12 Changes YOU Need to Know About Medicare Advantage Plans
Every year, plans change. For 2026, many Florida Medicare Advantage plans are tightening benefits or raising certain costs. The safest way to avoid a January 1 surprise is to review your coverage with Palm Medical Centers now—with a senior care specialist before AEP ends on Dec 7, 2025.
Below are the most important “watch-outs” we’re seeing in 2026 plan documents. Not every item applies to every plan, but these are the areas where seniors are most at risk of losing value.
1) Prescription drugs (Part D): higher out-of-pocket before relief
- The annual drug spending cap is higher in 2026, so you may pay more out-of-pocket before your plan covers the rest.
- Some plans raised deductibles or coinsurance on Tier 3–5 medicines.
- Preferred pharmacies can change; the same drug at a non-preferred pharmacy can cost much more.
Palm can: re-run your medications for 2026 and check pharmacies to prevent a jump in monthly costs.
2) Hearing aids: rising copays and tighter limits
- Several plans raised the hearing aid copay or limited brands/vendors.
- Fewer visits for fittings/adjustments in some cases.
Palm can: check your plan’s 2026 hearing benefit and compare options if your out-of-pocket went up.
3) Eyewear & vision: smaller allowances, new rules
- Eyewear allowances are being reduced or separated from dental.
- More plans require in-network optical or limit how often you can use the benefit.
Palm can: confirm your 2026 eyewear dollars and where you can use them.
4) Dental: new exclusions and higher coinsurance for major work
- Dentures, crowns, bridges, and root canals may now have coinsurance instead of fixed copays.
- Some plans added frequency caps or excluded categories.
- Dental networks have changed for certain plans—your dentist may no longer be included.
Palm can: read your dental fine print with you and estimate costs for any planned dental work.
5) Hospital & rehab (SNF): higher per-day charges
We’re seeing per-day inpatient hospital copays rise on some plans.
- Skilled Nursing Facility (days 21–100) daily copays may be higher.
Palm can: compare 2025 vs. 2026 daily rates so you know what a stay could cost.
6) ER & urgent care: small increases that add up
- ER visit copays are ticking up on multiple plans (even if waived upon admission).
- Some urgent care copays (in-person and telehealth) increased.
Palm can: review your after-hours options and costs so you can avoid surprise bills.
7) Therapy & outpatient procedures: new or higher copays
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- Physical/occupational/lymphedema therapy and certain outpatient imaging may carry higher copays or new authorizations.
Palm can: map out expected therapy costs and help you plan visits affordably.
8) Transportation & in-home support: fewer rides, fewer hours
- Some plans reduced number of rides or narrowed eligibility.
- Companionship or in-home support hours (like Papa®) have been cut on certain plans.
Palm can: confirm your counts for 2026 and suggest alternatives if they dropped.
9) OTC allowances: lower amounts or stricter schedules
- Quarterly OTC dollars may be lower or limited to specific categories or vendors.
Palm can: show you how to use the full amount you have left and what changes for next year.
10) Acupuncture/chiropractic: removed or capped
A few plans removed acupuncture entirely.
- Chiropractic visits that were unlimited are now capped.
Palm can: verify what’s still covered and how often.
11) Network changes: doctors and pharmacies can move out
- 2026 provider and pharmacy networks changed on multiple plans.
- If your doctor, specialist, or pharmacy moved out of network, your costs can jump—or you might need to switch plans or providers.
Palm can: check your doctors and preferred pharmacy for 2026 and keep your care team intact whenever possible.
12) Plan consolidations & “simplified” designs: not always simpler for you
- Some carriers are combining or “streamlining” plans. Your 2025 plan could roll into a new 2026 design with different costs, rules, or benefits—even if the name looks similar.
How Palm Medical Can Help You Review Your Plan
Palm can: read your Annual Notice of Change (ANOC) with you and explain exactly what’s different.
Palm can: read your Annual Notice of Change (ANOC) with you and explain exactly what’s different.
How Palm Medical Can Help You Review Your Plan
Palm can: read your Annual Notice of Change (ANOC) with you and explain exactly what’s different.
What to do now (before Dec 7, 2025)
Bring to Palm:
- Your Medicare card
- Your medication list
- Your Annual Notice of Change (ANOC)
At your no-cost review, we will:
- Check your doctors & pharmacy for 2026 (keep your care team, avoid higher prices).
- Re-run your prescriptions (tiers, deductibles, approvals, preferred pharmacy).
- Compare your 2025 vs. 2026 costs for hospital, rehab, ER, and therapy.
- Audit your extras (dental, vision, hearing, OTC, rides, in-home support).
- Spot any losses—and, if needed, compare plan options that better protect your benefits.
Call Palm Primary Care Today
Don’t wait until January to find out what changed. A 15–30 minute benefits review now can prevent weeks of stress later.
Call your Palm Senior Care Specialist to schedule your no-cost 2026 benefits review Or CTA Request A Time Palm we’re happy to help, and caregivers are welcome.
AEP runs Oct 15–Dec 7, 2025. Changes you make by Dec 7 start Jan 1, 2026.
Friendly note
This guide is for education. Palm Primary Care is not a health plan. Actual benefits, costs, and networks vary by county and plan. Your plan’s ANOC, Summary of Benefits, and Evidence of Coverage are the final word—we’re here to read them with you and make everything easy to understand.
Review Your Plan
For questions about our locations or how to set up an appointment with a provider, please contact our office at (866) 840-7728.
