Plan options made public Oct. 1

Question: How can those of us already on Medicare find out what the changes to our plans will be for 2026? And what's the best way to compare them to other plans and companies?

Answer: The first day all 2026 Advantage Plan and Part D prescription drug premiums and benefits are made public and can be viewed is Oct. 1. This is the time to start investigating options, especially considering hundreds of thousands of Western Pennsylvanians are going to see what I consider to be significant changes to their Advantage Plans for next year.

October 15th marks the official start of the Medicare Annual Election Period (AEP) and the day applications for Advantage Plans and Stand-Alone Part D policies can be submitted. AEP runs through December 7th.

Advantage Plans

Each year, per regulation, Advantage Plan companies must mail out what is called an Annual Notification of Change (ANOC) booklet to all members by September 30th. It's designed to do what the name of the document implies, explain any and all changes to the current plan benefits that will be going into effect next year. Even if there's just a $5 increase in co-pay to get blood work or see a specialist, for example, it must be disclosed.

The ANOC contains around 50 pages, much of which is legalese and hard to read content. Within all of this, usually in the first third of the document, are the pages that clearly display the plan changes from 2025 to 2026.

However, only your current plan changes are in the ANOC. You can't see other plans within the same or another company. Unfortunately, there's no easy way to get comparisons because in Western Pennsylvania, for 2026, there are 10 companies approved to offer Advantage Plans and well over 100 total HMOs and PPOs to choose from. In 2025, in my professional opinion, only about 10 plans were worth considering. The rest weren't competitive for a variety of reasons. I don't expect that to change much in 2026.

The best way to compare your Advantage Plan to others is to have one of our experienced agents guide you. Every year, we research all plans and identify those that provide the best overall value, taking the following into consideration: premiums, overall medical co-pay structure with an emphasis on hospitalizations, prescription deductibles and costs, generosity of ancillary benefits or "extras," strength and size of doctor and hospital networks, and the annual Maximum Out of Pocket (MOOP ) which is a very important dollar figure that represents the most one can be billed for medical services in a calendar year.

We ask lots of questions as well. Do you need nationwide in-network access to doctors and hospitals? What medications are you taking and can you handle a $615 prescription deductible? Is it more important that you have lower hospital co-pays and MOOP, or is maximizing the "extras," a priority? What can't you live without? We can then determine which plans fit your needs and compare them side by side in an easy-to-read spreadsheet, eliminating the time and frustration of attempting to look at over 100 plans from 10 companies.

There's going to be some disruption we haven't had in the Advantage Plan market in a long time this AEP. As of today, at least one PPO that many in Western Pennsylvania currently have is being eliminated in all Western Pennsylvania and another, quite possibly the most popular, is being terminated in several rural counties. Those who don't make a new choice by January 1st will be left with Original Medicare only, which can leave people exposed to huge medical bills and provides no drug coverage.

Our current Advantage Plan clients don't need to do any research or comparisons because we send them a letter prior to each AEP informing them of any concerning changes in their plan and if a move to another is prudent. We're also available to clients anytime during the year if questions or issues arise regarding bills, prescription costs, delays in care or claim denials, and anything else even remotely related to their policies.

Supplements

It's much simpler for those with Supplements because plan benefits don't change from year to year or vary from company to company like Advantage Plans. There are literally only 11 standardized Supplement plans, labeled with letters A through N, to choose from and most people have G or N. Regardless of what company offers G and N, there's zero difference in what's covered, what doctors or hospitals can be used, how care is accessed, or how claims are paid and approved. The only variable between companies offering the same letter plan is cost.

There are only a couple things that need shopped as far as Supplements are concerned; price and letter plan. Premiums for the same Plan G or N with another company can be shockingly different. If you haven't got a quote recently, you need to get one as well as inquire how much lower premiums are on plan N versus G, how marginally small the differences in out-of-pocket medical costs are, and understand that the same exact services and procedures are covered on both plans G and N.

There are still too many seniors who have antiquated and overpriced plan letters C or F. Anyone who does should contact us to investigate the possibility of enrolling in G or N. On average, premiums are $2,000 to $4,000 less per year than C and F while the difference in out-of-pocket costs for G and N negligible.

As Supplements become more expensive or even unaffordable, especially for those in their 70s, 80s, or 90s, some may also want to consider a move to an Advantage Plan. Our agents can go over the pros and cons of making that move, ensuring the right decision is made.

Part D prescription drug plans

Those on Supplements must also purchase a Stand-Alone Part D prescription plan and AEP is generally the only time that can be changed. Part D companies also have to send out an ANOC as well as another notification stating if a drug currently being taken will no longer be covered or the Tier increased.

Shopping for Part D may not be necessary from year to year. Generally, if companies keep premiums similar and your current medications will remain covered and at the same Tier, renewing is usually the right choice. However, if premiums increase significantly and there are other less expensive plans, a new option should be considered. Obviously, if an important medication is no longer going to be covered, a change will almost certainly need to be made.

When necessary, shopping and comparing Part D plans can be confusing because drugs costs can vary by pharmacy. In addition, the pill form of the same drug versus a tablet, or a cream versus an ointment, can also make hundreds of dollars of differences in out-of-pocket costs. At times, only the brand version of a drug is covered and not the generic! There are many nonsensical aspects to Stand Alone Part D!

However, the agents at The Health Insurance Store are very experienced in this area. We make sure all our Supplement clients receive a recommendation prior to each AEP letting them know if they should renew their current Part D plan or need to consider a change. If a new plan might be in order, we request a list of the client's current medications and get them enrolled in the plan with the lowest total out of pocket costs for the following year. During this process we will often identify medications that may be less expensive without insurance, using Good Rx, or ordering from Canada. We also evaluate if there may be a "Patient Assistance Program" that can provide expensive brand name drugs at no cost. Ozempic, Trulicity, and Jardiance are examples of common drugs whose manufacturers offer these programs. Because the income limits can be quite liberal, many people are surprised to find out they qualify.

There's never a charge for our services. So, if you have questions, would like to find out if your Advantage Plan is going to have any significant changes, to get a quote on a new Supplement or make an appointment for AEP, give us a call at 724-603-3403, or email me personally, [email protected].