Your Medicare Plan Is Changing

If you have a Medicare Advantage plan, there is a reasonable chance something about it changed this year, or will change next year. Your premium might be higher. A benefit you counted on might be gone. In some counties, the plan itself may have stopped offering coverage entirely.

None of this happened by accident. The federal government changed how much money it pays to Medicare Advantage insurers, and those insurers responded by pulling back on the extras they had been offering to attract members. Understanding what changed, and what it means for you, is the first step toward making sure you have the right coverage.

Benefits Are Shrinking

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The extras that made Medicare Advantage attractive over the past decade were never guaranteed. Dental allowances, vision coverage, over-the-counter product cards, transportation to appointments, gym memberships: these were added benefits that plans offered because they had enough money from the federal government to fund them. When that money got tighter, the benefits got smaller.

In 2025 and 2026, many plans reduced or eliminated supplemental dental coverage, lowering annual allowances from several thousand dollars to a few hundred, or dropping it entirely for more than basic cleanings. Vision benefits contracted. Over-the-counter allowances, which some plans had set as high as $200 or more per quarter for items like vitamins and bandages, shrank. Transportation to medical appointments became harder to find in plan offerings.

Every fall, your plan is required to send you an Annual Notice of Change, typically called the ANOC letter. This document lists every material change to your plan for the coming year: premium changes, cost-sharing changes, and benefit changes. Many people set this letter aside without reading it. That is a costly habit.

When your ANOC arrives, look specifically for changes to dental, vision, and hearing benefits. Check whether your over-the-counter allowance changed. See whether any transportation or home-support benefits were modified. If the plan offers a fitness benefit, confirm it is still included. Then compare those numbers to what you actually used last year. If a benefit you relied on is now gone, it is worth your time to see whether a different plan in your area still offers it.

What the Rate Environment Means for You

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The reason benefits are contracting comes down to money. The Centers for Medicare and Medicaid Services, which is the federal agency that runs Medicare, sets the payment rates that determine how much money insurance companies receive for each person enrolled in a Medicare Advantage plan. In 2025, that rate increase was much smaller than insurers expected, and the agency has also been tightening the rules around how plans can code patient diagnoses to receive higher payments.

The result is that plans have less revenue, and they have responded by cutting costs. For you as a member, that means fewer extras, narrower networks of doctors and hospitals, and in some markets, higher premiums or higher cost-sharing when you need care.

The drug coverage picture is more encouraging. Starting in 2025, the out-of-pocket limit on Medicare Part D prescription drug costs is $2,000 per year. Before this cap existed, people with expensive medications could spend thousands of dollars on prescriptions without any ceiling on their exposure. Now there is a hard stop. If you take high-cost medications, this change is significant and worth verifying with your specific plan.

One additional coverage change worth watching: a federal program called BALANCE is being tested in several markets that would cover GLP-1 medications, the class of drugs used for weight loss and diabetes management that includes names like Ozempic and Wegovy. These drugs are not currently covered under standard Medicare, but the BALANCE program is a first step toward broader coverage. If you or someone you care for takes one of these medications, ask your plan whether it is included in your formulary.

When Your Plan Leaves Your County

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Plan exits are the most disruptive change a Medicare beneficiary can face. When an insurance company decides to stop offering a plan in your county or your region, you do not automatically lose Medicare coverage, but you do need to actively choose what comes next.

CMS is required to notify you if your plan is exiting your service area. Your plan is also required to send you a letter. These notifications typically arrive in the fall, before the Annual Enrollment Period that runs from October 15 through December 7. If your plan is exiting, you have a Special Enrollment Period that allows you to switch to a different Medicare Advantage plan or to return to Original Medicare without penalty. You have until February 28 of the following year to make that move.

If you are considering returning to Original Medicare after being in a Medicare Advantage plan, there is an important complication to understand. In most states, insurance companies that sell Medigap supplemental policies, also called Medicare Supplement insurance, are allowed to review your medical history before accepting your application. If you have significant health conditions, you might be denied coverage or charged a higher premium. This is not an option available to everyone who wants it, which makes the decision to leave Medicare Advantage more complicated than it might first appear.

A small number of states, including Connecticut, Massachusetts, and New York, require Medigap insurers to sell policies to anyone regardless of health status. Minnesota is adding similar protections in August 2026. If you live in one of these states, returning to Original Medicare plus Medigap is a more accessible option.

If You Have Both Medicare and Medicaid

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People who qualify for both Medicare and Medicaid, sometimes called dual eligible beneficiaries, now have a new flexibility that most have not heard about. As of 2023, if you have both programs, you can switch your Medicare Advantage plan once per month rather than waiting for the annual enrollment window.

This is a meaningful protection if you are in a plan that is not serving you well. But it has also created an opening for aggressive marketing. Insurance agents and brokers who sell Medicare plans have financial incentives to switch you from one plan to another, and the monthly enrollment window gives them twelve chances per year instead of one. If you are receiving frequent calls or visits from people urging you to change your plan, be cautious. The right question to ask is whether the plan being recommended to you actually coordinates your Medicare and Medicaid benefits, or whether it simply enrolls you in a new plan without improving your care.

If you want unbiased help evaluating whether to switch, contact your State Health Insurance Assistance Program, known as SHIP. SHIP counselors work for free, they receive no commission for any plan you choose, and they are available in every state. The number for your state’s SHIP program can be found at shiphelp.org or by calling 1-800-MEDICARE.

What to Do During Open Enrollment

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The Annual Enrollment Period runs from October 15 through December 7 each year. Changes you make during this window take effect on January 1. This is your primary opportunity to compare plans and make a different choice if your current plan no longer fits your needs.

The most common mistake people make is comparing plans by premium alone. A plan with a $0 monthly premium can easily cost more than a plan with a $40 premium once you factor in copayments for specialist visits, the cost-sharing for hospital stays, and the price of your specific medications under each plan’s drug formulary.

The Medicare Plan Finder tool at medicare.gov allows you to enter your specific medications and compare the total estimated annual cost across plans available in your zip code. That number, the total cost including premium, drug costs, and expected medical cost-sharing, is the figure that matters. Use it.

Also check your network. Confirm that your primary care physician and any specialists you see regularly are still in the plan’s network. Confirm that the hospitals you would go to in an emergency accept the plan. Networks change from year to year, and a doctor who was in-network last year may not be this year.

If you want personalized help, call your local SHIP. Counselors can walk through Plan Finder with you, explain your options in plain language, and help you understand the tradeoffs without any financial interest in what you choose.

The timeline works this way: ANOC letters arrive in late September. Plan Finder is updated with the coming year’s plans in mid-October. Open enrollment runs through December 7. Your new coverage starts January 1. Do not wait until December to start looking.

Related Reading

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MCR-04_02 Benefit Design 2026-2027: What Plans Will (and Won’t) Offer MCR-00_02 Original Medicare as Policy Choice