Fewer choices, higher costs: Lots of changes ahead with Medicare in 2026

Florida’s 5 million Medicare enrollees will see significant changes in 2026 to premiums, deductibles and choices in plans.

“You are going to need to pay close attention to your annual notice of change,” said Jenny Chumbley Hogue, a health insurance expert and contributor for medicareresources.org.

In Florida, like many other markets, Medicare Advantage plans are shrinking, shifting and exiting pockets of the state. Some existing Medicare Advantage plans may not be available next year, have higher premiums, or cover fewer doctors, hospitals, and pharmacies.

“If a doctor or other provider is important to you, do not rely on online directories,” Chumbly Hogue said. “Call and ask which plans they are participating in for 2026.”

In Broward County, SHINE liaison Gloria Ayan said many enrollees in Humana, Care Plus, and AvMed have received notice that their plans will not be available in 2026. Other individuals have received notification that their hospital system and the physicians affiliated with it are no longer in network. The changes are creating a demand for guidance from SHINE, which provides free assistance to Medicare beneficiaries.

“We had 254 calls last month alone,” Ayan said.

While switching plans can seem like a hassle, this enrollment period presents an opportunity to find a plan with better benefits that meet your needs.

Hospital coverage is a key factor to consider in making your choice. Some Medicare Advantage plans are raising the total out-of-pocket costs for inpatient care at hospitals or increasing the co-pays for hospital stays.

“You don’t want it to be a surprise if your hospital co-pay increases $75 a day and you’re in the hospital for four days,” said Louise Norris, a health policy analyst for medicareresources.org.  “That’s not something you want to find out when you go to the hospital.”

To lure new members, Medicare Advantage plans often offer perks such as grocery cards, transportation to medical appointments, and fitness programs. In 2026, some plans cap spending on these benefits or reduce their offerings.

“You really need to shop around during open enrollment,” Norris said.

Dental and vision coverage, a benefit offered by some Medicare Advantage plans, may also be less comprehensive in 2026.

“Plans this year may have dollar limits on dental coverage or change their network of dentists covered under their plan,” said Tricia Neuman, executive director for KFF’s Program on Medicare Policy. “That could affect how much someone spends on dental care, but it’s hard to assess during open enrollment. You have to dig deep into the materials to see what is covered and what the limits are to project your future spending.”

Original Medicare premiums rising

For those enrolled in Original Medicare, you will find changes for 2026, particularly in your costs.

Expect a projected double-digit increase in Medicare Part B premiums, an 11.6% rise to $206.50 per month.

“Premiums are based on spending, so as spending rises, premiums have gone up,” said Neuman of KFF, a health policy research organization.

Despite the increase, Neuman said, “It’s important to think of the tradeoffs and assess the ways Medicare Advantage plans vary and whether you should switch to traditional if you are dissatisfied. With traditional, you can see any doctor anywhere in the country, and you don’t need prior authorization.”

Drug plans that supplement Original Medicare or Medicare Advantage plans will become more costly in 2026: The maximum out-of-pocket cost for drug plans (also known as Part D) will increase by $100 in 2026. The good news is once you hit the $2,100 cap in 2026 (up from $2,000 in 2025), you’re done paying for covered prescriptions for the year. That’s still a vast improvement compared to past years when there was no maximum limit.

However, costs are still trending upward, so you’ll want to review your drug plan’s formulary closely to calculate the total cost of your medications rather than just looking at the monthly premium.

Medicare will continue to provide free coverage in 2026 for all CDC-recommended adult vaccines — no deductible, no co-payment. That coverage includes shingles, pneumonia, and flu vaccinations and COVID boosters.

Depending on a person’s income, adjustments are made to premium surcharges for Original Medicare and the drug plan.  Anyone who earns above the designated threshold pays a premium surcharge for Medicare.  That threshold rises to $109,000 in 2026, an increase of $3,000. It is based on your 2024 tax return, so if your financial situation has changed, there is an appeal process, Norris notes.

Prior authorization changes

One of the most common complaints among seniors is the process of prior authorizations. Some shifts should ease this process: Insurer approvals for inpatient care must last until discharge (no more re-approvals mid-stay); plans must respond within 14 business days; denials must come with a clear, clinical reason; and plan holders who are denied can request an independent external review.

In another move, the federal government is testing a system that uses AI to approve or deny care for Original Medicare enrollees. The five-year pilot program will launch on Jan. 1 in six states. While Florida is not one of them, much attention is focused on whether this will save Medicare money or contribute to the problems already posed by prior authorization.

Ratings are getting an overhaul

Medicare is updating its Star Ratings system, increasing the threshold for achieving top ratings and prioritizing patient satisfaction and plan quality. In 2026, it should be easier to know which plans provide great value and reliable coverage.

A score of 5 stars indicates the highest quality.

“I don’t think star ratings are something you should start with when choosing a plan,” said Norris, of KFF health policy research.  “Ratings are something you look at after you narrow it down based on things that matter to you.”

Sun Sentinel health reporter Cindy Goodman can be reached at [email protected].

Medicare changes for Floridians

In Florida, Medicare recipients should expect these changes in 2026:

Medicare Advantage

Medicare Part D:

Source: CMS (Centers for Medicare & Medicaid Services)

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