What to expect from Medicare Advantage in 2026 — Policy shifts, Medicaid cuts, and the top plans (plain-spoken guide)
If you're on Medicare or about to enroll, 2026 brings a mixed bag of changes. Below, I break down key policy updates, top Medicare Advantage carriers, and pricing trends—so you can make a more informed decision.
What will change in your Medicare Advantage plan for 2026? (what to actually expect)
1.Lower headline premiums — but read the fine print. CMS projects average MA monthly premiums to fall (the national average is expected to be around the low-teens per month after adjustments), and Part D premiums are also forecast to edge down — but many plans are trimming extras (like some dental or transportation benefits) or narrowing networks to protect margins. That means the plan with a lower premium might also offer less in benefits or have higher copays.
2.Drug changes: negotiated prices and new caps. The 2026 changes further the drug pricing reforms and Part D adjustments; there’s also a new structure for Part D out-of-pocket limits that beneficiaries should check. New negotiated prices may lower costs for some high-cost drugs, but formulary placement still matters.
3.Star ratings matter — and carriers are reacting. CMS star ratings for 2026 were released and insurers with many low-rated plans face financial pressure. Some big carriers have trimmed where they operate and restructured networks to protect margins — which may change whether your doctors remain in-network. Check your plan’s rating and any notices about network changes.
4.More prior authorization activity and pilot programs. There are ongoing pilots and expansions of prior authorization rules (original Medicare pilots in some states), which means more pre-approvals might be required for certain services — another reason to check benefit details and prior-auth rules before you need care.
Medicare Open Enrollment 2026 — what you should do (step-by-step)
1.Get your paperwork together: current plan, list of prescriptions with doses, your preferred providers (doctors/hospitals), and last year’s out-of-pocket totals.
2.Compare total cost — not just the premium: add up monthly premium + drug copays/deductibles + expected medical visits + worst-case OOP (maximum). CMS’s plan finder and insurer formularies are the tools for this.
3.Check formularies and pharmacy networks: even if a plan has a low premium, a drug being placed on a non-preferred tier could cost you hundreds. Use the plan finder to enter your meds.
4.Confirm provider network: if keeping your doctors matters, verify they’re in-network for the MA plan you’re considering. Big carriers have been narrowing service areas in 2026.
5.Look at star ratings: plans with higher CMS star ratings tend to have better quality scores and fewer service problems — they’re worth a second look.
What Medicaid cuts mean for Medicare beneficiaries
If you’re dual-eligible, proposed federal changes and state budget moves could reduce Medicaid supports (like premiums paid on your behalf, long-term services, or dental/vision benefits). That can raise your net cost or limit access to services that MA plans don’t fully cover. Keep an eye on KFF updates and state Medicaid notices — if you rely on state wraparound benefits, check whether they’ll change next year.
Top 5 Medicare Advantage carriers — quick review & price signals for 2026
(Here’s a practical, plain list of big players and what they’re known for in 2026 — use this as a short shopping map.)
1.UnitedHealthcare (UHC) — huge network national footprint; many very low premium MA options in lots of counties. Good for broad provider access; sometimes higher plan fragmentation across counties. (UHC remains a top carrier by enrollment.)
2.Aetna / Elevance — strong on star ratings and member satisfaction in many markets; competitive premiums and solid Part D integration. If ratings matter to you, Aetna shows up well in 2026 CMS data.
3.Humana — widely available MA plans with many value-added perks (dental/vision/hearing/wellness); in 2026 many Humana MA plans emphasize routine care extras but may shrink in some geographies. Shop by ZIP for local prices.
4.Kaiser Permanente — integrated system (clinics + insurer) where available; often competitive total cost for members who want coordinated care and can use Kaiser facilities. Not available everywhere, but highly rated where it is.
5.Blue Cross Blue Shield plans / regional carriers (including Centene/Wellcare) — BCBS affiliates and Centene/Wellcare hold big regional footprints; some local plans offer very low premiums or options, but coverage detail varies by county.
Price snapshot: CMS projects average MA premiums to fall to about $14 per month nationally for 2026 (many beneficiaries will still be able to find very low premium plans in their county), while average standalone Part D plan premiums are also expected to decline. That said, total costs can vary widely by county and plan details.
Final practical checklist (what to do this Open Enrollment)
🔹Enter your ZIP at Medicare.gov Plan Finder and compare at least three plans (include one you’re leaving and two alternatives).
🔹For each plan, run your prescription drug list through the formulary tool.
🔹Confirm whether your doctors and preferred hospitals are in network.
🔹Check star ratings and read the plan’s Evidence of Coverage for prior-auth rules and limits.
Bottom line
2026 brings a mixed bag: lower average MA and Part D premiums on paper, plus new drug pricing rules — but insurers are trimming benefits and narrowing footprints in places, and proposed Medicaid cuts could ripple into real changes for dual-eligibles. Your best move is simple: use the Open Enrollment window (Oct 15–Dec 7), run your meds and providers through the Plan Finder, and compare total expected costs — not just the monthly premium.