Getting a New Medicare Advantage Plan in 2026? 3 Things to Be on the Lookout For

You’ll be turning 65 in the near future or perhaps you’re in Medicare and considering Medicare Benefit plans in 2026. Since Open Enrollment kicking off October 15 and continuing through December 7th, you’ve got only a short time to change or choose an alternative plan that begins the 1st of January. But wait a second, things are changing in a big way this year. Insurance companies are cutting back on perks such as meals and gym memberships and increasing out-of-pocket limits in certain places.

The cost of premiums dropped a little to around $14 per month, but the fewer plans means more options, particularly if you’re located in rural areas or require specialists. CMS has finalized its rules in April, reshaping prior authorizations and the payment process in an effort to reduce costs, while also warnings of delays and shrinking networks. A million people could lose their current plans and force you to make a decision. Do not just take the first advertisement you see. Smart buying now will save you headaches (and money) in the future. You’ve worked hard; protect your health coverage right.

Getting a New Medicare Advantage Plan in 2026

You must act quickly during the annual enrollment period that runs from October 15 through December 7, 2025. Changes will be effective on January 1 2026. Did you miss it? You’re locked in through when the Medicare Advantage Open Enrollment Period from January 1 through 31 March, but it’s only applicable to switching plans for Advantage or changing back to Original Medicare. If your plan doesn’t renew (check those letters from the fall! ) You will be granted an extended enrollment period until February 2026. Plans are combining in general, with general options dropping almost 10% and PPOs leaving earlier, so make sure to compare plans earlier on Medicare.gov.

New Medicare Advantage Plan Overview

Feature	2025 Average	2026 Outlook
Monthly Premium	$16.40	$14.00, 67% zero beyond Part B
Max Out-of-Pocket (In-Network)	Median $5,400	$5,900 median, cap $9.250
Plan Availability	50% enrollment	Down 10%, SNPs up to 33%
Key Perks (e.g., Meals)	Discount of 65%	57 percent Transportation 24%, 57 percent
Enrollment Periods	Oct 15-Dec 7	Same, plus Jan-Mar OEP
Official Website	https://www.medicare.gov/

Thing 1: Shrinking Networks and Exits

Pay attention to your hospitals and doctors, as insurance companies are removing providers and whole plans, affecting more than 1 million people. Rural areas are the most affected as they have to wait longer for care that is in-network. PPOs are rapidly disappearing and forcing you to join HMOs that have tighter networks. If your chronic illness has your seeing specialists regularly make sure you check the provider directory right now. Many doctors are leaving Advantage due to the lack of reimbursement. A denied MRI or appointment with a specialist could result in hundreds of dollars out-of-pocket.

Thing 2: Benefit Cuts and Rising Costs

Expect less extras – vision dental, hearing, and vision remain in all plans (98 percent) however, the allowance for over-the-counter medications fell to 66 percent, meals dropped up to 57% and transportation is now 24 percent. The maximum out-of-pocket limit increases to $9250 in-network ($14,750 when combined with out-of-network) an increase from last year’s levels, which means special copays and prescriptions may be more expensive. Average premiums dropped to $14, yet the majority of insurance plans have no cost above Part B’s $202.90–yet certain plans increase copays or cut perks such as access to gyms. The rules on prior authorization will tighten in 2026. 72 hours of decision-making mandatory, however denials of “not medically necessary” are growing.

Missouri’s Medicaid Funded Home Care Option

New Medicare Physician Fee Schedule

Thing 3: Prior Authorization Traps

Plans must accommodate previous medical necessity requests and expedite appeals, as per CMS’s April rules and expect to receive more calls for routine treatments such as MRIs or treatments. It’s not to hold you back, but to confirm coverage, but denials are on the rise, resulting in appeals or out of pocket costs. People with chronic conditions are the worst hit; one doctor claims that Advantage locks you in every year, and can result in thousands of unexpected bills. Examine the policies for each plan’s use Some employ internal guidelines Medicare questions.

You’re in charge this Open Enrollment period. Go to Medicare.gov and call 1-800-MEDICARE and select a reliable plan that meets your doctor’s requirements. With cuts, terminations and hurdles to auth looming and a bad choice can mean anxiety and costs. Be smart about your shopping, make sure you are covered and live your life without regrets.

FAQ’s

When does 2026 Medicare Advantage Open Enrollment end?

December 7, 2025 – enroll by the 1st of January for coverage.

Will my doctors stay in-network?

Check directories, since networks decrease and plan to are made to leave.

Are premiums going up?

The averages fell slightly, however the caps on out-of-pocket expenses increased. Review costs.