Prepare for jump in 2026 health insurance premiums

Before you begin shopping for holiday gifts, take time to shop for your 2026 health insurance. Medicare Open Enrollment is underway while Medicare Advantage open enrollment as well as enrollment in many private employer health plans and the Affordable Care Act Marketplace plans begins soon.

You may be able to stick with your same plan as long as both the plan and your health needs haven’t changed significantly. However, your health needs may be much different this year compared to 12 months ago. In either case, most insurance experts recommend reviewing the materials from private plans, Medicare Advantage, Medicare and Medicare supplemental plans to make sure you’re choosing wisely. Comparing options can save money and/or lead to better coverage.

According to the nonprofit healthcare research group KFF (formerly the Kaiser Family Foundation), 70% of Medicare beneficiaries don’t compare plan options. Due to some improvements in the Medicare website, it’s easier than ever to compare plans, as well as look for the physicians you rely on.

You should also receive notifications from your plan about any 2026 changes as well as a Medicare & You handbook to review your options, says Anne Sparkle, a Nassau County volunteer with SHINE of Northeast Florida. SHINE (Serving Health Insurance Needs of Elders) offers seniors, adults with disabilities and their caregivers free, unbiased counseling on Medicare health insurance issues.

“People need to open all of their mail from their insurance companies because many Medicare supplemental plans, drug plans and Medicare Advantage plans have been discontinued or changed for next year,” Sparkle says. “That doesn’t mean the health insurance companies haven’t added any plans. But people need to know if their current plan is being changed or discontinued.”

Medicare basics

Medicare Open Enrollment is from Oct. 15-Dec. 7. This is the period when you can join, drop or switch Medicare Parts A and/or B plans. You can:

• Switch from original Medicare to Medicare Advantage
• Switch from Medicare Advantage to original Medicare
• Change your Medicare Advantage plan
• Switch your Medicare plan
• Drop Medicare coverage
• Join or change drug plans

If your 2025 plan is being offered again in 2026 and you’re happy with it, you don’t need to do anything. You will be automatically re-enrolled.

If you are already enrolled in a Medicare Advantage (also called Part C), you can switch plans from Jan. 1, 2026, through March 31, 2026. During this period, you can also switch from Medicare Advantage to original Medicare.

Typically, original Medicare premiums cost more than Medicare Advantage because people who choose original Medicare also need a supplemental plan (also called a Medigap plan) and a Part D prescription drug plan, Sparkle says.

Alternatively, Medicare Advantage plans typically cost less, however patients in these plans have fewer choices among physician and hospital networks and often must seek prior authorization to see specialists or for procedures. Medicare Advantage plans may include dental and vision coverage, while original Medicare typically does not.

Sparkle notes that many people who sign up for Medicare Advantage end up not benefiting much from vision and dental coverage because their dentists aren’t in the plan or are not taking new patients. She also advises people to weigh the cost of their health insurance plans against the freedom and convenience of having access to a variety of physicians and hospitals.

“Cost is a big factor for people,” Sparkle says. “With Medicare, 80% of your costs are covered, and the supplemental plans pay 20%. But supplement plans are expensive, and a lot of people can’t afford them. Medicare Advantage takes care of your Part B premium. But if you have an Advantage plan, you can’t go to certain doctors, and they make you jump through hoops to get care.”

Changes to 2026 coverage

You may see significant cost changes to Medicare supplemental plans and some Medicare Advantage plans. Some insurers may not offer as many plans or will offer different plans. The Part B monthly premium is expected to jump 12%, from $185 in 2025 to $206.50, according to AARP. You will receive notice of any premium increase in 2026.

A new Medicare benefit in 2025 included a $2,000 cap on out-of-pocket costs for prescription drugs. This will increase to $2,100 in 2026. Moreover, the Part D deductible will increase from $590 in 2025 to $625 in 2026. People with Part D coverage were able to enroll in a monthly installment plan in 2025 to cover the annual $2,000 out-of-pocket cost in a manageable and predictable manner. Anyone enrolled in that plan will be automatically renewed in 2026 unless they drop or change their Part D plan.

“I think one of the biggest changes in Medicare occurred last year with the $2,000 cap on how much people have to pay for prescription drugs,” Sparkle says. “That was a huge benefit and saves people a lot of money. But not everyone is aware of it.”

One positive change for the coming year regarding prescription drugs stems from a Biden Administration law (the Inflation Reduction Act) passed in 2022 that will heavily discount 10 popular prescription drugs. Look for discounts of more than 38% and up to 79% on: Eliquis, Xarelto, Januvia, Jardiance, Enbrel, Imbruvica, Farxiga, Entresto, Stelara, Fiasp and NovoLog, according to the Health and Human Services agency.

Jardiance, for example, will be reduced from a list price of $573 to $197 under the law, according to the Center for Medicare Advocacy.

The discount on these drugs makes it even more important for consumers to study their Part D drug plans to see if they need to switch to a different plan, Sparkle says.

“Everyone should check their plan every year because of those drugs [that have been discounted] and because other medications may have changed in price or been dropped or added to the formulary,” she says.

Non-Medicare health insurance

Open enrollment for people who receive health insurance through their companies typically occurs this time of year, as well. Check with your employer to find out when you will receive materials on your coverage options.

Open enrollment for people who receive coverage through the Affordable Care Act (ACA) Marketplace can drop, add or switch plans beginning Nov. 1 through Jan. 15, 2026.

Americans who obtain health insurance through the Affordable Care Act Marketplace as well as those with private insurance plans offered by employers can also expect to see premiums rise, according to KFF. The cost increase is largely due to a big jump in hospital costs as well as rising prescription drug costs, according to KFF.

It's important to make your decision during this time period for coverage to take effect Jan. 1. If you miss the ACA Marketplace Open Enrollment period, you’ll have to wait until next year’s Open Enrollment period — unless you experience certain changes during the year that qualifies you for a “special enrollment period.”

For Americans who purchase plans through the Affordable Care Act marketplace, the situation is more fraught this year due to the Trump Administration plan to allow the Enhanced Affordable Care Act tax credits (enacted by Congress in 2021) to expire at the end of this year. The current government shutdown is largely due to a disagreement between Republicans, who have voted to allow the tax credits to expire, and Democrats who want the tax credits reinstated in the federal government budget.

According to KFF, ACA premiums will more than double, on average, if the enhanced tax credits are allowed to expire. About 24 million Americans obtain health insurance through the ACA Marketplace.

However, KFF notes that many health insurers have already set their rates for 2026, and it may be difficult to adjust those rates depending on what happens with the federal budget showdown and the enhanced ACA tax credits situation.

Help with choosing your coverage

Medicare resources are available at 1-800-633-4227, 24 hours a day, seven days a week. You may qualify for assistance with Medicare drug costs if you make less than $23,000 a year. Go to Social Security for an application.

You can also get help with choosing a Medicare health plan at SHINE or 1-800-96-ELDER. A SHINE counselor is available twice a month (second and fourth Tuesdays) by appointment at the Council on Aging, 1901 Island Walkway, Fernandina Beach. Contact. 904-775-5470 for an appointment with the SHINE counselor.