Medicare Advantage Plan Changes for 2026: What Mainers Need to Know (or any other state)
If you’re enrolled in a Medicare Advantage plan, one thing is guaranteed: your plan can change every year.
Now that we are in 2026, many Medicare Advantage plans are adjusting benefits, costs, provider networks, and prescription drug coverage. Some plans may look very similar to last year. Others may change enough that they no longer fit your needs.
If you live in Maine, these annual changes matter even more due to provider availability, rural access, and plan options that can vary by county.
Let’s walk through what typically changes, how to spot issues early, and what you should do next.
🔄 Why Medicare Advantage Plans Change Every Year
Medicare Advantage plans are offered by private insurance companies that contract with Medicare. Each year, those companies can adjust their plans based on:
Medicare payment updates
Changes in healthcare costs
Provider contract negotiations
Prescription drug pricing
Plan performance and enrollment
As a result, the plan you chose last year is not automatically the same plan this year, even if the name looks familiar.
📬 The Most Important Document You’ll Receive: ANOC
Every fall, Medicare Advantage members receive a document called the Annual Notice of Change (ANOC). These typically arrive in late September or early October.
This document outlines what’s changing for the upcoming year, including:
Premiums
Copays and coinsurance
Prescription drug coverage
Provider network changes
Prior authorization rules
Extra benefits
Many people don’t read it. That’s a mistake. The feeling must be that it’s not a bill, so it’s not important.
For 2026, reviewing your ANOC is one of the most important steps you can take to avoid surprise costs or access issues.
⚠️ Common Medicare Advantage Changes for 2026
While exact changes vary by plan and county, here are the most common areas where members may see differences in 2026.
1️⃣ Provider Networks
Doctors, hospitals, and specialists can be added or removed from a plan’s network.
In Maine, where provider choice may already be limited in certain areas, a network change can have a big impact, especially if you see specialists or receive care outside your immediate area.
2️⃣ Prescription Drug Coverage
Drug formularies can change yearly. A medication that was affordable in 2025 may:
Move to a higher tier, so it’s more expensive
Require prior authorization
Have quantity limits
Be removed entirely
This is one of the most common reasons people see higher costs year over year.
3️⃣ Copays and Out-of-Pocket Costs
Even if your premium stays the same, copays for services like:
Hospital stays
Skilled nursing or rehab
Imaging and procedures
can increase.
Lower premiums don’t always mean lower overall costs.
4️⃣ Extra Benefits
Dental, vision, hearing, fitness, transportation, and over-the-counter allowances can change, shrink, or disappear.
Extra benefits are helpful, but they should never be the only reason you keep a plan.
📍 Why Maine Residents Should Pay Extra Attention
For Mainers, plan changes can have outsized effects due to:
Fewer hospitals and specialists in some regions
Longer travel distances for care
County-specific plan availability
Seasonal residents who receive care out of state
A plan that works well one year may feel very different the next.
🗓️ What Are Your Options If Your Plan Changes?
If your Medicare Advantage plan changed for 2026, you typically have options during the Annual Enrollment Period (October 15 – December 7), including:
Staying in your current plan
Switching to a different Medicare Advantage plan
Returning to Original Medicare
Adding or changing prescription drug coverage
The key is reviewing your options before changes take effect on January 1.
If you missed that option, there is The Medicare Advantage Open Enrollment period (January 1 - March 31), when if you are dissatisfied with your coverage, you can:
Switch to a different Medicare Advantage plan
Return to Original Medicare and get a PDP.
🧠 A Common Mistake to Avoid
Many people assume:
“If my plan is still available, it must still be good for me.”
Availability does not equal suitability.
Plans can remain active while quietly becoming more expensive or more restrictive for certain types of care. You could also be automatically moved to another like plan with the carrier, with different potential names of the plan and different plan numbers. This is called cross-walking, and does happen, often without people even knowing why.
🛠️ What’s Changed in Medicare Advantage for 2026
Several specific updates and trends are already affecting Medicare Advantage plans in the 2026 plan year — and many will show up in the materials you should have received a couple of months ago.
📈 1. Slight Payment Increases for Plans
CMS finalized the 2026 Medicare Advantage and Part D rate announcement, and payments to Medicare Advantage plans are expected to increase by about 5.06 % overall compared to 2025. That translates to more than $25 billion flowing to plans next year, which may help stabilize networks or benefits in some markets.
What this means for members
• Plans may try to hold premiums steady
• Networks or benefits could remain similar, even if costs rise elsewhere
• In some areas, benefits are being maintained rather than cut due to this bump
💊 2. Part D and Prescription Payment Plan Updates
The Medicare Prescription Payment Plan — which lets beneficiaries spread out their annual drug costs in monthly payments — continues for 2025 and into 2026. This affects Medicare Advantage plans with drug coverage (MA-PD) as well as standalone Part D plans.
What this means for members
• Drug cost predictability may improve
• You could see monthly payment options for prescriptions instead of large up-front charges
🧾 3. Guardrails on Supplemental Benefits
Recent CMS policy clarifications for 2026 confirm that plans must follow new rules on what they cannot offer as “special supplemental benefits” to people with chronic illness. For example, things like unrelated non-health items or services that don’t clearly improve health can’t count as benefits under these rules.
What this means for members
• Some benefits you saw previously may no longer be offered
• Always review your plan’s updated Evidence of Coverage (EOC) and ANOC
📉 4. Star Ratings and Quality Bonus Payments Continue to Shift
CMS is updating some aspects of how ratings impact plans — including refining quality data and how plans are rewarded. While the overall system remains in place, certain measures insurers care about (and that beneficiaries indirectly feel through benefits or plan stability) are changing as CMS modernizes its quality framework.
What this means for members
• Plans with better performance may continue to receive bonus incentives
• How these quality incentives affect rebates and benefits could shift year to year
📦 5. Ongoing Trends in Plan Availability
Many carriers continue to adjust their plan offerings, including dropping or changing plan options in certain areas. This means:
• Plans that existed in 2025 may not be available in 2026
• Members may be moved to replacement options
• Some county-level choices may shrink, especially for PPO or broader-network options — a trend seen nationwide.
What this means for members
• Always compare all available plans each year
• Your doctor or hospital access can change due to plan availability
💊 6. Broader Medicare Cost and Benefit Shifts Affect Advantage Plans Too
While not specific to Advantage alone, things changed for 2026 that influence how Advantage coverage functions overall:
• Prescription drug out-of-pocket caps are rising (e.g., Medicare Part D $2,100 cap) — this affects Advantage plans with drug coverage.
• Insulin cost caps continue at $35/month with no deductible.
• Premium and deductible increases in Original Medicare and Part D influence how Advantage plans price and structure benefits.
What this means for members
• Prescription costs and caps are still something you need to check closely each fall
• Even if your Advantage plan looks similar, how your drug costs count toward out-of-pocket totals may change
🧠 Bottom Line on 2026 Changes
Compared to 2025, 2026 isn’t a year of massive overhaul — but it is a year of subtle shifts that matter:
⭐ Bigger plan funding overall
⭐ Continued refinement of quality measures
⭐ Prescription drug payment options
⭐ Benefit guardrails and supplemental benefit limits
⭐ Ongoing plan availability changes
🌲What I’ve seen/heard from Mainers
Some carriers have abruptly stopped offering Medicare Advantage plans altogether, or are only offering Special Needs Plans. This affected over 40,000 Mainers! That’s ONE out of every six!
Plans that remained from last year year had a retraction of benefits for the extras.
Many more rural areas have fewer plan options available.
Way fewer stand alone Prescription Drug plans available. (PDP’s) With a total of 9 different plans in 2026!
Mainers had it way better than New Hampshirites and Vermonters, who had a decimation to their carrier supply. Over 125,000+ left without their plans from 2025.
We love Drake Maye! GO PATS!
✨ Jon’s Final Thought
Medicare Advantage plans aren’t set-it-and-forget-it coverage. They require an annual check-in to make sure the plan still matches your health needs, providers, and budget. They are your plan for THIS year only, as there are no guarantees what next years coverage will look like!
Every year taking the time to review plan changes now can help prevent frustration, unexpected costs, and access issues later.
If you’re unsure how changes affect you, reviewing your options with a licensed Medicare professional can bring clarity before deadlines arrive. If your agent didn’t contact you in this tumultuous year, are they really working for you?
The most important takeaway remains the same: don’t assume your plan stays the same year to year. Always review your ANOC and plan details during the annual enrollment period to make sure coverage still works for you.
