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Friday, October 31
Medicare Watch
Medicare Advantage Is Changing in 2026 — Here’s What’s Good (and What’s Not)
I spent the weekend reading through the new 2026 Medicare Advantage proposals, and I’ll be honest — it’s a mix of good news, small wins, and a few “wait, really?” moments.
If you’re on Medicare or planning ahead, these changes could directly impact your premiums, benefits, and out-of-pocket caps. Let’s walk through what’s actually changing — and what it means for us. 👇
🌟 Today’s Highlights
Why Medicare Advantage plans are getting stricter about marketing and broker bonuses
How new payment adjustments may shift plan availability
What “value-based care” really means for your doctor visits in 2026
📊 Stat of the Day:
Nearly 52% of all Medicare beneficiaries are now enrolled in a Medicare Advantage plan — up from 19% in 2007.
(Source: KFF Medicare Enrollment Trends)
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💡 Today’s Insight: What’s Changing (and Why It Matters)
Here’s what stood out from the 2026 CMS proposal:
1. Tighter marketing and broker rules
Starting in 2026, Medicare Advantage brokers will face stricter limits on commissions and incentives. This aims to reduce misleading marketing practices that have flooded the system in recent years.
→ CMS Press Release
2. Payment adjustments to high-risk populations
Plans serving chronically ill and low-income beneficiaries may see new payment boosts — a shift meant to improve care quality, not just enrollment numbers.
→ Modern Healthcare Analysis
3. Value-based care expansion
CMS continues its move toward value-based models, meaning more plans will reward doctors for keeping you healthy, not for performing more services.
→ Health Affairs: What Value-Based Care Means
4. Out-of-pocket maximum limits
The maximum may tighten again, protecting seniors from catastrophic costs. CMS is evaluating whether caps should be below $8,850 per year in 2026.
→ AARP Coverage of Proposed Caps
Together, these shifts suggest a more consumer-focused Medicare Advantage landscape — but one where fewer “too good to be true” plans will survive.
🔑 What It Means for Us
If you’re currently enrolled:
Expect clearer plan comparisons and fewer gimmicks in the fall 2025 open enrollment season.
Some extra benefits (like dental or fitness perks) might slim down to offset new rules.
Look closely at provider networks — some plans may quietly adjust them to manage costs.
If you’re not yet enrolled:
Watch for plan availability in your ZIP code; smaller insurers may consolidate or exit some regions.
Start exploring value-based care options early — these often lead to better outcomes long term.
📬 To Do This Week:
Review your current plan’s benefits and note any changes announced for 2025.
Bookmark trusted Medicare news sources like KFF Medicare Watch and AARP Medicare Updates.
Talk with your advisor or SHIP counselor about whether switching plans in 2026 could save money or improve care.
📬 Question for you:
Do you think the new 2026 Medicare rules will make plans clearer — or just more complicated?
Hit reply and share your take; I’d love to include a few perspectives in next week’s edition.
💌 PS: If this email landed in Promotions, just drag it into Primary — so you don’t miss the next Medicare Watch update.
With clarity,
Sarah