Your Complete Guide to Medicare Plans for 2026: Everything You Need to Know

Navigate Medicare with Confidence | Updated for 2026

Are you approaching 65 or reviewing your Medicare coverage for 2026? Understanding your Medicare options doesn’t have to be overwhelming. With significant changes coming in 2026—including lower prescription drug costs, new consumer protections, and updated premiums—now is the perfect time to ensure you’re getting the best coverage for your needs.

This comprehensive guide answers the most common Medicare questions, helps you avoid costly mistakes, and empowers you to make informed decisions about your healthcare coverage in 2026.

What’s New in Medicare for 2026?

Premium and Cost Changes

Medicare beneficiaries will see several cost adjustments in 2026. Here’s what you need to know:

Medicare Part B (Medical Insurance)

• Monthly premium: $202.90 (up from $185.00 in 2025)
• Annual deductible: $283 (up from $257 in 2025)

Medicare Part A (Hospital Insurance)

• Annual deductible: $1,736 (up from $1,676 in 2025)
• Days 61-90 coinsurance: $434 per day

Medicare Part D (Prescription Drug Coverage)

• Out-of-pocket maximum: $2,100 (up from $2,000 in 2025)
• Annual deductible cap: $615 (up from $590 in 2025)

Medicare Advantage Plans

• Average premium: $34.50 (down from $38.31 in 2025)
• Maximum out-of-pocket for in-network: $9,250 (down from $9,350)
• Maximum combined in/out-of-network: $13,900 (down from $13,950)

CMS

Game-Changing Benefits for 2026

1. Prescription Drug Out-of-Pocket Cap

The most significant change for 2026 is the $2,100 annual cap on out-of-pocket prescription drug costs. Once you reach this limit, your Part D plan pays 100% of your covered drugs for the rest of the year. This includes:

• Deductibles
• Copayments
• Coinsurance for covered drugs
• Brand-name and generic medications

This cap provides crucial financial protection for seniors taking multiple medications or expensive specialty drugs. Humana

2. Continued $35 Insulin Cap

All insulin products covered by Medicare Part D remain capped at $35 per month, regardless of the type or brand. This affordable pricing continues to provide relief for diabetic Medicare beneficiaries. AARP

3. Medicare Drug Price Negotiations

For the first time, Medicare is negotiating prices for high-cost prescription drugs, with more medications to be added in coming years. This historic change aims to reduce costs for beneficiaries taking expensive medications. Elder Law Answers

4. Enhanced Medicare Advantage Protections

New protections for 2026 include:

• Special enrollment period for those misled by inaccurate provider directories
• Tighter regulations on chronic care benefits
• Improved transparency in plan marketing
• Stronger consumer protections

Medicare Resources

What Are the Four Types of Medicare Plans?

This answers the Google “People Also Ask” question: “What are four types of Medicare plans?”

Understanding Medicare’s structure is essential for making informed decisions. Here’s a complete breakdown:

Medicare Part A (Hospital Insurance)

What It Covers:

• Inpatient hospital stays
• Skilled nursing facility care (following a hospital stay)
• Hospice care
• Some home healthcare

Costs in 2026:

• Most people pay $0 premium if they or their spouse paid Medicare taxes while working
• $1,736 deductible per benefit period
• After 60 days: $434/day coinsurance (days 61-90)

Medicare Part B (Medical Insurance)

What It Covers:

• Doctor visits and outpatient care
• Preventive services (screenings, vaccines, annual wellness visits)
• Medical equipment (wheelchairs, walkers)
• Ambulance services
• Mental health services

Costs in 2026:

• Monthly premium: $202.90 (higher for high-income earners)
• Annual deductible: $283
• Typically 20% coinsurance after deductible

Medicare Part C (Medicare Advantage)

Medicare Advantage plans are all-in-one alternatives to Original Medicare, offered by private insurance companies approved by Medicare.

What It Includes:

• Everything Part A and Part B cover
• Usually includes Part D prescription drug coverage
• Often adds extra benefits: dental, vision, hearing, fitness programs

Key Features:

• Must use plan’s network of doctors (with some exceptions)
• Lower premiums (average $34.50/month in 2026, many $0 plans)
• Out-of-pocket maximum protections
• Predictable costs with set copays

Available Plan Types:

• HMO (Health Maintenance Organization)
• PPO (Preferred Provider Organization)
• PFFS (Private Fee-for-Service)
• SNP (Special Needs Plans)

Medicare Part D (Prescription Drug Coverage)

What It Covers:

• Brand-name and generic prescription drugs
• Vaccines (some covered by Part B instead)

Costs in 2026:

• Premiums vary by plan (average $34.50)
• Maximum deductible: $615
• $2,100 annual out-of-pocket cap (major benefit!)
• After cap: $0 cost for covered drugs

Important: You can get Part D through:

• Stand-alone Part D plan (with Original Medicare)
• Medicare Advantage plan with drug coverage (MAPD)

Medicare.gov

Does Everyone Have to Pay $170 a Month for Medicare?

This answers the Google “People Also Ask” question about Medicare costs.

No, not everyone pays $170 per month for Medicare—and in fact, that figure is outdated for 2026. Here’s the reality:

Medicare Part A: Usually Free

Most people pay $0 for Part A if they or their spouse:

• Worked and paid Medicare taxes for at least 40 quarters (10 years)
• Are receiving Social Security or Railroad Retirement benefits

If you don’t qualify for premium-free Part A:

• 30-39 quarters of work: $278/month in 2026
• Less than 30 quarters: $505/month in 2026

Medicare Part B: Standard Premium $202.90

In 2026, the standard Part B premium is $202.90 per month (not $170). However, your actual cost depends on your income:

Income-Related Monthly Adjustment Amount (IRMAA)

If your modified adjusted gross income (MAGI) exceeds certain thresholds, you’ll pay more:

Individual Income

Couple Income

Part B Premium 2026

≤$106,000

≤$212,000

$202.90

$106,001-$133,000

$212,001-$266,000

$283.90

$133,001-$167,000

$266,001-$334,000

$405.90

$167,001-$200,000

$334,001-$400,000

$527.90

$200,001-$500,000

$400,001-$750,000

$649.90

>$500,000

>$750,000

$730.90

Income is based on your tax return from two years ago

Additional Costs to Consider

Medicare Advantage:

• Plan premiums: $0 to $100+/month (PLUS Part B premium)
• Average: $34.50/month in 2026

Medicare Part D:

• Stand-alone plan premiums: $0 to $45.70/month (PLUS Part B premium)
• IRMAA may apply to high-income earners

Medigap (Medicare Supplement):

• Premiums vary by plan type, age, location, and provider
• Typical range: $50 to $400+/month

NCOA

What Are the Biggest Mistakes People Make with Medicare?

This directly addresses a top Google “People Also Ask” question.

Avoiding these common mistakes can save you thousands of dollars and prevent coverage gaps:

Mistake #1: Missing Your Initial Enrollment Period

The Problem: If you don’t sign up when first eligible (at 65), you may face:

• Lifetime late enrollment penalties (10% per year for Part B)
• Coverage gaps leaving you uninsured
• Limited enrollment windows (only certain times of year)

The Solution:

• Enroll during your 7-month Initial Enrollment Period (IEP)
• IEP starts 3 months before your 65th birthday month
• Includes your birthday month
• Ends 3 months after your birthday month

Exception: If you have creditable employer coverage, you may delay without penalty, but you have only 8 months after leaving that job to enroll.

Mistake #2: Assuming Medicare Covers Everything

The Reality: Original Medicare has significant gaps:

• ❌ Dental care (except surgical procedures)
• ❌ Vision care (except certain medical conditions)
• ❌ Hearing aids
• ❌ Long-term care/nursing home (beyond skilled nursing)
• ❌ Cosmetic surgery
• ❌ Acupuncture (some exceptions)
• ❌ Most care outside the U.S.

The Solution: Consider supplemental coverage:

• Medicare Advantage plans (98%+ offer dental, vision, hearing in 2026)
• Medigap policies (cover copays, coinsurance, deductibles)
• Stand-alone dental/vision insurance

KFF

Mistake #3: Not Enrolling in Part D (Prescription Drug Coverage)

The Problem:

• 1% penalty per month you go without creditable coverage
• Penalty is permanent and added to all future premiums
• Even if you don’t take medications now, you might later

The Solution:

• Enroll in Part D during your Initial Enrollment Period
• Or have creditable coverage (employer, VA, TRICARE)
• Even if healthy, get a basic low-premium plan to avoid penalties

Mistake #4: Keeping the Same Plan Without Annual Review

The Problem:

• Plans change benefits, costs, and drug formularies every year
• Your healthcare needs change
• Better plans may become available in your area
• Your current medications may no longer be covered or may cost more

The Solution:

• Review your coverage every year during Annual Enrollment (Oct 15 - Dec 7)
• Check your Annual Notice of Change (ANOC) sent in September
• Use Medicare.gov Plan Finder to compare options
• Verify your doctors and prescriptions are still covered

Mistake #5: Choosing a Plan Based on TV Ads or “Free Perks”

The Problem:

• Marketing emphasizes perks (gym memberships, grocery allowances)
• May ignore important factors: doctor networks, drug coverage, total costs
• Celebrity endorsements don’t mean it’s the right plan for YOU

The Solution:

• Focus on healthcare needs first: doctors, medications, expected services
• Compare total costs (premiums + deductibles + copays)
• Verify your providers are in-network
• Check drug formularies for your specific medications
• Don’t let “free” perks distract from coverage quality

Mistake #6: Not Buying Medigap During Open Enrollment

The Problem:

• After your 6-month Medigap Open Enrollment Period (starts when you turn 65 and enroll in Part B), insurers can:
• Deny coverage based on health conditions
• Charge higher premiums
• Exclude pre-existing conditions

The Solution:

• Buy Medigap during your one-time guaranteed issue period
• Can’t be turned down or charged more due to health
• This window may not come again

CBS News

Mistake #7: Not Preparing for Different Part D Coverage Phases

The Problem:

• Misunderstanding deductibles, coverage gaps, and cost-sharing
• Using non-preferred pharmacies (costs significantly more)
• Not taking advantage of the $2,100 out-of-pocket cap in 2026

The Solution:

• Understand your plan’s structure: deductible → initial coverage → catastrophic coverage
• Use preferred pharmacies in your plan’s network
• Consider mail-order for maintenance medications (often lower cost)
• Track spending toward the $2,100 cap

Mistake #8: Enrolling Without Professional Guidance

The Problem:

• Medicare is complex with 100+ decisions to make
• Call centers may provide generic information
• Friends/family situations may differ from yours

The Solution:

• Work with a licensed, independent insurance agent specializing in Medicare
• Use free resources:
• State Health Insurance Assistance Program (SHIP)
• Medicare.gov tools and counselors
• 1-800-MEDICARE (1-800-633-4227)

At Xact Insurance, we provide personalized Medicare guidance at no cost to you. Our experts help you navigate your options and find coverage that fits your specific healthcare needs and budget.

SelectQuote

Which Medicare Plan Covers Dental, Vision, and Hearing?

This answers another critical “People Also Ask” question.

Original Medicare (Parts A & B): Minimal Coverage

What Original Medicare DOES cover:

• Dental: Only medically necessary procedures (jaw surgery, oral cancer treatment, emergency dental due to accident)
• Vision: Eye exams for diabetes or medical conditions, cataract surgery and corrective lenses after surgery
• Hearing: Diagnostic hearing tests ordered by physician (not routine screenings or hearing aids)

What Original Medicare DOES NOT cover:

• Routine dental cleanings and exams
• Fillings, crowns, dentures
• Routine vision exams and eyeglasses
• Hearing aids and exams for fitting

Medicare Advantage (Part C): Comprehensive Coverage

The Good News: In 2026, 98% or more Medicare Advantage plans offer dental, vision, and hearing benefits!

Typical Medicare Advantage Coverage:

Dental Benefits:

• Preventive: Cleanings (2-4 per year), exams, X-rays, fluoride
• Comprehensive: Fillings, extractions, root canals
• Major services: Crowns, bridges, dentures
• Annual allowances: $1,000 to $6,000 depending on plan

Vision Benefits:

• Routine eye exams (1-2 per year)
• Eyeglass frames and lenses allowance ($100-$400)
• Contact lenses
• Some plans cover upgrades (progressive lenses, anti-glare coating)

Hearing Benefits:

• Routine hearing exams
• Hearing aid allowances: $500 to $4,000 per ear (varies by plan)
• Hearing aid fittings and adjustments
• Some plans offer ongoing maintenance

Top Medicare Advantage Carriers for Dental/Vision/Hearing in 2026:

• Humana: Up to $6,000 dental allowance, $0 copays on many plans
• UnitedHealthcare: Extensive national networks
• Aetna/HealthSpring: Comprehensive coverage with high ratings
• Wellcare: Generous allowances, $0 copays for routine services
• Kaiser Permanente: Integrated care (where available)

Important Considerations:

• Must use in-network providers (especially with HMO plans)
• Some services require prior authorization
• Annual maximums apply to dental, vision, hearing benefits
• Review each plan’s specific benefits—they vary significantly

KFF

Alternative Options for Dental, Vision, Hearing

Stand-alone Dental Insurance:

• Can purchase separately if you have Original Medicare
• Typical premiums: $20-$75/month
• Usually has waiting periods for major services

Vision Insurance:

• Stand-alone plans: $10-$30/month
• Discount programs (like VSP, EyeMed)
• Retail optical chains offer membership programs

Hearing Aid Coverage:

• Stand-alone hearing insurance
• Discount programs through AARP, Costco
• Some states offer assistance programs

Medicare Supplement (Medigap):

• Does NOT cover dental, vision, or hearing
• Covers copays/deductibles for Medicare-covered services only

Original Medicare vs. Medicare Advantage: Which Is Right for You?

This is one of the most important decisions you’ll make. Let’s break down the pros and cons:

Original Medicare (Parts A & B)

Pros:
✅ Freedom of choice: See any doctor or hospital that accepts Medicare nationwide
✅ No referrals needed for specialists
✅ No network restrictions
✅ Consistent coverage across the country (great for snowbirds)
✅ Predictable structuredoesn’t change year to year
✅ Can add Medigap for comprehensive coverage of out-of-pocket costs
✅ Can add stand-alone Part Dfor prescription coverage

Cons:
❌ No out-of-pocket maximum(costs can be unlimited)
❌ Doesn’t cover dental, vision, hearing, prescriptions (without additional plans)
❌ 20% coinsurance on Part B services (no limit)
❌ Multiple plans to manage(Medicare + Medigap + Part D = 3 cards, 3 premiums)
❌ Higher premiums when combining Medigap + Part D
❌ No extra perks (no gym memberships, transportation, etc.)

Best For:

• People who travel frequently or live in multiple states
• Those who want unrestricted doctor choice
• Individuals with specialists they don’t want to lose
• People who can afford Medigap premiums
• Those who value consistency and simplicity in provider access

Medicare Advantage (Part C)

Pros:
✅ All-in-one coverage(hospital, medical, usually drugs)
✅ Out-of-pocket maximum($9,250 max in 2026 for in-network)
✅ Extra benefits: dental, vision, hearing (98% of plans)
✅ Additional perks: gym memberships, OTC allowances, transportation, healthy food benefits
✅ Lower premiums (many $0 plans, average $34.50/month)
✅ Predictable copays (e.g., $10 doctor visit, $50 specialist)
✅ One card, one plan to manage
✅ Preventive care focus with care coordination

Cons:
❌ Network restrictions (must use plan doctors/hospitals, except emergencies)
❌ Referrals often required for specialists
❌ Prior authorization may be needed for services
❌ Coverage tied to location(can’t use plan benefits if you move or winter elsewhere)
❌ Plans change annually(benefits, costs, networks can change)
❌ Can’t use Medigap with Medicare Advantage
❌ May face denials for non-emergency care outside network

Best For:

• People comfortable with network restrictions
• Those who stay in one geographic area
• Individuals wanting dental/vision/hearing coverage
• People on limited budgets (lower premiums)
• Those who value extra perks and preventive care coordination
• Individuals with predictable healthcare needs

AARP

Decision-Making Framework

Choose Original Medicare + Medigap + Part D if you:

• Want complete doctor choice freedom
• Travel frequently or live in multiple states seasonally
• Have complex medical needs with multiple specialists
• Can afford higher monthly premiums ($350-$600+ total)
• Value consistent, unchanging coverage

Choose Medicare Advantage if you:

• Are comfortable with network-based care
• Stay in one area most of the year
• Want dental, vision, hearing coverage included
• Prefer lower monthly premiums with predictable copays
• Value extra benefits (fitness programs, OTC allowances)
• Don’t mind plan reviews during Annual Enrollment

Not sure? Consider:

• Your health status and expected medical needs
• Your doctors—are they in Medicare Advantage networks?
• Your medications—are they covered by Advantage plan formularies?
• Your budget—can you afford Medigap premiums?
• Your lifestyle—do you travel or stay local?

How to Choose the Best Medicare Plan in 2026: Your Decision Checklist

This addresses the “People Also Ask” question: “How do I decide which Medicare plan is best for me?”

Follow this step-by-step process to find your ideal coverage:

Step 1: Assess Your Healthcare Needs

Current Health Status:

• [ ] List all current medical conditions
• [ ] List all prescription medications (names and dosages)
• [ ] Identify all doctors, specialists, and hospitals you visit
• [ ] Note any upcoming surgeries or procedures

Anticipated Healthcare Needs:

• [ ] Expected doctor visits per year
• [ ] Specialist visits needed
• [ ] Expected medications
• [ ] Dental/vision/hearing needs
• [ ] Physical therapy, mental health, or other services

Step 2: Evaluate Your Doctors and Facilities

• [ ] Call each doctor’s office to verify they accept Medicare
• [ ] Ask if they accept Medicare Advantage plans (which ones?)
• [ ] Confirm your preferred hospital accepts Medicare/specific MA plans
• [ ] Check if specialists require referrals

Pro Tip: Don’t assume your current doctor accepts all Medicare plans. HMO networks can be restrictive.

Step 3: Review Your Prescription Drug Costs

Use Medicare.gov Plan Finder:

• [ ] Enter all your medications
• [ ] Include dosages and quantities
• [ ] Compare drug costs across different plans
• [ ] Check if drugs are on preferred tier (lower cost)
• [ ] Verify your pharmacy is in-network
• [ ] Compare mail-order options

Key Factor: A plan with a $0 premium but expensive drug costs can be more expensive overall than a plan with a premium but lower drug copays.

Step 4: Compare Total Annual Costs

Don’t just look at premiums! Calculate:

Total Annual Cost Formula:

(Monthly Premium × 12)

+ Annual Deductible

+ Estimated Copays/Coinsurance

+ Prescription Drug Costs

= TOTAL ANNUAL COST

Example Comparison:

Cost Factor

Plan A

Plan B

Monthly Premium

$0

$45

Annual Deductible

$0

$0

PCP Visits (10× $10)

$100

$0

Specialist Visits (6× $50)

$300

$180

Prescriptions (annual)

$1,800

$900

TOTAL

$2,200

$1,620

Plan B with the $45 premium is actually $580 cheaper annually!

Step 5: Check Plan Quality Ratings

Medicare rates plans on a 5-star scale:

• ⭐⭐⭐⭐⭐ Excellent (rare)
• ⭐⭐⭐⭐ Above average (very good choice)
• ⭐⭐⭐ Average
• ⭐⭐ Below average (proceed with caution)
• ⭐ Poor (avoid)

What Star Ratings Measure:

• Quality of care provided
• Member satisfaction
• Customer service
• Plan administration
• Health outcomes

Find Ratings: Medicare.gov Plan Finder shows stars for each plan

Step 6: Evaluate Extra Benefits

Medicare Advantage Bonus Features:

Dental:

• [ ] Preventive coverage (cleanings, exams, X-rays)
• [ ] Comprehensive coverage (fillings, extractions)
• [ ] Major services (crowns, dentures)
• [ ] Annual allowance amount

Vision:

• [ ] Routine eye exams
• [ ] Eyeglasses/contacts allowance
• [ ] Frequency of coverage

Hearing:

• [ ] Hearing exams
• [ ] Hearing aid allowance per ear
• [ ] Replacement frequency

Other Perks:

• [ ] Gym membership (SilverSneakers, Renew Active)
• [ ] OTC allowance (over-the-counter items)
• [ ] Transportation to appointments
• [ ] Healthy food/produce benefits
• [ ] In-home support services
• [ ] Telehealth options

Prioritize: Which benefits matter most to YOU?

Step 7: Understand Plan Networks and Restrictions

If considering Medicare Advantage:

HMO (Health Maintenance Organization):

• Must use in-network providers (except emergencies)
• Need referrals for specialists
• Lowest premiums
• Best if: you stay local and don’t mind referrals

PPO (Preferred Provider Organization):

• Can see out-of-network providers (higher cost)
• No referrals needed
• Higher premiums
• Best if: you want flexibility and travel occasionally

PFFS (Private Fee-for-Service):

• Can see any provider who accepts plan terms
• No network or referrals
• Limited availability
• Best if: you want flexibility but can’t afford Medigap

SNP (Special Needs Plans):

• For specific conditions or situations
• Tailored benefits
• Must qualify

Step 8: Review Enrollment Periods

When You Can Enroll:

Initial Enrollment Period (IEP):

• 7 months around your 65th birthday
• 3 months before + birthday month + 3 months after

Annual Enrollment Period (AEP):

• October 15 – December 7
• Change any Medicare coverage
• Coverage starts January 1

Medicare Advantage Open Enrollment Period:

• January 1 – March 31
• Switch Medicare Advantage plans or return to Original Medicare
• One-time change only

Special Enrollment Periods (SEPs):

• Moving to new service area
• Losing employer coverage
• Medicaid changes
• Plan errors or misleading information
• Other qualifying events

Step 9: Get Expert Help

Free Resources:

• Medicare.gov: Official plan comparison tool
• 1-800-MEDICARE (1-800-633-4227): 24/7 counseling
• State Health Insurance Assistance Program (SHIP): Free local counseling
• Xact Insurance: Licensed agents provide personalized guidance at no cost

Questions to Ask an Agent:

• [ ] Are you licensed in my state?
• [ ] Do you represent multiple carriers (independent agent)?
• [ ] What is your fee? (Should be $0 to you—carriers pay commissions)
• [ ] Can you show me all options that fit my needs?

NCOA

Step 10: Make Your Decision & Enroll

Before Finalizing:

• [ ] Triple-check doctor/hospital network participation
• [ ] Verify all prescriptions are covered
• [ ] Confirm pharmacy is in-network
• [ ] Review Summary of Benefits document
• [ ] Understand costs: premiums, deductibles, copays, out-of-pocket max
• [ ] Check plan’s star rating
• [ ] Read member reviews if available

Enrollment Methods:

• Online: Medicare.gov or plan’s website
• Phone: 1-800-MEDICARE or plan directly
• Through licensed agent
• Mail: paper application

After Enrolling:

• [ ] Keep confirmation number
• [ ] Watch for ID cards (arrives before start date)
• [ ] Cancel old coverage if switching (don’t cancel before new coverage starts!)
• [ ] Mark calendar for next Annual Enrollment Period

Understanding Medicare Enrollment Periods: When Can You Sign Up?

This answers “People Also Ask” questions about enrollment timing.

Timing is everything with Medicare. Missing enrollment deadlines can result in penalties, coverage gaps, and limited options. Here’s your complete guide:

Initial Enrollment Period (IEP)

Who: First-time Medicare enrollees turning 65

When: 7-month window

• 3 months before your 65th birthday month
• Your birthday month
• 3 months after your birthday month

What to Do:

• Enroll in Part A (usually automatic if receiving Social Security)
• Enroll in Part B (if you want it)
• Choose Part D plan or Medicare Advantage plan

Coverage Start Dates:

• Enroll 3 months before or during birthday month: Coverage starts your birthday month
• Enroll after birthday month: Coverage delayed 1-3 months

Important: If you’re still working with employer coverage at 65, you may delay Part B without penalty (but must enroll within 8 months of retirement).

General Enrollment Period (GEP)

Who: People who missed their Initial Enrollment Period

When: January 1 – March 31 (every year)

Coverage Starts: July 1

Penalty Warning: If you don’t have creditable coverage, you’ll face:

• Part B: 10% penalty per 12-month period without coverage (permanent)
• Part D: 1% penalty per month without coverage (permanent)

Bottom Line: Try to avoid needing this period—penalties add up quickly!

Annual Enrollment Period (AEP) / Open Enrollment

Who: Everyone with Medicare

When: October 15 – December 7 (every year)

Coverage Starts: January 1

What You Can Do:

• Switch from Original Medicare to Medicare Advantage (or reverse)
• Change Medicare Advantage plans
• Add, drop, or change Part D plans
• Make any Medicare coverage changes you want

Why It Matters:

• Plans change benefits, costs, and networks every year
• Your health needs may have changed
• Better options might be available
• This is your annual opportunity to optimize coverage

Action Steps:

• Review Annual Notice of Change (ANOC) sent in September
• Compare current plan to alternatives using Medicare.gov
• Check doctor/hospital networks
• Verify prescription drug coverage
• Consider new plans in your area

Medicare Advantage Open Enrollment Period (MA OEP)

Who: People currently enrolled in Medicare Advantage

When: January 1 – March 31 (every year)

Coverage Starts: First of the month after enrollment

What You Can Do:

• Switch to different Medicare Advantage plan (one time only)
• Drop Medicare Advantage and return to Original Medicare
• Add Part D if returning to Original Medicare

What You CAN’T Do:

• Switch from Original Medicare to Medicare Advantage
• Change Part D plans (if you have Original Medicare)

Use Case: Buyer’s remorse after Annual Enrollment Period—gives you a second chance to make changes.

Special Enrollment Periods (SEPs)

Who: People experiencing qualifying life events

Common Qualifying Events:

Moving:

• Permanently moving to new service area (even within same state)
• Moving back to U.S. from abroad
• Leaving prison/jail
• 2-month window before move and 2 months after

Losing Coverage:

• Losing employer/union coverage
• COBRA ends
• Medicaid ends
• Losing eligibility for employer coverage
• 8-month window for creditable employer coverage
• 2-month window for other coverage types

Plan Problems:

• Plan leaves Medicare program
• Plan significantly changes service area
• Plan violated contract
• You were misled by incorrect provider directory information (NEW in 2026)
• Usually 2-3 month window

Other Events:

• Gaining Medicaid or Extra Help
• Entering/leaving skilled nursing facility
• Chronic condition diagnosis (for certain SNPs)
• Disaster declaration in your area

How to Use SEP:

• Contact Medicare or plan directly
• Provide documentation of qualifying event
• Enroll within your SEP window
• Don’t wait—act quickly once eligible

Five-Star Special Enrollment Period

Who: Everyone with Medicare (once per year)

When: December 8 – November 30 (continuous)

What: Can enroll in a 5-star Medicare Advantage or Part D plan

Limitation: Only once per calendar year, only for plans with 5-star rating

Why It Exists: Rewards high-quality plans and gives beneficiaries access to excellent coverage year-round.

Medicare.gov

Medicare Advantage in 2026: What You Need to Know

Enrollment Trends and Availability

• Projected enrollment: 34 million (48% of all Medicare beneficiaries)
• Slight decrease from 2025’s 34.9 million (50% of beneficiaries)
• More plans available with enhanced benefits

2026 Medicare Advantage Highlights

Lower Premiums:

• Average total premium: $34.50/month (down from $38.31)
• Many $0 premium plans available
• Average for MA plans with drug coverage: $11.50/month

Enhanced Benefits:

• 99% of plans offer vision benefits
• 98% offer dental benefits
• 98% offer hearing benefits
• 67% of Special Needs Plans offer transportation
• 94% of SNPs offer OTC allowances

Improved Protections:

• Special enrollment for those misled by inaccurate directories
• Tighter chronic care benefit regulations
• Focus shifting from perks to quality healthcare
• Enhanced transparency requirements

Cost Protections:

• Maximum out-of-pocket: $9,250 in-network (down from $9,350)
• Maximum combined in/out-of-network: $13,900

KFF

Top Medicare Advantage Carriers for 2026

Based on quality ratings, benefits, and member satisfaction:

Best Overall: Aetna CVS Health

• High star ratings across plans
• Comprehensive benefits
• Strong provider networks

Best for Low Costs: Alignment Health

• Competitive premiums
• Good value proposition
• Growing availability

Best for Patient Experience:Humana

• Excellent member satisfaction
• Generous dental allowances (up to $6,000)
• Strong supplemental benefits

Best Quality: HealthSpring (formerly Cigna)

• High-quality care metrics
• Good member experience
• Comprehensive coverage

Best for Drug Coverage: Kaiser Permanente

• Integrated care model
• Strong formulary management
• Excellent coordination (where available)

Availability varies by location—use Medicare.gov to see plans in your area.

Part D Prescription Drug Coverage: Major Changes for 2026

The $2,100 Out-of-Pocket Cap: A Game Changer

The most significant Part D change in 2026 is the $2,100 annual out-of-pocket maximum. This cap provides crucial financial protection:

What Counts Toward the Cap:
✅ Your deductible
✅ Copayments for covered drugs
✅ Coinsurance for covered drugs
✅ Amount paid during initial coverage phase

What Doesn’t Count:
❌ Plan premiums
❌ Non-covered drugs
❌ Drugs purchased outside your plan’s network
❌ Drugs purchased at out-of-network pharmacies (except in emergencies)

After Reaching the Cap:

• Your plan pays 100% for covered drugs
• No more copays or coinsurance for rest of year
• Applies to all Part D plans (stand-alone and Medicare Advantage)

This is especially valuable for people taking:

• Multiple medications
• Expensive specialty drugs
• High-cost biologics
• Medications for chronic conditions

UnitedHealthcare

Part D Cost Structure for 2026

Deductible Phase:

• Maximum deductible: $615 (if plan has one)
• Many plans have $0 deductible
• You pay full cost until deductible met

Initial Coverage Phase:

• You pay copays or coinsurance according to drug tier
• Continues until you reach $2,100 out-of-pocket

Catastrophic Coverage Phase:

• Begins after you spend $2,100 out-of-pocket
• Plan pays 100% for covered drugs
• No more costs for rest of year!

The Donut Hole is GONE:
In previous years, there was a “coverage gap” where costs increased. That’s eliminated—you now have a straightforward path to the $2,100 cap and then free covered drugs.

Premium Trends for 2026

Stand-Alone Part D Plans:

• Average premium: $34.50 (down from $38.31 in 2025)
• Range: $0 to $45.70 depending on state and plan
• Many plans decreasing premiums

Medicare Advantage with Part D (MAPD):

• Average drug coverage portion: $11.50
• Often included in plan premium
• Some plans have integrated $0 premium

Why Premiums Vary:

• Geographic location
• Plan benefits and formulary
• Insurer pricing strategy
• Your income (IRMAA may apply)

KFF

Insulin and Vaccine Cost Protections

$35 Insulin Cap:

• All covered insulin products capped at $35 per month
• Applies to all types (rapid-acting, long-acting, intermediate)
• Both brand and generic insulins
• No exceptions—all Part D plans must comply

Free Vaccines:

• Adult vaccines recommended by CDC covered at $0 cost
• Includes: shingles, pneumonia, flu, COVID-19
• No copays, coinsurance, or deductible
• Part D must cover; some covered by Part B instead

How to Optimize Your Part D Coverage

1. Compare Plans Annually:

• Use Medicare.gov Plan Finder
• Enter ALL your current medications
• Include exact dosages and quantities
• Compare total annual costs (not just premiums)

2. Check Your Drug Tier:

• Tier 1-2 (preferred generic): Lowest cost
• Tier 3 (preferred brand): Moderate cost
• Tier 4 (non-preferred): Higher cost
• Tier 5 (specialty): Highest cost
• Ask doctor if lower-tier alternatives exist

3. Use Preferred Pharmacies:

• “Preferred cost-sharing” pharmacies have lowest copays
• “Standard” pharmacies cost more
• Can save hundreds annually by using preferred pharmacy
• Check your plan’s pharmacy network

4. Consider Mail-Order:

• Often cheaper for 90-day supplies
• Convenient for maintenance medications
• Usually 2.5× the cost of 30-day supply (vs 3×)

5. Ask About Generic Alternatives:

• Generics are significantly cheaper
• Medically equivalent to brand names
• Can move you to lower tier
• Not all brands have generic equivalents yet

6. Request Exceptions:

• If your drug isn’t covered, request formulary exception
• If tier is too high, request tier exception
• Requires documentation from doctor
• Plan must respond within 72 hours

2026 Medicare Costs Quick Reference Guide

Medicare Part A (Hospital Insurance)

Cost Category

2026 Amount

Premium (if not eligible for free)

$278 or $505/month

Deductible per benefit period

$1,736

Days 1-60 in hospital

$0 (after deductible)

Days 61-90 in hospital

$434/day coinsurance

Days 91+ (60 lifetime reserve days)

$868/day coinsurance

Skilled nursing (days 21-100)

$217/day coinsurance

Medicare Part B (Medical Insurance)

Cost Category

2026 Amount

Standard Monthly Premium

$202.90

Annual Deductible

$283

Coinsurance

20% of Medicare-approved amount

IRMAA (high-income surcharge)

+$81 to +$527.90/month

Medicare Part D (Prescription Drug Coverage)

Cost Category

2026 Amount

Average Premium

$34.50

Maximum Deductible

$615

Out-of-Pocket Maximum

$2,100

After Maximum

$0 (100% covered)

Insulin Cap

$35/month

Medicare Advantage (Part C)

Cost Category

2026 Amount

Average Premium

$34.50 (plus Part B)

Many Plans Premium

$0 (plus Part B)

Max Out-of-Pocket (in-network)

$9,250

Max Out-of-Pocket (combined)

$13,900

NCOA

Your Action Plan for Medicare in 2026

If You’re Turning 65 Soon:

3-4 Months Before 65th Birthday:

• [ ] Determine if you’re automatically enrolled (receiving Social Security)
• [ ] Decide if you need Part B now or can delay with employer coverage
• [ ] Research plan options: Original Medicare + supplements vs Medicare Advantage
• [ ] List your doctors, medications, and healthcare needs
• [ ] Contact licensed Medicare agent or SHIP counselor

3 Months Before Birthday:

• [ ] Enroll in Medicare Part A and Part B (if not automatic)
• [ ] Choose Part D plan or Medicare Advantage plan with drug coverage
• [ ] If choosing Original Medicare, compare Medigap plans
• [ ] Enroll in your selected coverage

Around Your Birthday:

• [ ] Watch for Medicare card in mail
• [ ] Watch for plan ID cards
• [ ] Contact providers to update insurance information
• [ ] Cancel old coverage (if applicable) after new coverage starts

If You Currently Have Medicare:

September:

• [ ] Receive and read your Annual Notice of Change (ANOC)
• [ ] Note any changes to premiums, benefits, drug formulary, doctor networks
• [ ] Assess your healthcare needs for upcoming year
• [ ] Gather list of current medications

October 15 - December 7 (Annual Enrollment):

• [ ] Use Medicare.gov Plan Finder to compare options
• [ ] Review your current plan’s star rating
• [ ] Compare total costs (premiums + drugs + expected healthcare)
• [ ] Verify your doctors are still in-network
• [ ] Confirm your medications are still covered at same cost
• [ ] Make changes if better options exist
• [ ] If staying with current plan, ensure it still meets needs

January 1:

• [ ] New coverage begins
• [ ] Verify new plan cards arrive
• [ ] Update pharmacy on new coverage
• [ ] Inform doctors of any plan changes

Throughout the Year:

• [ ] Keep records of all medical expenses
• [ ] Track spending toward Part D out-of-pocket maximum
• [ ] Save Explanation of Benefits (EOBs) statements
• [ ] Report any plan problems to Medicare (1-800-MEDICARE)
• [ ] Update plan if you have a Special Enrollment Period event

Get Expert Medicare Guidance from Xact Insurance

Navigating Medicare doesn’t have to be overwhelming. At Xact Insurance, we specialize in helping individuals and families find the right Medicare coverage for their unique needs and budget.

Why Choose Xact Insurance?

✅ Independent, Unbiased Advice– We represent multiple carriers and show you all your options
✅ No Cost to You – Our services are completely free; insurance companies pay us
✅ Local Expertise – Licensed agents who understand your community and providers
✅ Personalized Guidance – We take time to understand YOUR specific situation
✅ Ongoing Support – We’re here for you beyond enrollment with questions and changes
✅ Annual Reviews – We proactively reach out each year to optimize your coverage

Our Services Include:

• Medicare plan comparison and enrollment
• Medicare Advantage plan selection
• Part D prescription drug plan analysis
• Medigap (Medicare Supplement) policies
• Medicare eligibility and enrollment period guidance
• Annual plan reviews and optimization
• Claims assistance and advocacy
• Provider network verification

Ready to Get Started?

Contact Xact Insurance Today:

📞 Phone: [Your Phone Number]
🌐 Website: www.xactinsure.net
📧 Email: [Your Email Address]
📍 Office: [Your Location]

Schedule your free Medicare consultation today and let our experts guide you to the perfect coverage for 2026!

Frequently Asked Questions (FAQ)

Q: Can I have both Medicare and employer insurance?
A: Yes! If your employer has 20+ employees, employer insurance typically pays first (primary), and Medicare pays second (secondary). If fewer than 20 employees, Medicare usually pays first. Coordinate with both to maximize coverage.

Q: What happens if I travel outside the United States?
A: Original Medicare generally doesn’t cover care outside the U.S. (except limited situations in Canada/Mexico). Medicare Advantage plans vary—some offer emergency coverage abroad, others don’t. Consider travel insurance or Medigap Plan C, D, F, G, M, or N for foreign travel coverage.

Q: Can I change from Medicare Advantage back to Original Medicare?
A: Yes, during Annual Enrollment (Oct 15-Dec 7) or Medicare Advantage Open Enrollment (Jan 1-Mar 31). However, getting a Medigap plan might be difficult due to medical underwriting (unless you have guaranteed issue rights).

Q: What if my doctor leaves my Medicare Advantage network?
A: You have a Special Enrollment Period to change plans. You can switch to a different Medicare Advantage plan or return to Original Medicare. Act within 2-3 months of notification.

Q: Is dental care covered by Medicare in 2026?
A: Original Medicare still doesn’t cover routine dental. Medicare Advantage plans (98% in 2026) offer dental benefits. You can also purchase stand-alone dental insurance.

Q: Will there be a Part D penalty if I didn’t enroll?
A: Yes, unless you had creditable coverage. The penalty is 1% of the national base beneficiary premium per month you were without coverage, added permanently to your Part D premium.

Q: What’s the difference between Medigap and Medicare Advantage?
A: Medigap supplements Original Medicare, paying copays/deductibles/coinsurance but doesn’t add extra benefits. Medicare Advantage replaces Original Medicare entirely and often includes extra benefits (dental/vision/hearing) but has network restrictions.

Q: Can I be denied a Medigap plan?
A: During your 6-month Medigap Open Enrollment Period (starts when you turn 65 and enroll in Part B), insurers must sell you any plan they offer regardless of health. Outside this period, they can deny coverage or charge more based on health conditions (except in some states with additional protections).

Key Takeaways for Medicare 2026

✔️ Part B premiums increased to $202.90/month, but Medicare Advantage premiums decreased on average

✔️ Part D out-of-pocket cap of $2,100 provides major financial protection—after hitting this, covered drugs are free

✔️ $35 insulin cap continues, helping diabetic beneficiaries afford life-saving medication

✔️ 98%+ of Medicare Advantage plansoffer dental, vision, and hearing coverage in 2026

✔️ Avoid costly mistakes by enrolling on time, reviewing plans annually, and seeking expert guidance

✔️ Original Medicare offers freedom; Medicare Advantage offers comprehensive benefits at lower premiums—choose based on YOUR priorities

✔️ Annual Enrollment (Oct 15-Dec 7)is your yearly opportunity to optimize coverage—don’t skip it!

✔️ Work with licensed professionalslike Xact Insurance for personalized, no-cost guidance

Additional Resources

Official Government Resources:

• Medicare.gov – Official Medicare website with plan comparison tools
• 1-800-MEDICARE (1-800-633-4227) – TTY: 1-877-486-2048
• MyMedicare.gov – Create account to view claims, coverage, and manage benefits
• Social Security Administration – SSA.gov – Enrollment and eligibility

Free Counseling:

• SHIP (State Health Insurance Assistance Program) – Free local Medicare counseling
• Medicare Rights Center – 800-333-4114 – Non-profit advocacy and counseling

Cost Assistance Programs:

• Extra Help (Part D Low-Income Subsidy) – Call Social Security: 800-772-1213
• Medicare Savings Programs – Contact your state Medicaid office
• Pharmaceutical Assistance Programs – NeedyMeds.org, RxAssist.org

Plan Comparison Tools:

• Medicare.gov Plan Finder – Compare all plans available in your area
• Medicare Options Compare – MedicareOptionsCompare.com

Conclusion: Take Control of Your Medicare Coverage in 2026

Medicare in 2026 brings meaningful improvements—lower prescription drug costs, enhanced protections, and continued comprehensive benefits through Medicare Advantage plans. But with dozens of plans to choose from and important decisions to make, having expert guidance makes all the difference.

Whether you’re enrolling for the first time or reviewing your current coverage, understanding your options empowers you to make confident decisions that protect your health and your budget.

Don’t navigate Medicare alone.The team at Xact Insurance is ready to provide personalized guidance, answer your questions, and help you find coverage that fits your unique needs—all at no cost to you.

Take action today:

• Contact Xact Insurance for your free consultation
• Review your coverage during Annual Enrollment (Oct 15-Dec 7)
• Verify your doctors and medications are covered
• Optimize your benefits for 2026

Your health is your most valuable asset. Make sure your Medicare coverage protects it.

📞 Contact Xact Insurance Today
Website: www.xactinsure.net
Phone: 239-341-9545

Medicare insurance is available to individuals aged 65 and older, certain younger people with disabilities, and people with End-Stage Renal Disease. Xact Insurance is an independent agency representing multiple insurance carriers. We are not connected with or endorsed by the U.S. government or the federal Medicare program.