Medicare 2026: The Changes Coming (and How to Protect Yourself)

• Service Area Reductions (SARs): Entire Medicare Advantage plans can exit your county.
  If yours disappears and you do nothing, you revert to Original Medicare (A & B) on Jan 1 —
  with no drug coverage unless you enroll in a standalone Part D or a new MA-PD.
• “2026 Reset”: Expect tighter networks, more prior authorization, and fewer “extras” (dental/vision/allowances/gyms).
• MOOP reality check: Many MA plans are moving medical maximum out-of-pocket toward the upper limits.
  One rough year can mean several thousand dollars in cost-sharing.
• Deadlines matter: Your ANOC (Annual Notice of Change) arrives by
  September 30. Read it. Compare during AEP (Oct 15–Dec 7) or during any
  Special Enrollment you qualify for.
• Silver lining after SAR: If your MA plan exits, you may qualify for a
  guaranteed-issue Medigap window (no health questions) for a limited time—ask about it.

A SAR means your Medicare Advantage plan leaves your county on January 1.
It’s not a tweak; it’s gone—for everyone on it.

If this happens and you do nothing:

• You automatically return to Original Medicare (Parts A & B).
• Drug coverage is not automatic. Unless you enroll in a standalone Part D plan
  (or a new MA plan with drug coverage)
  during AEP or your Special Enrollment Period, you’ll start the year with no Part D—and could face a late-enrollment penalty later.

Good news (time-limited): A plan exit often triggers a guaranteed-issue right to buy certain Medigap plans
without medical questions. Many people never hear about this because it typically pays agents far less than replacing you
with another MA plan. Ask for it by name.

Rural readers: SARs can create Medicare Advantage deserts—areas with few or no MA options.
Start exploring alternatives now, not in late December.

Plans are pushing co-pays toward legal limits, trimming extras, including dental, vision, hearing, and transport. They’re also tightening networks.

Prior authorization isn’t going away; in some cases it’s expanding. Ads will still tout $0 premiums, but the
fine print (the rules, networks, authorizations, and cost-sharing) is where your real experience and costs live.

Your plan’s MOOP (maximum out-of-pocket for medical) is your worst-case this year
(not counting premiums or drugs).
Many plans are already near the upper limits and may remain there in 2026.
One hospital stay or surgery can turn a $0-premium plan into thousands out of pocket.

When comparing this fall, don’t just ask: “What’s the premium?”

Also ask: “If something goes wrong, what’s my realistic worst-case?”

By law, your Annual Notice of Change (ANOC) must arrive by September 30.
It spells out exactly what’s changing for 2026—co-pays, authorizations, networks, extras, drug formularies, and MOOP.
Do not toss it. Use it to build your compare list for AEP (Oct 15–Dec 7).

• Find your ANOC and mark what’s changing (co-pays, MOOP, drugs, networks, extras).
• List your must-haves: doctors, hospitals, meds, budget, travel, and tolerance for risk/authorizations.
• Plan your path: If your MA plan is exiting, ask about guaranteed-issue Medigap timing.
  If staying MA, compare MOOP, authorizations, and networks—not just extras.
• Make changes during AEP (Oct 15–Dec 7) or your qualified Special Enrollment Period.
• Get unbiased help if you want a coach, not a closer.