If you’ve been on Medicare for more than a year, you’ve likely noticed that something always changes—whether it’s your plan premium, your drug coverage, or which doctors are in-network. Many people ask us: “Why doesn’t Medicare just stay the same?”
The truth is, while Original Medicare (Parts A and B) stays relatively stable, Part D drug plans and Medicare Advantage plans are offered by private insurers—and they’re allowed (and expected) to make changes annually. Here’s why those changes happen—and more importantly, what you can do to stay ahead of them.
Plans Adjustments Based on Federal Funding & Regulations
Each year, the Centers for Medicare & Medicaid Services (CMS) announces changes to payment structures, coverage rules, and plan requirements. These updates are often tied to:
- Inflation and rising healthcare costs
- New laws like the Inflation Reduction Act
- Changes in how much Medicare reimburses insurers
📌 In 2026, for example, a major prescription drug cost overhaul is taking effect—impacting how plans structure their formularies and copays.
Drug formularies are reviewed and modified each year
If you have a Part D or Medicare Advantage plan with drug coverage, your insurer re-evaluates which medications they cover, how much they cost, and which pharmacies are preferred.
That’s why your plan may cover your medication one year and drop it or raise the cost the next.
💡 This is one of the top reasons we encourage clients to review their coverage every October—even if nothing else has changed.
Premiums, Copays, and Deductibles change alongside market conditions
Insurance companies adjust plan premiums, deductibles, and copay amounts based on:
- Medical trends
- Prescription drug pricing
- Provider contracts
- Member usage
While these changes are often modest, some plans may increase costs significantly—or reduce benefits to keep premiums low.
⚠️ That “great plan” you had last year may no longer be the best value for you today.
Plans can be discontinued or renamed
Some plans are removed from the market entirely. Others are renamed or merged with similar options.
In 2026, for example, several major carriers are terminating certain Advantage plans, impacting hundreds of thousands of beneficiaries nationwide.
🏥 If your plan is discontinued, you’ll get a Special Enrollment Period—but waiting too long to act could lead to coverage gaps.
✅ What You Can Do: Review and Reassess Annually
The Annual Enrollment Period (October 15 – December 7) exists for this exact reason: to give you the opportunity to switch plans, compare drug coverage, and adjust your Medicare strategy for the year ahead.
At Emerald Medicare, we provide:
- Coverage reviews every fall
- Access to smart tools like RxCare for real-time drug plan savings
- Help comparing Part D, Medigap, and Medicare Advantage options
- Unbiased advice from licensed brokers (never pushy sales tactics)
Be Proactive, Not Reactive
The only constant in Medicare is change—but that’s not a bad thing. With a trusted partner on your side, these annual adjustments become opportunities to improve your coverage, reduce your costs, and feel more confident in your choices.
Let us help you prepare for 2026 and beyond.
Click below to schedule an appointment with one of our Medicare Experts.
Or, Contact Us
📞 (888) 683-6372 or (845) 358-1220
📧 office@emeraldmedicare.com
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