Medicare Advantage (MA) plans have become increasingly popular among seniors, offering bundled benefits and typically lower premiums compared to traditional Medicare with supplemental coverage. However, 2026 is bringing significant changes that will reshape how these plans operate and what beneficiaries can expect. From cost-sharing adjustments to new supplemental benefit rules and enhanced oversight measures, seniors need to stay informed to avoid unwelcome surprises during the upcoming open enrollment period.
Whether you’re already enrolled in a Medicare Advantage plan or considering making the switch from traditional Medicare, these seven updates could substantially affect your coverage options, out-of-pocket costs, and access to care. Understanding these changes now will help you make informed decisions and ensure you’re getting the best possible coverage for your healthcare needs and budget.
1. Out-of-Pocket Maximums Are Increasing
One of the most significant financial changes coming in 2026 involves the maximum out-of-pocket (MOOP) limit for Medicare Advantage plans. The Centers for Medicare & Medicaid Services (CMS) is increasing this ceiling, which caps the amount that beneficiaries pay for covered services in a year. While the exact limit varies depending on the specific plan you choose, the federal maximum is expected to increase by several hundred dollars compared to 2025 levels.
This increase means that seniors could potentially pay more in copays, coinsurance, and deductibles before reaching the point where their plan covers 100% of additional costs. For those with chronic conditions or who anticipate needing significant medical care, this change could represent a meaningful increase in annual healthcare expenses. It’s crucial to carefully review your plan’s specific MOOP limit and budget accordingly for the coming year, especially if you’re managing multiple health conditions that require regular care.
2. Telehealth Coverage Is Expanding
Despite the cost increases in some areas, there’s positive news on the telehealth front. Virtual care services will remain a core benefit in 2026, with CMS actively encouraging Medicare Advantage plans to expand their telehealth offerings. This expansion is particularly focused on behavioral health services, chronic disease management programs, and improving access for seniors living in rural or underserved areas where in-person care may be limited.
Some plans will offer zero-cost telehealth visits, eliminating copays for virtual appointments, while others may include innovative remote monitoring tools that enable healthcare providers to track vital signs and health metrics remotely. Seniors should proactively ask their healthcare providers about how to access these telehealth services and verify whether their specific plan covers them fully or if there are any associated costs.
3. Supplemental Benefits Are Being Restructured
Medicare Advantage plans have long distinguished themselves by offering supplemental benefits beyond what traditional Medicare covers, including dental care, vision services, hearing aids, and fitness programs. However, 2026 brings important changes to how these benefits are structured and presented to consumers. CMS is implementing tighter regulations requiring plans to clearly separate medical benefits from non-medical supplemental benefits and provide transparent disclosure of eligibility criteria.
This restructuring aims to reduce consumer confusion and prevent misleading advertising practices that have sometimes overstated the actual benefits of plans. Seniors should read benefit summaries more carefully than ever and don’t hesitate to ask plan representatives for clarification on exactly what’s included, who qualifies for specific benefits, and whether there are any limitations or restrictions on accessing these supplemental services.
4. Star Ratings Will Be More Stringent
The Medicare Star Ratings system, which measures plan quality on a scale of one to five stars, is undergoing significant updates for 2026. CMS is revising its calculation of these ratings, placing greater emphasis on member experience and actual health outcomes, rather than just process measures. Plans that receive poor ratings may lose bonus payments or face enrollment restrictions, creating stronger incentives for quality improvement.
For seniors, this change means that Star Ratings will become an even more reliable and meaningful indicator of plan performance. When comparing options during open enrollment, pay close attention to these ratings as they’ll better reflect real-world experiences of current members and the quality of care delivered by the plan’s network.
5. Prior Authorization Rules Are Changing
Prior authorization requirements—where plans require advance approval before covering certain services, such as MRIs, surgeries, or rehabilitation—have been a source of frustration for many Medicare Advantage beneficiaries. In 2026, CMS is implementing new guidelines designed to streamline this process and reduce unnecessary delays in care. Plans will be required to provide faster decisions on authorization requests and offer greater transparency about their approval processes.
While these changes won’t eliminate prior authorizations entirely, they should make the system less burdensome for both patients and healthcare providers. Seniors should continue to work closely with their doctors to ensure that necessary approvals are obtained before scheduling procedures or treatments.
6. Dual-Eligible Plans Are Being Standardized
For the approximately 12 million seniors who qualify for both Medicare and Medicaid, Dual-Eligible Special Needs Plans (D-SNPs) are receiving a significant overhaul. CMS is requiring improved coordination between Medicare and Medicaid benefits, including the development of unified care plans and clearer communication between the two programs. This change is specifically designed to reduce the fragmentation of care that has historically plagued this vulnerable population and improve overall health outcomes for low-income seniors.
If you’re dual-eligible, it’s essential to contact your plan administrator to understand precisely how these updates will impact your coverage and care coordination.
7. Marketing Oversight Is Tightening
Following a surge in complaints about misleading Medicare advertisements, CMS is significantly strengthening its oversight of how Medicare Advantage plans are marketed to seniors. The 2026 rules impose stricter requirements on television commercials, online promotions, and telephone marketing. Insurance brokers must clearly disclose their plan affiliations, and unsolicited contact will be more tightly regulated to protect seniors from aggressive or deceptive sales tactics.
Seniors should remain cautious of high-pressure sales approaches and always verify claims through official Medicare channels, such as Medicare.gov or 1-800-MEDICARE, before making enrollment decisions.
What to Remember Moving Forward
The 2026 Medicare Advantage changes represent a mix of consumer protections, quality improvements, and cost adjustments. Staying informed is your best defense against unexpected changes to your coverage or costs. Make sure to carefully review your Annual Notice of Change (ANOC) when it arrives, compare multiple plans during the open enrollment period, and don’t hesitate to ask questions of plan representatives or Medicare counselors.
A little preparation now can save you significant money and prevent frustrating surprises later. Have you reviewed your Medicare Advantage plan for the upcoming year? Consider sharing your insights or questions with others navigating these changes.
You May Also Like…
Teri Monroe started her career in communications working for local government and nonprofits. Today, she is a freelance finance and lifestyle writer and small business owner. In her spare time, she loves golfing with her husband, taking her dog Milo on long walks, and playing pickleball with friends.
Read the full article here
