2026 Medicare Advantage plans are generating fresh attention as the Centers for Medicare & Medicaid Services (CMS) and insurers unveil key cost adjustments, benefit tweaks, and enrollment expectations. Beneficiaries across the country now face a shifting landscape—lower average premiums, changing supplemental benefits, and new rules that could reshape choices during the upcoming Open Enrollment.
Below, you’ll find a thorough guide to what’s changing, how it might affect you, and what actions to take before enrollment deadlines.
What’s New with 2026 Medicare Advantage Plans
In 2026, many Medicare Advantage (MA) plans will look different than in past years. While CMS projects relative stability in benefits and options, several important modifications merit attention.
Key Points Summary
- Average MA monthly premiums are projected to drop from about $16.40 to $14.00
- Some supplemental benefits (like non-emergency transportation or premium dental coverage) may face restrictions
- New rules will demand more accurate provider directory data from insurers
- Humana will reduce prior authorization requirements for certain services
- Medicare Part D out-of-pocket drug cap increases to $2,100
- Open Enrollment for 2026 runs from October 15 to December 7
CMS Predicts Premium Declines and Stability
CMS expects average monthly premiums across MA plans to fall in 2026, from $16.40 in 2025 to about $14.00. That projection includes MA plans offering prescription drug coverage and Special Needs Plans.
Benefit offerings are designed to remain stable, with hearing, dental and vision supplemental benefits likely to continue at similar levels.
Though CMS estimates enrollment might dip slightly—from 34.9 million in 2025 to 34 million in 2026—historical trends suggest that number could stabilize or rebound. Access to options remains broad: more than 99% of eligible individuals nationwide will have at least one Medicare Advantage choice, and 97% will have access to ten or more MA plans.
Final Rule & Technical Changes to MA Plans
On April 4, 2025, CMS issued a final rule detailing policy and technical changes for CY 2026 that will affect Medicare Advantage and Part D. These updates include:
- Inpatient admission decisions: Once approved, plans cannot later reverse them except for fraud or obvious error
- Stricter appeals and notice procedures: Insurers must better notify both beneficiaries and providers of adverse decisions
- Tighter rules around “non-allowable” supplemental benefits: Some non-health benefits will be restricted (for instance non-healthy food, life insurance)
- Better provider directory data: MA plans must submit provider directory updates to CMS within 30 days of any change, and attest annually to accuracy
These changes aim to improve transparency and reduce surprise denials.
Reimbursement Rates & Insurer Incentives
In January 2025, the U.S. government proposed a 2.2% increase in base payments to MA insurers for 2026. After adjusting for risk scores (which consider the relative health severity of enrollees), total effective payments could rise by about 4.3%. Major insurers welcomed this boost as beneficial for plan funding and benefits.
By April, final payments were expected to increase by over 5%, reflecting higher-than-anticipated health care utilization and aligning with more favorable policies toward private insurers.
Benefit Adjustments & Supplemental Changes
While core health benefits are largely preserved, some MA plans may scale back or limit supplemental benefits. For example:
- Some plans may reduce non-emergency transportation and premium dental or vision add-ons
- Humana has pledged to cut prior authorization requirements by 2026, especially for diagnostic services like CT scans, MRIs, colonoscopies, and echocardiograms
- Humana will also begin publicly disclosing prior authorization metrics (approval/denial rates and decision times)
These shifts reflect a broader push for transparency and streamlined access.
Prescription Drug Updates & Part D Integration
The final rule codifies several critical changes to Part D:
- Insulin cost sharing remains capped. Enrollees pay no more than $35 for covered insulin products, and deductibles do not apply
- Vaccines remain zero cost-sharing: Adult vaccines recommended by ACIP will continue to be free to beneficiaries
- The Medicare Prescription Payment Plan (MPPP) will gain an automatic renewal option for those who prefer paying prescription costs monthly versus at the pharmacy
- Out-of-pocket drug cap (the catastrophic threshold) will increase from $2,000 to $2,100, meaning after that point enrollees owe nothing further for prescriptions
These reforms aim to balance affordability with fiscal sustainability.
Projected Enrollment Trends
Some analysts forecast MA enrollment may decline by nearly one million in 2026. Insurers and CMS attribute this to:
- Beneficiaries reviewing their coverage amid cost changes
- Slight plan exits or enticements back to Original Medicare in certain regions
Yet, CMS expects more robust enrollment than early projections suggest. Many beneficiaries rely on MA’s integrated coverage (health + drug + extras), making wholesale shifts less likely.
How 2026 MA Changes Affect You: What to Watch
If you’re enrolled in or considering Medicare Advantage, these changes may directly impact your coverage, costs, and choices.
Premiums vs. Total Costs
Lower premiums are appealing, but total costs may rise. Part B premiums, deductibles, and Part D cost sharing adjustments could offset savings. Always compare total out-of-pocket costs, not just monthly price.
Provider Networks & Directory Accuracy
With MA plans required to submit updated provider directories within 30 days of a change and attest annually to accuracy, finding your doctors will become more reliable. Still:
- Confirm that your primary care physician or specialist remains in network
- Always check the 2026 provider directories before enrolling
Supplemental Benefit Tweaks
If your plan previously included generous extras (transportation, meal delivery, etc.), confirm whether they remain for 2026. Some supplemental benefits may be scaled back or subjected to new rules.
Ease of Prior Authorizations
Plans like Humana will reduce prior authorization burdens. If your current plan mandated frequent approvals for common diagnostic services, you may see improved access and fewer delays.
Drug Costs & Part D Changes
With the new drug cap and cost-sharing rules:
- Insulin affordability remains protected
- Vaccines stay free
- The slight increase in the drug cap to $2,100 means you’ll reach the “100% coverage after threshold” point a bit later
Open Enrollment Timing & Actions
Open Enrollment runs October 15 to December 7, 2025. During that window:
- Review your Annual Notice of Change (ANOC)—it will detail all changes
- Use tools like Medicare’s Plan Finder to compare 2026 plans
- Evaluate providers, premiums, drug formularies, and extra benefits
- If already in MA and satisfied, no action may be needed—but always verify changes
Steps to Get Ready for 2026 Medicare Advantage Plans
To make the most of the changes and avoid surprises, follow this checklist:
- Wait for your ANOC, arriving by September 30, and read it closely
- Use Plan Finder starting October 1, 2025, to compare 2026 options
- Check your doctors, hospitals, and prescriptions in new networks
- Estimate total costs, not just premiums
- Consider switching plans if your current MA no longer meets your needs
- Ask for help from a SHIP counselor or Medicare helpline if needed
Acting early boosts your chances of locking in optimal coverage for 2026.
Frequently Asked Questions
1. Will my current Medicare Advantage plan work in 2026?
Possibly—but only if your plan retains your doctors, benefits, and drug formulary. Always check your 2026 notice and network updates before assuming continuity.
2. Can I switch plans mid-year if something changes?
Medicare Advantage has a limited Special Enrollment Period from January 1 to March 31 for enrollees to make one change. But major changes should be handled during Open Enrollment.
3. Are outpatient services changing under new rules?
Yes, plans will face tighter rules on appeals and coverage decisions. Approved inpatient admissions are more protected, and insurers cannot later cancel them except for fraud.
Disclaimer: This article is for informational purposes only and should not be taken as legal, financial, or medical advice. Always consult professionals or official Medicare resources before making decisions.