Anna Wilde Matthews reports for the Wall Street Journal on some of the big changes to Medicare Advantage in 2026. Overall, people in Medicare Advantage will pay more, have fewer benefits, and less choice of physicians and hospitals. Look at your Medicare options carefully during this open enrollment season which began on October 15 and runs through December 7.
If you are in a Medicare Advantage plan, be sure to confirm that your plan is not ending, that the providers you want to use will be in-network, and that your drugs are covered. Also, find out what your new costs will be. Insurers are ending many Medicare Advantage plans that offer more generous benefits in order to maximize their profits.
Around 1.2 million people in Medicare Advantage will need to find new Medicare coverage because their Medicare Advantage plans are ending. If your Medicare Advantage plan is ending, you can switch to traditional Medicare with the guaranteed right to buy Medicare supplemental coverage (“Medigap”), regardless of your health status. The high-deductible Medigap Plan G and plans K, L and N offer relatively low cost monthly premiums.
If you’re looking at Medicare Advantage options, take note of what your annual out-of-pocket maximum will be. That amount is rising but varies widely among Medicare Advantage plans. It can be more than $9,000 a year, although it is generally somewhat less than that. You might want to take a look at the Medicare Advantage plan’s benefits summary to find out hospital stay costs and monthly premiums. But, that won’t tell you what you really need to know.
You need to know whether the insurer will cover the care you need from the specialists and hospitals you want to use or whether the insurer will inappropriately deny you that care. Inappropriate denials are widespread, according to the Office of the Inspector General. But, you can’t find out what the insurer will do ahead of time. That’s why enrolling in a Medicare Advantage plan means gambling with your life.
If you are in traditional or original Medicare, which the government administers, you can see the doctors and hospitals of your choice and get the care you need without delays or inappropriate denials. If the cost of supplemental coverage in traditional Medicare is unaffordable, contact your members of Congress and let them know that you want the choice of traditional Medicare. Congress should be ensuring traditional Medicare is affordable to everyone with Medicare and not forcing older adults and people with disabilities to gamble with their health in Medicare Advantage.
Here’s more from Just Care:
- Five things to think about when choosing between traditional Medicare and a Medicare Advantage plan
- Medicare Advantage delivers unreliable coverage
- Congressional Budget Office finds $1 trillion in Medicare Advantage overpayments
- Medicare Advantage: Expect lots of care denials
- Medicare Advantage plans continue to endanger hospitals and patients
- Medicare Advantage needs an overhaul
