If you’re enrolled in a Medicare Advantage plan, you’ve likely noticed changes in your 2026 Annual Notice of Change. Some carriers are scaling back supplemental benefits, narrowing provider networks, and raising maximum out-of-pocket limits. Hospitals and health systems are also reevaluating their Medicare Advantage relationships because of administrative and financial pressures. Here’s what you should know as you review your plan for 2026.
Shrinking Extra Benefits
Medicare Advantage offered generous extras for many years, but 2026 brings reductions. Carriers are working with tighter budgets as medical costs rise, so they’re reducing what they offer in areas like dental, vision, hearing, transportation, fitness programs, and over-the-counter allowances. A plan that once promoted robust extras may now provide far less once you look closely at the updated benefit details. This reduction is happening because insurers must decide how to divide limited rebate dollars, and more of that money is being redirected toward medical expenses instead of optional perks.
You’ll also see larger differences between plans within the same county. Extras aren’t standardized, which means each carrier builds its offerings based on its own contracts, costs, and priorities. One plan may put most of its rebate into dental coverage, while another focuses on lowering doctor’s copays or strengthening drug coverage. Network size, provider contracts, and previous-year utilization all influence how much money a plan can devote to supplemental benefits. The result is a patchwork of coverage where two plans in your area might look similar but deliver completely different levels of value. This is most notable for high-demand extras like dental work, vision allowances, OTC benefits, and hearing aid support.
These variations become even more noticeable in competitive counties. Insurers frequently adjust their extras from year to year to attract enrollment, which is why a plan that offered strong benefits in 2025 may suddenly scale them back for 2026 while another carrier improves its offerings. With so much fluctuation, reviewing the updated benefits section in your 2026 plan documents becomes essential if you rely on services outside standard medical care.
Tighter Doctor and Hospital Networks
You’re seeing one of the most significant Medicare Advantage changes unfold as hospitals and health systems across multiple states end their Medicare Advantage contracts. They cite problems with low reimbursement rates, claim denials, payment delays, and administrative burdens. Hospitals consistently report that Medicare Advantage pays them less than Original Medicare for identical services, creating financial strain that makes accepting these plans unsustainable. The situation is continuing to unfold as hospitals across the country reassess their participation in Medicare Advantage for 2026.
You’ll also face narrower provider networks as insurers renegotiate contracts. Doctors are leaving Medicare Advantage networks because they’re overwhelmed by increasing prior authorization requirements, denied claims, and administrative workload. Some practices must hire dedicated staff just to manage insurance hurdles. The time and cost associated with these tasks often outweigh the value of remaining in-network. If your doctor or hospital stops accepting your Medicare Advantage plan, your access to care may be affected. Be sure to verify your providers for 2026 instead of assuming they’re still in-network.
Higher Out-of-Pocket Exposure
You’re likely to see higher out-of-pocket costs in 2026 Medicare Advantage plans as insurers adjust to rising medical expenses. Maximum Out-of-Pocket limits are trending upward across many counties, and plans are shifting cost-sharing structures in ways that increase what you may owe during the year. Even if your premium stays at zero, your overall expenses can rise through higher copays for specialists, increased per-day hospital costs, and steeper charges for outpatient services. These changes can be especially important if you rely on ongoing treatments, frequent visits, or chronic care management.
Prescription drug coverage inside Medicare Advantage plans is also undergoing updates. Formularies are expected to put more medications into higher tier categories, require step therapy, or expand prior authorization rules. With the continued implementation of the Medicare Part D redesign, carriers are adjusting how they manage costs related to brand-name and specialty medications. You may find that drugs you used without issue in 2025 now require extra approvals or have moved to a tier with higher copays. Reviewing your 2026 formulary is especially important to avoid unexpected pharmacy costs.
More Prior Authorization Barriers
You’re facing an expansion of prior authorization requirements in 2026 as insurers tighten utilization controls to manage spending. Prior authorization has become a growing concern within Medicare Advantage plans, impacting both patients and providers. Plans are applying authorization rules to imaging, surgeries, physical therapy, post-acute care, and even routine treatments that previously didn’t require review. These delays can affect how quickly you receive services your doctor recommends.
Hospitals and doctors feel this pressure as well. Many health systems report that they must employ entire teams to handle authorization requests and appeals. Some hospitals say denial rates for Medicare Advantage claims far exceed those under Original Medicare, and over 80 percent of denied post-acute requests are eventually overturned on appeal. As authorization requirements expand, you may see increased wait times for treatments or changes in how your provider approaches your care. In many cases, authorization policies are one of the reasons hospitals and doctors have stepped away from Medicare Advantage networks.
Reduced Plan Variety
You may notice fewer Medicare Advantage plans available in 2026 as insurers consolidate products and remove offerings that no longer make financial sense. Carriers have been restructuring plan portfolios due to rising administrative load, provider contract issues, and increasing risk costs. Plans that underperform or fail to meet financial targets are being eliminated, especially in counties where carriers offered numerous lookalike plans in previous years. This doesn’t mean you’ll have limited choices overall, but the mix of plans will shift in ways that might affect your options.
You’ll also see changes in available plan types. Some counties may experience a reduction in PPO options, replaced by narrower HMO structures. While HMOs often keep premiums low, they can also restrict your access to specialists and hospitals that fall outside tight networks. As hospitals continue dropping Medicare Advantage contracts, these network restrictions become even more significant. You may want to consider whether a narrower network plan still fits your healthcare needs or whether Original Medicare with a Medigap policy provides more flexibility and stability for 2026.
Conclusion
You’re entering Medicare Open Enrollment at a time when Medicare Advantage plans are changing in ways that directly affect your experience in 2026. Shrinking extras, rising out-of-pocket exposure, narrower provider networks, and expanded prior authorization policies can all influence your access to care and overall costs. Hospitals and health systems are continuing to distance themselves from Medicare Advantage due to payment delays, high denial rates, and administrative burdens, which may limit your choice of doctors and facilities.
These factors make it essential to review how your current plan measures up for the coming year. If you’re weighing whether to stay with your plan or explore alternatives like Original Medicare with Medigap, taking a closer look at network access, cost-sharing, and benefits can help you avoid any disruptions in care. For more information about Medicare and to get personal help reviewing your 2026 options, please call 866-633-4427 to speak with a Senior Healthcare Solutions Medicare expert.
