By Christian Regalado
Fasten your seatbelts! Significant changes are on the horizon for individuals enrolled in Medicare and/or Medicaid, and for those who purchase individual coverage through the Affordable Care Act (ACA) beginning in 2026. Changes are largely influenced by the recent passage of the “One Big Beautiful Bill” and finalized rules through the Centers for Medicare and Medicaid Services (CMS). Let’s break down some of the changes we know about so far:
First, for Medicare enrollees, changes are anticipated for Medicare Advantage (MA) plans, Part D prescription drug plans (PDP), and Medicare Supplement plans.
The Centers for Medicare & Medicaid Services (CMS) finalized a 5.06% increase in payments to Medicare Advantage plans for 2026. Increased funding is aimed at ensuring seniors may continue receiving quality medical care without excessive financial strain. Nevertheless, in the Panhandle market, extra benefits commonly found in MA plans, such as dental, were already reduced in 2025, and additional cuts to dental, vision, and over-the-counter benefits are anticipated in 2026. We may also see the number of available zero-premium MA plans reduced next year.
For seniors enrolled in Part D, the annual out-of-pocket max for prescription drugs will increase modestly from $2000 to $2100 in 2026. The monthly cap for insulin costs of $35 or less will now apply annually, beginning in 2026, and deductibles won’t apply to insulin. PDP plans will continue to cover recommended vaccines by the Advisory Committee on Immunization Practices (ACIP) with no cost sharing; however, future recommendations authorized by the Secretary of Health and Human Services may change.
For those enrolled in Traditional Medicare with a Supplement Plan, anticipate potentially impactful premium increases in 2026, though we don’t yet know what that will look like.
Medicaid will see the biggest disruptions, with changes phasing in over the coming few years. Many will lose coverage, and there will be more hoops to jump through for most who are able to remain enrolled starting in late 2026. By late 2028, many enrollees will also see new cost-sharing requirements.
At the time of this writing, we’re still learning how the individual ACA market will be impacted. We know the enhanced individual tax credits extended through the Inflation Reduction Act will expire at the end of 2025. The loss of these credits will leave many people unable to afford health insurance. Hopefully this will soon be addressed, but there is no sign that Congress intends to do so this year.
The healthcare landscape in the U.S. is only getting more complicated. People will benefit from local experts’ help more than ever. Brokers won’t see 2026 plans until September, and we can’t discuss them until October 1. October and November will be busy with the Annual Election Period (AEP) starting October 15 and Florida ACA health insurance plans Open Enrollment starts November 1. If you don’t already have a broker, it’s never too late to find one!
How can you prepare for the coming disruptions in 2026? We’ll know more in the next few months. What’s most important is to understand your options so that you can make the best decision for you and your family. If I can help, please reach out! We can chat over the phone or meet in person. I’m happy to help! Email Christian@evergreenhealthins.com or call (850) 687- 7606.
