Big changes for 2026 Medicare plans

A practical, action-oriented guide for financial advisors, insurance agents, and retirement planners

Medicare open enrollment (Oct. 15–Dec. 7) is always busy — this year it’s urgent. The Wall Street Journal reports insurers are pulling plans, trimming perks, switching plan networks toward HMOs, raising cost-sharing and shrinking stand-alone Part D choices. As WSJ puts it, for many enrollees “This year is a nightmare.” 

Those market changes create immediate planning work and a real opportunity for advisors and agents to demonstrate value. Here are five things every advisor/agent should examine this week.

1) Out-of-pocket maximums and key line items

What WSJ found: Several large insurers raised maximum MOOP caps and added or increased per-day hospital fees and monthly premiums for plans that were previously free or very low cost.  

Action: Run clients’ current plan ANOC (Annual Notice of Change) and Evidence of Coverage. Flag increases to: OOP max, hospital day fees, monthly premium, and deductible. Re-model 12–18 months of cash flow under the new numbers.

2) Provider networks (PPO → HMO shifts)

What WSJ found: Insurers are shrinking PPO options and favoring HMOs, which restrict out-of-network care.

Action: verify each client’s primary provider, specialists and preferred hospital on the insurer directory — and call the provider to confirm participation. If continuity of care matters, run Original Medicare + Medigap cost scenarios vs. Medicare Advantage alternatives.

3) Prescription drug coverage (Part D)

What WSJ found: The number of stand-alone Part D plans is collapsing and many plans switch from copays to coinsurance; deductibles are rising. 

Action: for every client on maintenance meds, run the drug-lookup tool at Medicare.gov/plan-compare for 2026 options. Test generics/alternative formulations and verify whether specialty drugs move to different tiers or require prior authorization.

Useful link: Medicare Plan Finder — https://www.medicare.gov/plan-compare 

4) Perks and ancillary benefits trimmed

What WSJ found: Grocery allowances, OTC credits, fitness benefits and other extras are being reduced or eliminated by several carriers.

Action: Re-evaluate whether a client was relying on these extras (e.g., home-delivery of healthy groceries) for monthly budgeting. If so, model replacement strategies (cash flow, community supports, non-insurance programs).

5) Broker incentives and “hidden” plan availability

What WSJ found: Carriers are cutting commissions for less-profitable (often PPO and Part D) plans, which can bias some agents toward plans that pay.

Action: proactively disclose how you source options; use Medicare.gov plan finder (which lists all products) and, when appropriate, suggest SHIP (State Health Insurance Assistance Program) or Medicare Rights Center support to ensure clients see all public options.

Helpful resources:

• Medicare Plan Finder: https://www.medicare.gov/plan-compare 
• State Health Insurance Assistance Program (SHIP): https://www.shiphelp.org/ 
• Medicare Rights Center: https://www.medicarerights.org/ 

A simple, repeatable workflow advisors can run in 30–60 minutes per client

1. Pull client’s ANOC and Evidence of Coverage (EOC) for 2026. Mark changes to premiums, OOP max, hospital/day fees, drug cost structure.

2. Confirm provider participation — phone the doctor or hospital if directory info is questionable.

3. Run the client’s medication list through Medicare.gov Plan Finder for the client’s zipcode and test 3–4 likely plan candidates. Document cost differences for the client.

4. Model worst-case annual out-of-pocket exposure and show the client the difference between their 2025 and 2026 expected spend.

5. Present 2 recommended options to the client: (A) Keep current plan if changes are minor, (B) Switch (with rationale). Provide clear pros/cons and next steps for enrollment.

6. If client needs Medigap, act quickly — underwriting windows and pricing matter.

Quick checklist to give to clients

Review 2026 Annual Notice of Change (ANOC)

Verify provider participation (call office)

Run meds through Medicare.gov Plan Finder (2026 formularies)

Compare OOP max, deductibles, hospital/day fees, and premium changes

Check whether plan changed from PPO → HMO (network limits) 

Confirm IRMAA / means-tested benefit exposure for large retro payments

If switching to Original Medicare, check Medigap eligibility windows

Case Study

Before: 69-year-old retired teacher on a $0 premium MA PPO, stable meds, favorite hospital in network.

Discovery: ANOC shows a new $48 monthly premium, a $550/day hospital fee for first five days, and a reduced drug formulary. The insurer removed the PPO and switched to an HMO in the county.

Action: We called the hospital (confirmed out-of-network), ran Plan Finder and found an MA plan with similar networks but higher premium vs. Original Medicare + Medigap. Client chose Original + Medigap to keep provider access; we modeled the cost and documented underwriting window implications.

Compliance & Ethics

Disclose any compensation conflicts. WSJ highlights that commission cuts can change agent incentives — make your sourcing transparent and document recommendations and why you chose them.

How NSSA® Can Help

• NSSA® Certified Social Security Advisor training: teach your team to integrate Medicare plan changes into retirement income planning, run benefits audits, and communicate confidently.

• Live and on-demand courses: practical modules on coordinating Medicare with Social Security claiming, IRMAA and tax effects, and client conversations. (Link to training landing pages on your site.)

Why Acting Quickly Matters

WSJ’s reporting makes something plain: 2026 Medicare plan design is more volatile than most recent years — from fewer Part D choices to plan eliminations and higher out-of-pocket exposure. That volatility equals opportunity for advisers and agents who show up with answers, not excuses. A timely benefits audit and the right communication now will save clients money, reduce stress, and build long-term trust.

Read the full WSJ article: Big Changes Are Coming for 2026 Medicare Plans. What You Need to Know.