Staying with current plans

Question from Chistina: If I plan on staying on my current Medicare Advantage Plan in 2026, do I need to do anything? Do I need to inform the company or sign any documents?

Answer: The short answer is no. If you choose to stay on the same Advantage Plan next year, you will automatically be renewed and issued a new insurance card if there are changes to your plan name or doctor and emergency room co-pays.

Changes in drug coverage will be significant in 2026

However, you do need to be aware of changes to your plan benefits!

There are hundreds of thousands of Western Pennsylvania seniors who are going to see significant modifications to drug coverage on Tier 3 through 5 medications. For those currently on a single Tier 3 drug, these changes are going to result in up to $1,500 more in out-of-pocket medication costs in 2026 versus 2025!

How much more expensive in will Tier 3 drugs be in 2026?

Almost every company and plan in 2026 will employ a drug deductible on Tier 3 through 5 medications of up to $615. In addition, these same plans and companies have changed the cost of Tier 3 medications from a flat co-pay of under $50, to a coinsurance of 20% to 25% of the retail price. With the average retail cost of $600 for Tier 3 meds, we're talking about $150 per month instead of $45. And that's in addition to the new or increased deductible.

Those currently on a single Tier 3 medication, which is extremely common, who have little or no deductible and Tier 3 co-pays of under $50 will spend around $550 to $725 out of pocket for their lone brand name drug in 2025. In 2026, the out-of-pocket costs for that same drug will balloon to around $1,800 to $2,000.

Options that may reduce drug costs in 2026

There are a few select plans available in 2026 that will still have little or no drug deductible as well as flat co-pays. But most of those plans have higher hospital co-pays and don't provide comprehensive dental coverage or OTC allowances.

As brokers, The Health Insurance Store can help compare all available Advantage Plans with every competitive company on the market. More than ever, and as we move beyond just 2026, it's going to be important to have someone help you prioritize what you want most in a Medicare HMO or PPO and make a choice based on those. Do you want a larger network of hospitals and doctors? Lower premiums? Lower medical co-pays and MOOP? The most generous "extras" or ancillary benefits? The lowest possible drug costs?

Unfortunately, there's not one plan that will be providing all of those in 2026. That wasn't the case in 2025.

Should you stay on my plan or investigate others?

You will always get unbiased advice from us here at The Health Insurance Store. If we feel you're currently on the best plan for your circumstances we will let you know and put you in our database as what we call a "non-commissionable client." You will then be provided the same great services we give all our other clients if you need help with any issues such as erroneous medical bills, claim denials or delays, high prescription costs, evaluation of qualifications for state, federal, or private programs that can help ease the financial burdens of Medicare premiums, prescription costs, and out of pocket medical expenses. You will also get our annual recommendation letter we mail to every client prior to each Annual Enrollment Period (AEP) informing them of any significant changes from year to year and if we think an evaluation is warranted.

And you don't need to even make an appointment. If you'd like to have a short phone conversation or email correspondence with one of our agents or myself, to find out what significant changes for 2026 and if we think it's best to remain with your current plan, or if a meeting to do over plans side by side is prudent, that's a great place to start. Reach out via phone at 724-603-3403 or email me personally, [email protected].