Why 2026 Is a Pivotal Year for Medicare
The 2026 Medicare plan year is one of the most consequential in recent memory. A combination of federal policy changes under the Inflation Reduction Act, carrier market adjustments, and new CMS regulations means that millions of Florida beneficiaries will see meaningful changes to their coverage — whether they realize it or not.
If you are currently enrolled in a Medicare Advantage or Part D plan and you did nothing during the Annual Enrollment Period (AEP), your plan may have changed significantly on January 1, 2026. Here is what you need to know.
Change #1: The $2,000 Out-of-Pocket Drug Cost Cap
This is the biggest structural change to Medicare drug coverage in decades. Starting January 1, 2026, the Inflation Reduction Act eliminates the "catastrophic phase" of Part D coverage and replaces it with a hard annual out-of-pocket cap of $2,000 for covered prescription drugs.
What this means in practice:
- Once you spend $2,000 out of pocket on covered drugs in a calendar year, your plan pays 100% for the rest of the year
- The $2,000 cap applies to both standalone Part D plans and Medicare Advantage plans with drug coverage (MAPD)
- A new "Medicare Prescription Payment Plan" allows you to spread your drug costs across monthly installments rather than paying large amounts at the pharmacy
For beneficiaries who take expensive specialty medications — cancer drugs, biologics, MS treatments — this change can save thousands of dollars per year.
Change #2: Medicare Advantage Plan Reductions in Florida
Several major carriers reduced benefits or exited markets in Florida for 2026. In Pinellas and Hillsborough counties specifically:
- Some plans eliminated or reduced dental and vision allowances
- A number of plans increased copays for specialist visits and outpatient procedures
- Several plans narrowed their provider networks, removing hospitals and specialist groups
- At least two carriers exited certain Florida counties entirely
If you did not actively review your plan during AEP (October 15 – December 7, 2025), you were auto-renewed into whatever your existing plan became for 2026 — which may be materially different from what you had in 2025.
Change #3: Part B Premium Increase
The standard Medicare Part B premium increased to $185.00/month in 2026, up from $174.70 in 2025. Higher-income beneficiaries subject to IRMAA (Income-Related Monthly Adjustment Amount) pay more, with surcharges ranging from $74.00 to $443.90 per month depending on income.
Change #4: Part A Deductible Increase
The Medicare Part A inpatient hospital deductible increased to $1,676 per benefit period in 2026, up from $1,632 in 2025. This deductible applies each time you are admitted to a hospital for a new benefit period — not just once per year.
Change #5: New Prior Authorization Rules
CMS finalized new rules requiring Medicare Advantage plans to streamline prior authorization processes. Plans must now respond to urgent requests within 72 hours and standard requests within 7 days. While this is an improvement, prior authorization remains a significant friction point for complex care in managed care plans.
What Florida Beneficiaries Should Do Right Now
- Review your current plan's Annual Notice of Change (ANOC): Your plan mailed this in September 2025. If you didn't read it, call your plan or check your online account to see what changed.
- Check your drug formulary: Confirm your medications are still covered at the same tier. Formulary changes are common year-to-year.
- Verify your providers are still in-network: Network changes happen mid-year. Call your doctors' offices directly to confirm they still accept your plan.
- Consider a Medicare Review: If you haven't had a comprehensive plan review in the past 12 months, now is the time. A licensed advisor can compare your current plan against all available options in your zip code.
Special Enrollment Periods (SEPs) Available in 2026
If your plan changed significantly or you missed AEP, you may qualify for a Special Enrollment Period. Common SEPs include:
- 5-Star SEP: If a 5-star rated plan is available in your area, you can switch to it once between December 8 and November 30
- Medicare Advantage Open Enrollment Period (OEP): January 1 – March 31 — you can switch MA plans or return to Original Medicare once during this window
- Loss of coverage SEP: If your plan is discontinued or you lose employer coverage
Get a Free 2026 Medicare Review
At Integrity Health Solutions, we offer free, no-obligation Medicare reviews for Pinellas County residents and Florida beneficiaries statewide. We compare your current plan against every available option in your zip code and help you understand exactly what changed and whether a switch makes sense.
Book your free 2026 Medicare review or use our 2026 Florida Health Insurance Comparison Tool to start exploring your options now.
Have questions about your coverage?
Our team offers free, no-pressure consultations for Florida residents. We compare every option available in your county.