Important Medicare Advantage changes in 2026
In 2026, Medicare Advantage Plans will see several changes and enhancements. These are some of the changes coming to Part C plans.
- Updates to cost-sharing for behavioral health
- Automatic renewal for Medicare Prescription Payment Plan (MPPP) members
- Adjustments to the insulin cost cap
- Increase in the Medicare Advantage out-of-pocket maximum
Overall, the federal Medicare Advantage changes help insurers like Wellpoint provide better Medicare Advantage plans.
What are the changes to Medicare Advantage Plans in 2026?
Updates to cost-sharing for behavioral health
Medicare Advantage plans will be required to match or improve upon traditional Medicare Fee-for-Service (FFS) cost-sharing for behavioral health services. This means you will not pay more for mental health or substance use disorder services than you would under Original Medicare.
Automatic renewal for Medicare Prescription Payment Plan (MPPP)
If you are enrolled in the MPPP, which allows monthly payments for out-of-pocket drug costs, you will be automatically re-enrolled each year unless you actively opt out. This ensures continued access to budget-friendly payment options without requiring annual re-enrollment.
Changes to the insulin cost cap
Starting in 2026, insulin costs will be capped annually at the lowest of:
- $35 per month
- 25% of the maximum fair price (if negotiated under Medicare)
- 25% of the negotiated plan price
Importantly, no deductible will apply to insulin purchases, ensuring you have predictable and affordable access to your medication.
Increased Medicare Advantage out-of-pocket maximum
The maximum out-of-pocket limit for in-network services under Medicare Advantage plans will decrease to $9,250 in 2026 (down from $9,350 in 2025). While this is the federal cap, most Medicare Advantage plans set their limits well below this threshold, so actual costs may vary by plan.
Is a Medicare Advantage plan right for you?
With several important updates coming to Medicare Advantage in 2026, now is a great time to evaluate your coverage and choose a plan that fits your health and lifestyle needs for the upcoming year.
Wellpoint Medicare Advantage plans cover everything Original Medicare (Parts A and B) does, and many plans may also include additional benefits:
- Low or $0 monthly premiums
- Prescription drug coverage (Part D)
- Dental, vision, and hearing benefits
- Monthly allowances for over-the-counter items, healthy foods1,2, and even utilities1,2
- Access to the SilverSneakers® fitness program
- A dedicated support team to help you make the most of your plan
Plan availability, premiums, copays, deductibles, benefits, and benefit amounts may vary based on where you live, the plan you choose, and your eligibility.
Am I eligible for a Medicare Advantage plan?
To be eligible for a Medicare Advantage plan you must be eligible or enrolled in Original Medicare Part A and Part B.
Getting ready to turn 65? You’ll have a seven-month Initial Enrollment Period (IEP) to apply for Original Medicare - starting three months before your birthday month, continuing through your birthday month, and ending three months after.
Once you’ve signed up for Original Medicare, you can explore Medicare Advantage plans designed to fit your health and lifestyle. Coordinating your enrollment to start on the first day of your birthday month helps ensure continuous coverage.
Each year, you can explore Medicare Advantage options during the Annual Enrollment Period, October 15 to December 7. You might also qualify for a Special Enrollment Period if life changes, like moving or losing coverage, affect your health plan. Let us help you navigate the changes to Medicare Advantage plans in 2026.
Find plans in your area
Need more help navigating Medicare?
1 Members may receive a monthly or quarterly allowance in the form of a benefits prepaid card to pay for a wide range of approved healthy foods and utilities. Unused amounts will expire at the end of the month or quarter.
2 The benefits mentioned are Special Supplemental Benefits for the Chronically Ill (SSBCI). You may qualify for SSBCI if you have a high risk for hospitalization and require intensive care coordination to manage chronic conditions such as Chronic Kidney Diseases, Chronic Lung Disorders, Cardiovascular Disorders, Chronic Heart Failure, or Diabetes. For a full list of chronic conditions or to learn more about other eligibility requirements needed to qualify for SSBCI benefits, please refer to Chapter 4 in the plan's Evidence of Coverage.
The Benefits Mastercard® Prepaid Card is issued by The Bancorp Bank, N.A., Member FDIC, pursuant to license by Mastercard International Incorporated. Mastercard is a registered trademark, and the circles design is a trademark of Mastercard International Incorporated. This is a benefits card that can only be used at certain Mastercard merchants participating in this program and will be authorized for qualified purchases as set forth in your Terms and Conditions. Valid only in the U.S. No cash access. Other languages are available upon request.
The SilverSneakers fitness program is provided by Tivity Health, an independent company. Please talk to your doctor before starting an exercise program. SilverSneakers, the SilverSneakers shoe logo type and SilverSneakers Flex are registered trademarks of Tivity Health, Inc. © 2025 Tivity Health, Inc. All rights reserved.
Plan availability, premiums, copays, deductibles, benefits, and benefit amounts may vary based on where you live, the plan you choose, and your eligibility.
Wellpoint, a Medicare Advantage organization with a Medicare Contract, offers HMO, D-SNP, C-SNP, and I-SNP plans. Wellpoint D-SNP plans additionally contract with state Medicaid programs. Enrollment in a Wellpoint health plan depends on contract renewal.