Time is running out to pick your new plan
By Deborah Jeanne Sergeant
Medicare health plans have a few changes for 2026. For one, your plan may no longer be available at all.
“Everybody should be checking to see if their plan will continue into 2026,” said Terry James, sales manager with Clear Benefits Advisors in Rochester. “Read the mail from your particular carrier. Some have elected to eliminate current plans and create new plans. Other insurance companies in other areas have elected to reduce or potentially vacate an area. Depending on the county you live in, you may find the carrier you’ve done business with may not have a plan for you next year.”
If this happens and you do nothing between now and Dec. 7, you will automatically be reduced to basic Medicare on Dec. 31.
Only if the carrier’s plan continues in 2026 will it automatically continue the next year. James said that most people will need to select new plans. If you feel uncertain, call the number on your card to confirm that your plan will continue.
“If you don’t have a broker who works independently and does a competitive analysis, call someone,” James said.
Their services are free to consumers and brokers are paid the same amount of money regardless of which plan you select. Check with the broker about whether the new plan will include:
• Coverage for all of your prescriptions. Know your medications’ names and doses before calling.
• Your primary care provider, dentist, eye doctor and any other specialists. Provide their names and contact details.
• Any special things you want such as gym membership.
Don’t anticipate as many bells and whistles. James said that many insurers are trying to reduce coverage for extras like over-the-counter benefits and restoratives benefits.
James said that other trends include higher costs for prescription drugs. Deductibles for prescription drugs will increase from around $400 in 2025 to $615 in 2026.
“Traditionally, they didn’t apply deductibles until tier 3 drugs,” James said. “Now they’ll say you have to meet the deductible of $615 before they’ll assist a copay on tiers 2 through 5.”
The annual out-of-pocket maximum for covered prescriptions has increased from $2,000 in 2025 to $2,100 for 2026. But that’s still better than the $8,000 maximum in 2024.
James said that many insurance companies are changing their formularies, meaning that some drugs previously covered may not be covered at the same level as in 2025. Some subscribers may need to select a plan that covers their most expensive prescription and paying for their less expensive medication out of pocket.
James offered as another option that patients can discuss their medication with their prescribing providers to determine if they have unnecessary polypharmacy—taking medication they no longer need—and considering changing medication to one that is covered by their new insurance plan.
“Some people may have to find substitutes by talking with their provider to find something they can take that won’t affect them negatively and is covered,” James said. “Or they may need to find a company that covers their most expensive drugs.”
People who “snowbird” in the South for the winter should obtain coverage based upon where they live for at least six months and a day annually.
“Don’t wait,” James said. “The number of people I help is unreal. Be aware if your plan is being eliminated. If it is, proactively go find another plan. No one will automatically get mapped to another plan.”