If you’ve gotten word that your Medicare plan is undergoing some serious changes (or completely going away) in 2026, you’re not alone. 2026 marks one of the biggest Medicare updates in years, with new CMS rules, drug pricing reforms, and plan consolidations.
If you’re finding yourself confused, unsure of what to do next, or unsure where to even start, worry not; Healthpilot is here for you. In this article, we’ll cover Medicare changes for 2026, why plans are disappearing, and what to do during the Annual Enrollment Period (AEP), also called Medicare Open Enrollment (Oct 15–Dec 7, 2025).
What’s Changing In Medicare For 2026?
At a high level, the changes to Medicare in 2026 can be summarized as follows:
- The Centers for Medicare & Medicaid Services (CMS) has introduced new rules impacting Medicare Advantage (Part C) and Part D prescription drug plans.
- The Medicare Drug Price Negotiation Program and Prescription Payment Plan are going into effect for plans that begin January 1st, 2026 (if you’re changing or enrolling in your plan during Open Enrollment, this impacts you).
While the underlying intent of these changes is to lower costs and improve coverage for beneficiaries, these shifts are causing carriers to make changes to their plan offerings to align with new regulations. In some instances, this has even caused carriers to significantly modify or completely drop certain plans.
Key Medicare Changes 2026
📊 Drug Negotiations: Drug price negotiations began in 2023, with expected expansion between 2026 and 2029. There are 10 Part D drugs that were announced to be part of price negotiations in 2023, and changes will be taking effect in 2026:
- Eliquis
- Jardiance
- Xarelto
- Januvia
- Farxiga
- Entresto
- Enbrel
- Imbruvica
- Stelara
- NovoLog
CMS is also set to select 15 more drugs (that will fall under Part B or Part D) for negotiation to go into effect in 2027.
🛑 New Prior Authorization Rules: Prior authorization requirements are being introduced for select services that fall under Original Medicare in six pilot states: New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington. These requirements are part of the new Wasteful and Inappropriate Service Reduction (WISeR) model, the purpose of which is to reduce waste or fraud for these services.
📍 Service Area Reductions: Major insurers like Aetna CVS Health, UnitedHealthcare®, and Blue Cross Blue Shield are shrinking coverage areas or leaving specific counties. To check whether your carrier is still going to be active in your area, check the Annual Notice of Change (ANOC) you should have received in the mail, or use a Medicare Advantage plan finder and comparison tool like Healthpilot.
🔄 Carrier Plan Restructuring: Mergers and network updates mean some plans will no longer be offered. This comes as a response to the drug negotiation model, as well as the need to adjust to the new $2,000 prescription drug cap (explained in the section below) and risk-sharing mechanisms.
💡 What To Do: Even if your plan continues, check your Annual Notice of Change (ANOC) this fall to understand cost and coverage updates.
Other Factors To Consider
While there are several key changes being made to Medicare plans starting in 2026, there remain a few newer (post-2020) changes that you should still keep in mind when reviewing your coverage during Open Enrollment (AEP):
💊 Part D Benefit Redesign: You may already be familiar with this concept, as it was enacted by the Inflation Reduction Act (2022) and first rolled out in 2025. The same will be true in 2026: out-of-pocket spending will be capped at $2,000 for prescription drugs. This has and will continue to apply to Medicare Part D beneficiaries, as well as those enrolled in Medicare Advantage Prescription Drug (MAPD) plans.
💰 Insulin Price Caps: The $35 monthly insulin cap remains in effect across all Medicare Part D and Part B plans, included among the provisions of the Inflation Reduction Act.
💉 Expanded Vaccine Coverage: ACIP-recommended adult vaccines (e.g. shingles, RSV) remain at $0 cost. Some vaccines are covered under Medicare Part B, while others are covered under Medicare Part D. This coverage was first rolled out to Medicare beneficiaries in 2023, but will continue into 2026.
💡 What This Means: If none of the above apply to your Medicare plan, don’t assume that your coverage isn’t being affected. We highly recommend always reviewing your coverage during Medicare Open Enrollment.
Why Are Some Medicare Plans Going Away In 2026?
As mentioned previously, some Medicare Advantage plans will not be available in 2026 due to service area changes, mergers, or network updates. If you’ve recently received a notice saying that your plan won’t be available next year, don’t panic; you’re not losing your Medicare coverage.
New federal policies and market adjustments have caused insurance carriers to reevaluate their offerings, leading to many plans being discontinued or consolidated in 2026. Here are a few reasons why your plan may be going away:
- CMS Policy Updates: The Centers for Medicare & Medicaid Services (CMS) introduced stricter requirements for plan performance, prior authorization, and star ratings.
- Carrier Consolidations: Insurers may merge similar plans or discontinue underperforming ones to simplify their portfolios.
- Shrinking Service Areas: Some carriers are reducing coverage in specific regions to focus on larger markets.
- Rising Administrative & Drug Costs: Inflation and new drug pricing reforms (such as the Drug Price Negotiation Program) are impacting plan sustainability.
💡 What To Do: If you’ve received a plan termination notice in the mail, don’t ignore it. It’s your sign to review your coverage options during Open Enrollment (which runs from October 15th to December 7th, 2025) to ensure uninterrupted coverage.
Keep in mind that in many cases, people whose plans are ending are automatically “crosswalked” into a new plan chosen by their current insurance company, but that new plan may not include the same doctors, drug coverage, or costs. That’s why it’s so important to use the Medicare plan finder like Healthpilot to review your new plan details and make sure it still fits your needs before the December 7th deadline.
What Is The 2026 Medicare Premium?
The official Original Medicare premium rate for 2026 has not been released yet, but has been projected to sit around $206.50 per month, an increase from 2025’s $185 rate.
Rising premiums for Original Medicare are not uncommon. Historically, the standard Part B premium increases each year to reflect inflation and rising healthcare costs.
At the same time, Part D premiums are projected to stabilize or decrease slightly thanks to new drug pricing reforms and the $2,000 annual out-of-pocket cap.
💡 Tip: Healthpilot can help you estimate your total monthly costs when comparing plans.
What Should You Do If Your Medicare Plan Is Going Away?
To recap, if your plan is being discontinued, don’t worry. It doesn’t mean you’ll go without coverage. It does, however, mean that you will need to find a new plan during this year’s Open Enrollment (Medicare AEP). Follow the below steps to ensure you stay covered without interruption:
- Watch for a plan termination notice: Carriers typically send these out in September if your plan is ending. If you haven’t received one, we still encourage you to review your Medicare plan to be certain that you’ll have similar coverage in 2026.
- Review your Annual Notice of Change (ANOC): This document outlines what’s changing in your plan for 2026. Pay attention to the components of your plan that are most important to you; if there are significant changes being made to those components, it could be time to find a new carrier.
- Compare your plan options during AEP (Oct 15–Dec 7, 2025): During Medicare Open Enrollment (AEP), you can switch to a new Medicare Advantage or Part D plan without penalty.
- Enroll in a new plan by Dec 7: Once enrolled, you’re all set! Coverage for your new plan will begin on January 1st, 2026.
💡 Tip: Even if your plan isn’t ending, it’s worth comparing your options and reviewing your coverage. Many beneficiaries save hundreds per year just by switching to a better-fitting plan.
Why Is Medicare Open Enrollment (AEP) Important?
This year’s Open Enrollment (which runs from October 15th to December 7th, 2025) is your one chance to make changes for 2026 coverage.
If you do miss Open Enrollment, Medicare will typically assign you to a similar plan from the same carrier (if available) so that you won’t be left without coverage on January 1st, 2026 if your current plan is ending. Though reviewing your coverage annually is always recommended, with so many plans changing or disappearing this year, it’s more important than ever to review your options early.
Remember, during Open Enrollment (AEP), you can:
- Find a new plan if yours is being phased out or discontinued.
- Switch between Medicare Advantage and Original Medicare.
- Join, drop, or change a Part D prescription drug plan.
- Change your Medicare Advantage plan for better benefits or lower costs.
💡 Tip: Even if you’re happy with your current plan, play it safe and use a tool like Healthpilot to confirm that your doctors and prescriptions will still be covered in 2026.