Medicare isn’t standing still… and neither should you.
2026 is shaping up to be one of the biggest shake-ups Medicare has seen in years. From skyrocketing Medigap premiums to drug cost reforms and shrinking Advantage networks, millions of seniors will be affected.
The good news? You don’t need to figure it all out alone. My job is to keep track of the details so you don’t have to — and to explain them in plain English so you can feel confident and prepared.
1. Medigap Rates Are Skyrocketing Nationwide
It’s not just New York (where UnitedHealthcare plans to raise Medigap rates by 17.8%). Across the country, carriers are filing double-digit increases: here are few examples.
- Texas:: UnitedHealthcare +15.1% (July 2025); Mutual of Omaha +21.6% (June 2025).
- Illinois, North Dakota, Ohio:: UHC +12.6%.
- Kentucky: : Aetna +14.3%.
- Maryland & Pennsylvania:Aetna +15.8%.
- South Dakota: Aetna +19%.
- Arizona: BlueCross +14.5%.
- North Carolina: Blue Cross NC +4.7%.
- Washington: Asuris +15.9%.
- Alaska: Premera a shocking +55.6%.
Why the spikes? Medical inflation and higher claims after the pandemic have driven up loss ratios, forcing insurers to raise premiums.
What this means for you: Even if your premiums feel stable now, don’t be surprised to see major hikes in 2026. A yearly review could save you hundreds.
2. Medicare Advantage: Expect More Plan Exits & Network Changes
Just like last year, we’re seeing plans exit the market, merge, or change benefits. On Long Island (my home base), hospital networks are getting tighter — and many seniors are finding that their preferred doctors or hospitals (like Stony Brook) aren’t included.
What this means for you: Don’t assume your plan will be the same as last year. Always double-check your network and your Annual Notice of Change (ANOC) before October 15th.
3. Part D Prescription Drug Changes
The Inflation Reduction Act continues to reshape Medicare Part D in 2026.
- The annual out-of-pocket cap rises from $2,000 in 2025 to $2,100 in 2026.
- Deductibles are also climbing — projected at $615 in 2026 $615 in 2026
- More insurers are pulling back on standalone Part D plans, which means you may see fewer choices.
Another behind-the-scenes change: fewer carriers are paying agents commissions on Part D.
Why should you care? Because when agents don’t get paid, some may:
- Simply stop helping with Part D altogether, leaving seniors to figure it out on their own.
- Or worse — steer you toward a plan that pays them something, even if it’s not the best plan for you.
Let’s be real: Part D is one of the trickiest parts of Medicare. Plans change formularies, tiers, and preferred pharmacies every year. That’s why I continue to help my clients with it — whether I’m paid on a plan or not — because it’s critical to keeping your out-of-pocket drug costs under control.
4. The Gold Card Pilot: Prior Authorization Relief
Starting in 2026, CMS will test the “Gold Card” program — where some doctors can bypass prior authorizations for certain services.
Sounds good, right? It is… but only if your doctor qualifies. This won’t be automatic for every provider or every patient.
What this means for you: Ask your doctor if they’re participating. If not, you may still face prior auth red tape.
5. The Birthday Rule: What It Is (and Isn’t)
Most people have never heard of the Birthday Rule — and no wonder, it’s only available in certain states.
What the Birthday Rule Does
- Lets you switch from one Medigap plan to another without medical underwriting during a short window around your birthday.
- You can:
- Move from Plan G with Carrier A → Plan G with Carrier B (same coverage, new insurer).
- Downgrade from a higher-level plan to a lower-level plan (e.g., Plan F → Plan G, Plan G → Plan N).
- No health questions, no underwriting — just a clean switch.
What the Birthday Rule Does NOT Do
- It does NOT let you move from a Medicare Advantage plan into a Medigap plan.
- If you’re in Medicare Advantage today and want to move into a Plan G or N, you’ll need to:
- Wait for a valid enrollment window (like the Annual Enrollment Period or MA OEP).
- In most states, pass medical underwriting — unless you have a guaranteed issue right (such as your MA plan leaving the area, or you’re within your first 12 months of trying MA after dropping Medigap).
Why This Matters
Many agents and websites gloss over this distinction, but it’s critical. The Birthday Rule is a powerful tool for those already in Medigap who want to switch carriers or lower their costs. But it’s not a free pass to jump from Medicare Advantage into Medigap.
Bottom line: if you’re on Medigap, the Birthday Rule could save you money without risking denial. If you’re on Medicare Advantage and want Medigap, the rules are very different — and that’s where careful planning is key.
6. What You Should Do Now
- Watch for your Annual Notice of Change (ANOC) this fall.
- Keep an updated list of your doctors and prescriptions.
- Reach out for a personal review — my support is always free.
Final Thoughts
I know all of this can feel like a lot. Medicare changes never seem to stop — new rules, rising premiums, shifting plans — and it’s easy to feel overwhelmed or even discouraged. You’re not alone in that feeling.
Here’s what I want you to remember: being informed and prepared always puts you back in control. When you understand what’s happening and what your options are, the anxiety fades and the choices become clearer. That’s why I dedicate myself to bringing you updates like these — not to scare you, but to help you face Medicare with confidence instead of confusion.
I’ve walked this road with thousands of people, and one truth never changes: when you have the right information and someone you trust in your corner, Medicare doesn’t have to be a maze.
So as 2026 approaches, lean on me. My promise is simple — I’ll keep you educated, I’ll always be honest with you, and I’ll make sure you’re prepared to make the best decisions for your health and your wallet.
Because at the end of the day, Medicare isn’t just about insurance plans. It’s about your peace of mind.
Call me directly at 631-358-5793 or schedule a time here: Schedule a Free 2026 Medicare review With Paul
Let’s walk through these changes together — and make sure you’re in the best possible spot for 2026 and beyond.
