Overview
Major changes are coming to Medicare Advantage (MA) plans in 2026, with many plans being discontinued nationwide. Current MA enrollees, especially those whose plans are ending, must be proactive to maintain coverage and understand their options, deadlines, and guaranteed issue rights.
Medicare Advantage Plan Changes for 2026
- Over 1 million Medicare Advantage enrollees will lose their plans starting January 1, 2026.
- Major insurers, including United Health Group, are exiting or reducing certain plans, notably PPOs and some HMOs.
- No automatic "crosswalk" to a new plan: members must select a new plan or risk losing coverage, including prescription drugs (Part D).
- Insurance companies are changing requirements, such as adding referrals, network restrictions, and raising premiums or adding deductibles.
Causes Behind Plan Discontinuations
- Rising healthcare costs, increased care usage, and 2025 drug cost shifts from the Inflation Reduction Act have made many plans unprofitable.
- Insurers must spend at least 85% of revenues on care (medical loss ratio), leaving limited margins.
- Competitive bidding on plan designs sometimes led to unsustainable losses for insurers, prompting plan withdrawals.
Options for Affected Beneficiaries
- Select a new MA plan from the same or a different company during the special election window.
- Use guaranteed issue rights to switch to original Medicare and obtain a Medigap (supplement) plan without medical underwriting, within 63 days of plan termination.
- Medigap options may be limited by letter plan (e.g., Plan F only for those eligible before 2020; Plan N typically unavailable during guaranteed issue).
- Supplement plans require purchasing a standalone Part D plan for drug coverage.
- The annual notice of change (sent in September) and additional mailings will alert members of plan discontinuations.
Critical Deadlines and Enrollment Periods
- Annual Enrollment for unchanged MA plans: October 15 – December 7, with changes effective January 1.
- For discontinued plans, members can switch plans until December 31, effective January 1, avoiding any gap in coverage.
- Guaranteed issue right for Medigap runs from 60 days before to 63 days after MA plan ends (usually January 1 is the first inactive day).
Working With Agents and Brokers
- Agents/brokers are often not compensated for helping with Medigap enrollments during guaranteed issue in many states, affecting their willingness to assist.
- Contact your broker only after October 1 for info and after October 15 to make changes.
- Using a call center or direct insurer contact may sever your existing broker relationship.
Action Items
- September – All Medicare Advantage enrollees: Watch for and read the annual notice of change and any plan termination letters.
- October 1 – Medicare Advantage holders: Contact agents for upcoming plan details.
- October 15 – December 31 – Affected enrollees: Enroll in a new MA plan or Medigap plan to ensure continuous coverage.
- TBD – Those switching to Medigap: Obtain a standalone Part D plan for drug coverage.
Questions / Follow-Ups
- Clarify state-specific rules for Medigap plan options and agent compensation.
- Use provided checklist (if applicable) to guide self-enrollment if agent assistance is unavailable.
Recommendations / Advice
- Do not ignore official notices; take proactive steps to review and act on your coverage options.
- Consult a trusted agent or use available resources early in the election window to avoid rushed decisions or gaps in coverage.
- Share this information with friends and family on affected plans to ensure they are aware and prepared.