costs.
● Network Changes: Be aware that provider networks can change annually. Regularly confirm the participation of your healthcare providers.
Costs
● Premiums: Compare monthly premiums across different plans, keeping in mind that some MA plans may have a $0 premium but could include other costs.
● Out-of-Pocket Expenses: Review copayments, coinsurance, and deductibles. Consider how often you utilize healthcare services to estimate your potential expenses accurately.
● Maximum Out-of-Pocket Limit: Each plan has a cap on out-of-pocket spending. Once reached, the plan covers 100% of covered services for the remainder of the year.
Star Ratings
CMS assigns star ratings to MA plans based on quality and performance metrics, ranging from 1 to 5 stars. These ratings evaluate factors like customer service, member satisfaction, and health outcomes. Opting for higher-rated plans can indicate better quality and service. citeturn0search4
Enrollment and Eligibility
● Enrollment Periods: The Annual Enrollment Period (AEP) runs from October 15 to December 7 each year. During this time, you can join, switch, or drop a plan, with coverage beginning on January 1 of the following year.
● Eligibility: To enroll in an MA plan, you must have both Medicare Part A and Part B and reside in the plan’s service area.
Tools and Resources
● Medicare Plan Finder: Utilize the Medicare Plan Finder to explore and compare available MA plans in your area. This tool provides detailed information on coverage options, costs, and star ratings.
● Counseling Services: State Health Insurance Assistance Programs (SHIPs) offer free, unbiased counseling to help you navigate Medicare choices.
Staying informed about the latest changes and understanding how to evaluate your options are vital steps in selecting the right Medicare Advantage plan for your needs in 2026.
