Major Changes For Open Enrollment For Medicare And ACA 2026!

Unlike in past years, where most plan changes were minor or resulted in automatic enrollment into a similar plan, 2026 is bringing about plan terminations that won’t automatically transfer you into a new plan. That means if you ignore those letters in your mailbox, you may find yourself without coverage entirely.

Even if you're happy with your current Medicare Advantage or Part D plan, don’t assume it will be available next year. Many insurance carriers are making sweeping changes—some are exiting the market completely, others are modifying their benefits, prescription drug coverage, provider networks, or premiums.

The takeaway? Don’t sit this one out. This year, reviewing your plan is not optional—it’s essential.

What’s Happening in 2026?

The healthcare landscape is evolving quickly, with major shifts coming to both Medicare and ACA (Obamacare) plans.

For Medicare Beneficiaries:

Widespread Plan Terminations: Many carriers are discontinuing Medicare Advantage and Prescription Drug Plans for 2026. Those enrolled in terminated plans won’t be automatically reassigned—you must take action to enroll in a new plan, or you could lose your coverage.

Prescription Coverage Changes: The Inflation Reduction Act has begun to cap out-of-pocket costs on Insulin and other critical medications. However, many drug formularies (the list of drugs covered by a plan) are changing. What was covered affordably this year may not be in 2026.

Provider Network Updates: Some Medicare Advantage plans are shrinking their networks to cut costs, meaning your doctor may no longer be considered in-network. Always verify if your preferred providers are still part of the plan before renewing.

Premium Adjustments: Some plans are increasing premiums, while others are reducing them with fewer benefits. Understanding this trade-off is vital before you renew or switch.

For ACA (Marketplace) Participants:

Carrier Consolidations & Exits: Several carriers are exiting or merging in 2026, which could leave participants without coverage unless they actively select a new plan.

Subsidy Changes: Income thresholds for ACA subsidies are being updated, and many individuals may qualify for more help—or less—than last year. It’s critical to update your income estimate to ensure you’re getting the correct premium tax credit.

Essential Health Benefits Changes: Some ACA plans are adjusting what’s covered under their “essential benefits,” so what was included in 2025 may not be in 2026. Always review the benefits summary before renewing.

Key Enrollment Dates to Remember:

Medicare Open Enrollment: Wednesday, October 15th, 2025 – Sunday, December 7th, 2025

During this time, you can:

• Switch from Original Medicare to a Medicare Advantage Plan—or vice versa

• Change from one Medicare Advantage Plan to another

• Enroll in or change your Prescription Drug Plan (Part D)

ACA Open Enrollment: Saturday, November 1st, 2025 – Thursday, January 15th, 2026 (in most states)

This is your opportunity to:

• Renew your current ACA plan

• Switch to a new ACA plan

• Apply for subsidies or change your income information

Why You Should Work With a Licensed Agent

My name is Carol Foley, and I’m a Licensed Insurance Agent and Small Business Benefits Counselor with over 25 years of experience helping individuals and small businesses find the right coverage. Our team at Main Line Benefits Co., located in Hallandale Beach, offers free, no-obligation consultations to help you understand your options.

We assist clients with:

• Medicare

• ACA Health Insurance**

• Dental and Vision Plans**

• AFLAC Supplemental Coverage**

• Cancer, Heart Attack, and Stroke Policies

• Life, Disability, and Long-Term Care Insurance

• Small Group Health Plans for Businesses

We’re available 7 days a week from 8:00 a.m. to 8:00 p.m. during Open Enrollment. Call us at: (610) 639-5616. Or email: cfoley@mlbenefitsco.com to schedule your appointment.

Don’t Overpay: Medicare Supplement Plans Are Standardized

Here’s something most people don’t know: All Medicare Supplement Plans (Medigap) —like Plans F, G, and N—are standardized by the federal government. That means Plan G from one company offers identical coverage to Plan G from another. The only difference? Price.

During Open Enrollment, we can shop the market for you to find the most competitively priced supplement plans—potentially saving you hundreds or even thousands of dollars per year.

Peace of Mind Starts With a Review

Even if you’re confident in your current plan, let us help you review it at no cost. We’ll walk you through:

• Whether your medications are still covered affordably

• If your preferred doctors are still in-network

• How your plan compares to new 2026 options

• Whether you qualify for additional help (such as Extra Help, Medicaid, or premium subsidies)

Healthcare is not one-size-fits-all, and with the substantial changes coming in 2026, doing nothing is no longer safe. Whether you’re on Medicare or enrolled through the ACA marketplace, this year more than ever, you need to read your mail, mark your calendar, and take action.

Our team at Main Line Benefits Co. is standing by to assist you—at no cost to you. Let us help you navigate the changes, protect your coverage, and ensure you’re getting the most value for your healthcare dollar.

Carol Foley

Licensed Insurance Agent & Medicare Specialist

Main Line Benefits Co.

1980 South Ocean Drive, Hallandale Beach, Florida 33009

(610) 639-5616

www.mlbenefitsco.com

cfoley@mlbenefitsco.com