If you thought last year’s Medicare open enrollment was tough, brace yourself. The 2026 enrollment period brings another round of significant changes to Medicare Advantage plans, and they’re not good news for seniors.
According to the Wall Street Journal, Medicare insurers are dealing with squeezed profit margins due to higher medical costs and regulatory changes. Their solution is to cut benefits, raise costs and eliminate unprofitable plans.
In fact, the industry is projecting that Medicare Advantage enrollment will actually shrink in 2026 — the first time that’s happened in 15 years, according to health researcher KFF.
Here’s what you need to know about the changes coming your way.
1. Fewer plan options overall
Many Medicare Advantage plans are being eliminated, which means that at least 1.2 million enrollees will lose their current plans in 2026, according to Healthpilot, a Medicare plan brokerage.
The cuts are hitting hardest in the area of preferred provider organization plans, or PPOs. These plans typically give you more freedom to see doctors and specialists without referrals.
Insurers are shifting away from PPOs toward more restrictive health maintenance organization plans, or HMOs, which often require you to stay within a limited network of providers and get referrals from your primary care doctor before seeing specialists.
If you value flexibility in choosing your health care providers, you’ll want to pay close attention during open enrollment. Going with traditional Medicare, also known as Original Medicare, with Medigap coverage could be one option, but know what you’re signing up for.
Learn more in “6 Big Medicare Mistakes That Could Cost You in Retirement.”
2. Fewer drug plan options
The number of stand-alone Medicare Part D drug plans continues to drop. According to consulting firm Avalere Health, there will be just 360 plans available in 2026, down from 464 this year and 709 in 2024.
That’s a reduction of more than 100 plans in just one year, and nearly half the options available two years ago. With fewer choices, you’ll need to be more careful about finding a plan that covers your specific medications at a reasonable cost.
3. Higher drug costs
Beyond having fewer drug plan options, the plans that remain are becoming more expensive. Drug deductibles — the amount you pay before coverage starts — are increasing across many plans.
Another change is that many medications that currently come with a flat copay will switch to coinsurance in 2026. That means instead of paying a fixed dollar amount, you’ll pay a percentage of the drug’s total cost.
If you take expensive medications, this change could significantly increase your out-of-pocket costs.
The Wall Street Journal recommends running your medications through the Medicare.gov plan finder tool to see what you’d actually pay under different plans.
4. Higher out-of-pocket maximums
Major Medicare insurers including Elevance Health, UnitedHealthcare, and CVS Health’s Aetna are raising the maximum out-of-pocket costs in many of their plans, according to analysis by Wall Street analysts at Leerink Partners.
This maximum represents the total you could pay in copays and other charges over the year. These increases are happening even as insurers trim benefits elsewhere.
5. Fewer extra benefits
Many Medicare Advantage plans came with perks — like healthy grocery allowances, gym memberships and over-the-counter product credits. But many of those are being scaled back or eliminated.
Analysis by TD Cowen found that UnitedHealthcare, Aetna and Elevance are trimming coverage for extras that enrollees could use for healthy food, home repairs and similar needs.
The loss of these benefits is just one more way that Medicare Advantage plans are becoming less generous.
What you should do
With all these changes, it’s wise to review your plan. Check your Summary of Benefits and Annual Notice of Change documents to see what’s different for 2026.
Compare your options carefully, and don’t rely solely on insurance brokers. Some are receiving reduced or zero commissions on certain plans, which could affect their recommendations.
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