If you’re on Medicare, you’ve probably started hearing about big changes coming for 2026 — and it’s not your imagination. There’s a lot happening behind the scenes in the Medicare system right now, and many seniors are caught in the middle without realizing it.
In this post, Hans Scheil and Tom Griffith take a closer look at the disruption in the Medicare insurance market, why it’s happening, and what you can do to prepare during the Annual Enrollment Period (AEP) from October 15 to December 7.
A Look Back: 50 Years in Medicare
Hans began helping seniors with Medicare Supplement Insurance in 1976 — back when Medicare consisted only of Part A (Hospital) and Part B (Medical). At that time, there were no drug benefits, no Medicare Advantage plans, and no complex network rules. The system was simpler, but healthcare itself was also much different.
Fast forward to today: nearly 25% of the U.S. population is on Medicare, and the cost of care has grown dramatically. The system now includes prescription coverage, private insurance carriers, and countless moving parts — all trying to balance coverage, costs, and regulation. That’s where today’s disruption begins.
How the Inflation Reduction Act Started the Chain Reaction
In 2022, Congress passed the Inflation Reduction Act, which included new benefits for seniors — most notably, a $2,000 annual out-of-pocket cap on prescription drugs (Part D) beginning in 2025.
This was great news for retirees who spend thousands on medications each year. But here’s the issue: no new funding was provided to offset those costs. Private insurers are now responsible for covering more drug expenses, yet they’re not being paid more by the federal government.
In 2024, as the rule took effect, insurance companies and the Centers for Medicare & Medicaid Services (CMS) began negotiating how to make it work financially. The result? For 2026 and beyond, Part D premiums are expected to rise, and formularies (the lists of covered drugs) may tighten.
What This Means for You in 2026
If you have a stand-alone Part D drug plan or a Medicare Advantage plan, you’re likely to see:
Higher monthly premiums — even for plans that were previously $0.
Changes to drug formularies — some medications may no longer be covered.
Adjustments to ancillary benefits — like dental, vision, or gym memberships.
More complex communications — such as longer, harder-to-understand Annual Notice of Change (ANOC) letters.
You may have already received your ANOC in the mail. Don’t ignore it! It outlines every change coming to your plan next year — including premium increases and deductible updates.
The biggest takeaway: review your plan now so you’re not stuck in the wrong one until next year’s enrollment period.
Using Medicare.gov to Compare Your Plans
Tom demonstrates in the video how to use your Medicare.gov account to review and compare plans — something every Medicare beneficiary should do at least once a year.
Here’s how:
- Go to Medicare.gov.
- Click Log In or Create Account (you’ll need your Medicare number).
- Once logged in, select “Find Health & Drug Plans.”
- Review your current plan and see how your medications are covered.
- Compare other available plans in your ZIP code and preferred pharmacies.
This tool allows you to check premiums, copays, and drug coverage — and even enroll in a new plan if you find a better fit. It’s fast, free, and available 24/7.
Original Medicare vs. Medicare Advantage: A Quick Refresher
Medicare beneficiaries generally have two choices:
- Original Medicare (Part A & B) + a Medicare Supplement and Part D drug plan
- Medicare Advantage (Part C) — all-in-one private coverage that usually includes drug benefits
Here’s a quick overview:
| Option | Pros | Cons |
|---|---|---|
| Original Medicare + Supplement | No networks; nationwide coverage; predictable out-of-pocket costs | Monthly supplement premiums ($100–$200 on average) |
| Medicare Advantage (Part C) | Often $0 premium; includes dental/vision; simplified plan | Requires networks, pre-approvals; benefits can change yearly |
You can only have one or the other — not both. During AEP (Oct 15–Dec 7), you can switch between these options, but if you’re moving back to Original Medicare, it’s smart to apply for your supplement first to ensure you’re medically eligible.
Don’t Panic — Just Prepare
The upcoming changes don’t mean Medicare is broken, or that anyone’s out to get seniors. As Hans explains, every player — from the government and drug companies to hospitals, insurers, and agents — is part of a complicated system trying to balance care, cost, and access.
The key is understanding how these changes affect you personally and taking action before December 7 to ensure you’re in the right plan for 2026.
Our Best Advice
- Read your ANOC letter — especially the first few pages showing premium and deductible changes.
- Log into Medicare.gov to compare your current plan against next year’s options.
- Contact Cardinal Advisors if you’d like one-on-one help reviewing your coverage or running side-by-side comparisons.
We’ve been helping Medicare clients for decades — and our goal is to simplify this process so you can feel confident about your decisions.
