With Medicare Open Enrollment in full swing, beneficiaries are evaluating whether their plan still provides the benefits and access they rely on. Plans change every year, and those updates can affect your costs, provider access, and prescription coverage. Staying on the same plan might seem convenient, but convenience doesn’t always equal stability. Understanding what’s changed for 2026 and how those changes influence your coverage helps you decide whether keeping your plan is still the best option.
Annual Plan Changes
Did you know that Medicare Advantage and Part D plans can change their benefits every year? What felt like a comfortable fit last year may look very different for 2026. Many carriers are reducing supplemental benefits like dental, vision, hearing, transportation, and OTC allowances. These extras are valuable for many beneficiaries, and shrinking benefits can add unexpected out-of-pocket costs over the course of a year. If you’ve relied on those services, any reduction can immediately change the value of your plan.
You may also see adjustments in premiums, deductibles, copays, and out-of-pocket limits. Even plans that keep their premiums low often compensate by raising other costs. The 2026 trend across the country shows higher Maximum Out-of-Pocket limits and increased cost-sharing for specialist visits, hospital stays, and outpatient services. If you’ve had higher medical needs lately or expect more care in the year ahead, these increases can influence how affordable your plan truly is. Reviewing these changes ensures you understand what your coverage will look like once the new plan year begins.
Changes with Provider Access
One of the biggest reasons people decide to switch plans is the status of their doctors and hospitals. Many hospitals and health systems are reevaluating their contracts with Medicare Advantage plans due to administrative burdens, payment delays, and lower reimbursement rates than Original Medicare. If a hospital leaves your plan’s network, the specialists, primary care doctors, and nearby facilities you’ve relied on may no longer be available to you. That’s why checking your hospital access for 2026 is essential.
Doctors are facing similar challenges. Prior authorization requirements, denied claims, and administrative strain have pushed many practices to limit or stop accepting specific Medicare Advantage plans. Losing your doctor can be frustrating, especially if you’ve built a long-term relationship with them. That’s why verifying your providers for 2026 is essential. Even small changes in provider directories can affect how easily you receive care and how much you pay for it. If accessing your preferred doctors becomes harder or more expensive, it may be a sign that switching plans is a better option.
Medication and Drug Coverage
Your prescription drug coverage is another critical part of evaluating your plan. Formularies change every year, and many people experience surprises at the pharmacy when medications move to higher tiers or require prior authorization. Some medications may no longer be covered at all. These changes are part of how insurers manage rising drug costs, and the ongoing adjustments tied to the Medicare Part D redesign. Even so, they still have a direct impact on your monthly budget and your treatment plan.
If you take multiple medications or rely on a brand-name or specialty drug, even small formulary adjustments can lead to higher costs. Step therapy and prior authorization rules are also expanding in 2026, adding extra steps between you and your treatment. It’s important to check your plan’s updated drug list and see how each of your medications is classified for the new year. If your costs increase or your medications become harder to access, switching to a different plan with better drug coverage may be worth considering.
Rising Out-of-Pocket Costs
Staying on your old plan might feel easier, but it doesn’t protect you from rising costs. A large number of Medicare Advantage plans are raising their out-of-pocket maximums, making it more expensive if you experience a major health event. Even plans with zero-dollar premiums can expose you to high out-of-pocket expenses through hospital copays, specialist fees, imaging costs, and outpatient procedures. These increases may not be obvious unless you compare your 2025 and 2026 benefits side by side.
Your risk tolerance plays a role here. If you’re healthy and rarely visit the doctor, you might not feel these changes right away. But if you’re managing chronic conditions or anticipate more care in the coming year, higher cost-sharing can make a big difference. Comparing your current plan’s 2026 MOOP, hospital costs, and specialist copays to other available options may reveal better protection. You may find that switching plans offers more predictable expenses and less financial risk, even if your premium stays the same.
When Staying Makes Sense
Even with so many changes happening, staying with your current plan can still be the right choice in some cases. If your doctors are still in-network and your medications are covered at a good price, staying with your plan may be the best option. Just make sure your benefits and out-of-pocket limits haven’t changed in ways that negatively affect you. Some plans maintain strong value year after year, especially if they have stable provider networks and competitive cost structures.
It’s also possible that your plan has improved certain benefits for 2026. Some carriers adjust dental allowances, add new wellness programs, or strengthen drug coverage to remain competitive in certain counties. Reviewing your Annual Notice of Change gives you a clear picture of what’s different and helps you see whether your plan still aligns with what you need. If everything important to you remains intact, staying put can be a smart and low-effort decision.
Conclusion
You’re entering Medicare Open Enrollment at a time when plans are undergoing updates that could affect your coverage, costs, and access to care. Beneficiaries often stay on the same plan for years, but annual updates can create gaps in protection that aren’t obvious unless you take the time to compare what’s available. Be sure to look closely at your plan’s details to understand how new benefit structures, provider participation, and medication rules may affect you in the coming year.
Exploring your options doesn’t commit you to switching, but it gives you the confidence that you’re not overpaying or losing access to care without realizing it. Whether you decide to keep your plan or consider alternatives like Medicare Supplement with Part D, a quick review can make a meaningful difference in your healthcare experience. For help comparing Medicare plans, please call 866-633-4427 to speak with a Senior Healthcare Solutions Medicare expert.
