As 2025 draws to a close, seniors enrolled in Medicare Advantage plans are facing a wave of changes that could significantly impact their healthcare coverage. For the first time in years, beneficiaries are preparing for higher premiums, tighter provider networks, and a reduced selection of plans for 2026. Experts emphasize the importance of reviewing and comparing options during this year’s open enrollment, which runs through December 7.
Medicare Advantage, an alternative to traditional Medicare, is known for offering extra benefits like vision, dental, and drug coverage, often at low or no additional cost. But in 2026, many beneficiaries will find that those perks are shrinking, and the costs associated with their plans are rising. The impact of these changes could be particularly stark for those on a fixed income or those relying on supplemental benefits to cover out-of-pocket healthcare expenses.
Premiums and Out-of-Pocket Costs Rise Across the Board
According to the Centers for Medicare & Medicaid Services (CMS), premiums for Medicare Advantage plans are expected to fluctuate, with some decreasing slightly while others rise. More concerning, however, are the increases in out-of-pocket expenses, including deductibles and co-pays. Medicare Advantage plans have annual out-of-pocket maximums that can reach upwards of $9,250 for in-network care, with some plans capping combined in- and out-of-network costs at $14,750.
Many beneficiaries could face higher annual costs overall, as insurers adjust premiums to account for rising medical care and healthcare system changes. “The key factor, beyond premiums, is the annual out-of-pocket maximum — the point at which the insurer covers 100% of remaining costs.” says Jae Oh, author of Maximize Your Medicare
Seniors may still find “$0 premium” plans, but with added deductibles, these plans are becoming harder to find. While the average monthly premium for Medicare Advantage plans is expected to decrease, specific plans may see significant price hikes. These increases could directly affect seniors’ ability to access necessary services, especially if they are on fixed incomes.
Plan Availability Shrinks, Limiting Access to Doctors and Services
In addition to rising costs, Medicare Advantage beneficiaries will also face a reduction in the number of plans available to them. For instance, some insurers, like UnitedHealthcare, are scaling back their service areas, potentially leaving millions of seniors without coverage options in their geographic region. Experts caution that enrollees should be vigilant about checking which providers are in-network, as many insurance companies will drop doctors or entire hospital systems from their networks next year.
Philip Moeller, a Medicare and Social Security expert, noted, “Variations among plan premiums, co-pays, and annual deductibles are unusually large, leading to large differences in out-of-pocket costs among plans.” For those who are currently enrolled in plans that are being discontinued, this means either finding a new Medicare Advantage plan or switching to traditional Medicare, both of which could lead to substantial disruptions in their healthcare.
The narrowing of networks could have particularly serious consequences for those with specific healthcare needs, such as those requiring regular visits to specialized doctors or facilities.
Telehealth Challenges and Uncertainties
Another pressing issue for Medicare recipients in 2026 is the potential reduction in telehealth services. In recent years, telehealth has become a crucial lifeline for patients with limited mobility or those living in rural areas. However, some telehealth program that were offered during the pandemic expired in October 2025, and Congress has not yet taken action to extend them.
This could lead to gaps in access for vulnerable populations, according to Dr Kanwar Kelley, CEO of Side Health in California. “Patients with mobility issues, rural travel barriers, or caregiver constraints — who benefited most from telehealth — may face greater costs and logistical hurdles to get needed care, and delayed or avoided care can increase downstream costs and worse outcomes.” he explains.
While many beneficiaries have benefitted from these services, any reduction could increase overall healthcare costs for seniors, particularly those who rely on telehealth for routine consultations or chronic condition management. As such, beneficiaries must stay informed about their coverage options, including whether their current plans include telehealth services, before making decisions for 2026.
Navigating the complexities of these changes will require careful consideration. For those unsure, experts recommend using licensed insurance agents or digital marketplaces to compare plans, ensuring the most cost-effective and comprehensive coverage is selected.
