What’s Changing in 2026: Key Updates
October 10, 2025
With 2026 fast approaching, there’s no better time to book a consult or review of your health coverage — whether you have an individual/ACA plan or Medicare. There are several major changes coming, and understanding how they affect you personally can mean big savings, better protection, and fewer surprises later on. Below is a detailed look at what’s shifting, why it matters, and how a review can help you make smarter choices.
Individual / ACA Marketplace Plans
1. Premiums Are Rising Sharply
Insurers in many states are proposing increases in ACA marketplace premiums of 10–27% for 2026. Some preliminary data show a median premium increase around 18% nationwide.
2. Out-of-Pocket Maximums & Deductibles Increasing
With healthcare costs and inflation, government rules are pushing up the limits: what you pay in deductibles, copays, and the most you’ll ever pay in a year is going up. For many ACA-compliant plans, the maximum out-of-pocket is moving significantly higher in 2026.
3. Subsidies (Premium Tax Credits) Might Shrink
Enhanced premium tax credits that have helped many people afford marketplace plans are set to expire at the end of 2025 unless extended by Congress. When they expire, many people will see their net premiums (what you pay after subsidies) increase—possibly by a large margin.
4. Eligibility Rules and Participation Changes
There may also be changes in who qualifies for what levels of help, and how much. Household income, size, and even your recent medical needs could affect the cost and availability of plans more than before.
Medicare
1. Part B & Part D Premiums and Cost Sharing Are Increasing
Medicare Part B monthly premiums and Part D premiums are projected to go up in 2026. For example, the base beneficiary premium for Part D is expected to increase about 6%, while Part B premium increases are more significant.
2. Out-of-Pocket Drug Caps Go Up
The maximum out-of-pocket cost for prescription drugs under Medicare Part D will increase: from $2,000 in 2025 to $2,100 in 2026.
3. Medicare Prescription Payment Plan (MPPP) Changes
The MPPP, which helps you spread prescription drug costs across the year rather than paying full cost at the counter every time, will auto-renew unless you opt out. Also, plan sponsors must process opt-outs within three days.
4. Updates to Medicare Advantage (MA), Part D, Dual-Eligible Plans (D-SNPs), and Star Ratings
CMS’s 2026 final rule introduces nuanced changes in how plans are rated, how prescription drug benefits are structured, and enhancements/modifications for Dual Eligible Special Needs Plans.
Why These Changes Matter for You
These are not just abstract policy shifts — they can affect your wallet, your coverage, your access to care, and how much protection you really have. Here’s why reviewing your coverage matters:
• Costs Could Go Up Significantly
With premiums, out-of-pocket maximums, and deductibles rising, what seemed affordable last year may look very different in 2026. If you rely on subsidies for ACA plans, those shrinking could be a big hit.
• Your Health Situation May Have Changed
If your health needs have changed (new medications, more frequent doctor visits, upcoming surgeries, etc.), the plan you had before may no longer serve you well. A plan that seemed adequate might now expose you to large costs.
• Benefit Designs Differ Widely
Even within Medicare Advantage, Part D, and ACA plans, plan features vary: prescription drug formularies, preferred providers, prior-authorization rules, network coverage, and perks are not uniform. A review helps you match plan features to your actual needs (doctors you use, medications, specialists, etc.).
• Avoid Gaps, Surprises, & Administrative Issues
Auto-renewals or changes might happen that you miss. For instance, with MPPP auto-renewing, you might stay in a plan whose new cost structure works less well for you. Provider directories may change. If you don’t check, you could discover after the fact that your usual doctor isn’t in-network.
• Opportunity to Optimize
With change comes opportunity. You may find a cheaper plan, more subsidy, or better coverage that suits your situation. You might re-evaluate whether a high-deductible plan with HSA works, or perhaps a more robust Part D plan is worth the premium. A consult helps you see those trade-offs and make an informed decision.
What to Ask / Look at During Your Consult or Review
When you sit down to review, whether with a licensed agent, broker, or counselor, here are items you’ll want to cover:
- Projected total costs: premiums + deductibles + drug costs + copays + out-of-pocket maximums
- Changes to subsidies / tax-credits for ACA plans
- Plan networks: are your doctors / hospitals included?
- Drug formularies: are your prescription drugs covered? Are there shifts in prior authorization?
- Extra benefits (vision, dental, hearing, wellness perks) and trade-offs for those extras
- Whether your Medicare Advantage plan or Original Medicare plus a supplement better serves you, given new MA changes
- Timing: open enrollment periods, deadlines, required paperwork for subsidies, verification of income, etc.
Conclusion: Why You Should Act Now
Given all the changes ahead in 2026, waiting to review can leave you exposed: to cost increases you didn’t anticipate, to being “locked in” to a plan that no longer fits, or missing out on new benefits. Booking a consult / review now gives you lead time to:
- Understand what changes will hit you
- Adjust your budget or savings to cover increases
- Shop smartly and compare alternatives before open enrollment ends
- Make sure paperwork is in order so you don’t lose subsidies or coverage
Give us a call at 706-257-5073 to schedule your 2026 consult now!
How to Properly Access and Use Your Health Plan’s Online Portal In today’s digital-first world, your health plan’s online portal is one of the most powerful tools available to help you manage your healthcare. From reviewing benefits and finding providers to tracking claims and downloading important documents, online member portals are designed to make healthcare more convenient and transparent. However, many members either don’t know how to access their portal or aren’t using it to its full potential. Learning how to properly access and navigate your health plan’s online portal can save you time, reduce frustration, and help you take control of your health. What Is a Health Plan Online Portal? A health plan online portal is a secure website or mobile app provided by your insurance carrier. It gives members 24/7 access to their plan information in one centralized location. While features vary by insurer, most portals allow you to view coverage details, manage personal information, communicate with your health plan, and access wellness tools. If you’ve ever waited on hold to ask a simple question about your benefits, the portal can often provide those answers instantly. Step 1: Gather What You Need Before You Start Before registering, have a few key items ready. You’ll typically need: • Your health insurance ID card • Your member ID number • Personal information such as your date of birth and ZIP code • An email address you can access regularly Using a personal email address rather than a shared one helps keep your information secure and ensures you receive important plan notifications. Step 2: Register for an Account Visit your insurance carrier’s official website and look for a link labeled “Member Login,” “Register,” or “Create an Account.” If your plan offers a mobile app, you can also download it from the App Store or Google Play and register there. During registration, you’ll create a username and password. Choose a strong password that includes a mix of letters, numbers, and symbols, and avoid using the same password you use for other accounts. You may also be asked to set up security questions or enable two-factor authentication for added protection. Once registered, you’ll typically receive a confirmation email to verify your account. Step 3: Log In and Explore the Dashboard After logging in, you’ll be taken to your member dashboard. This is the home screen of your portal and provides an overview of your plan. Common sections include: • Coverage and benefits • Claims and explanations of benefits (EOBs) • Digital ID cards • Provider search tools • Prescription drug information Take a few minutes to click through each section so you know where to find things when you need them. Familiarity now can save stress later. Step 4: Learn How to Use Key Features View benefits and coverage The portal breaks down what your plan covers, including copays, deductibles, and out-of-pocket maximums. This is especially helpful before scheduling appointments or procedures. Check claims and costs You can track claims as they are processed and review EOBs to understand what was billed, what your plan paid, and what you may owe. This helps you catch errors early and avoid surprises. Find in-network providers Most portals include a provider search tool that helps you find doctors, specialists, hospitals, and pharmacies that are in-network, saving you money and ensuring coverage. Access digital ID cards If you forget your physical insurance card, your digital ID card can usually be accessed or downloaded directly from the portal. Did you know that some carriers are no longer sending physical ID cards? The online portal may be the only way to access your member ID. Manage prescriptions Many portals allow you to review covered medications, find lower-cost alternatives, and connect with mail-order pharmacy services. Step 5: Use Wellness and Support Tools Beyond basic plan information, many portals include wellness resources such as: • Preventive care reminders • Health assessments • Fitness and incentive program tracking • Telehealth access • Care management or nurse support lines These tools are often underused but can add significant value to your health plan. Step 6: Keep Your Information Updated Make sure your contact information, address, and communication preferences are current. This ensures you receive important notices, plan updates, and benefit reminders without delays. Step 7: Know Where to Get Help If you have trouble registering or navigating the portal, look for a “Help,” “Support,” or “Contact Us” section. Most insurers offer step-by-step guides, FAQs, or customer service support to assist you. Our office may also be able to assist, if needed. Why Using Your Portal Matters Your health plan’s online portal puts important information at your fingertips and helps you make informed decisions about your care. By learning how to properly access and use it, you can avoid unnecessary calls, better understand your benefits, and feel more confident managing your healthcare. Taking a little time to set up and explore your portal today can lead to smoother, smarter healthcare experiences tomorrow.
Making the Most of Your Health Plan: How to Use Fitness Benefits Like SilverSneakers and Incentive Programs Staying active is one of the most powerful ways to protect your long-term health, but gym memberships, fitness classes, and wellness programs can add up quickly. What many people don’t realize is that their health insurance plan may already include valuable fitness benefits at little or no cost. Whether you have access to a SilverSneakers® membership through Medicare or participate in an incentive-based wellness program through an individual or group health plan, these benefits are designed to help you stay active, engaged, and healthy. Understanding how to use them can make a meaningful difference in both your physical well-being and your wallet. What Are Fitness Benefits in Health Plans? Fitness benefits are programs or reimbursements offered by health insurers to encourage physical activity and healthier lifestyles. These benefits vary by plan but often include gym memberships, fitness classes, online workouts, health coaching, or rewards for completing wellness activities. The goal is simple: support preventive care and reduce long-term health risks by making healthy choices more accessible. Two of the most common types of fitness benefits are SilverSneakers for Medicare members and incentive-based wellness programs for individual and employer-sponsored (group) health plans. Understanding SilverSneakers SilverSneakers is a popular fitness program included with many Medicare Advantage and some Medicare Supplement plans. It is designed specifically for older adults and focuses on improving strength, balance, flexibility, and overall fitness. With a SilverSneakers membership, eligible members often receive: • Free access to thousands of participating gyms and fitness centers nationwide • Group fitness classes tailored to different ability levels • Online workout videos and on-demand classes for at-home use • Social opportunities that promote community and accountability One of the biggest advantages of SilverSneakers is flexibility. You can visit multiple participating gyms, try different classes, or exercise at home, whatever fits your comfort level and schedule. If you’re managing a chronic condition or returning to exercise after a long break, the program offers a supportive, low-pressure environment to get moving safely. To check your eligibility, go to www.silversneakers.com and enter your information. Fitness Incentive Programs in Individual and Group Plans For those with individual or employer-sponsored health plans, fitness benefits often come in the form of incentive programs. These programs reward healthy behaviors rather than offering a traditional gym membership. Common incentives include: • Premium discounts or contributions to health savings accounts (HSAs) • Gift cards or cash rewards for completing wellness activities • Points-based systems that can be redeemed for merchandise or services • Reimbursements for gym memberships, fitness trackers, or classes Activities that earn incentives may include completing a health risk assessment, tracking daily steps, attending preventive screenings, participating in fitness challenges, or enrolling in health coaching programs. These programs are designed to meet people where they are. Whether you prefer walking, yoga, strength training, or even mindfulness practices, many plans allow a wide range of activities to count toward rewards. Why You Should Use These Benefits Fitness benefits aren’t just “extras”. They are tools to help you invest in your health with less financial burden. Regular physical activity can lower the risk of heart disease, diabetes, obesity, and depression, while also improving energy, mobility, and sleep quality. For employers and insurers, these programs help reduce healthcare costs. For members, they offer motivation, accountability, and access to resources that might otherwise feel out of reach. When you use your fitness benefits, you’re maximizing the value of your health plan while taking proactive steps toward better health. Tips for Getting Started 1. Review your plan details Log in to your insurance portal or review your benefits summary to see what fitness programs are available. If you’re unsure, your insurer’s customer service team or benefits administrator can help clarify eligibility. 2. Choose what fits your lifestyle The best program is one you’ll actually use. If you enjoy social interaction, group classes or gym access may be ideal. If you prefer flexibility, online workouts or step-tracking challenges may be a better fit. 3. Start small and build consistency You don’t need to overhaul your routine overnight. Start with achievable goals, such as two workouts per week or a daily step target and increase gradually. 4. Track your participation Many incentive programs require activity tracking or documentation to earn rewards. Make sure you understand how and when to log your activities so you don’t miss out. 5. Use added support Take advantage of wellness coaching, educational resources, or fitness assessments if they’re included. These tools can help you stay motivated and exercise safely. Turning Benefits into Better Health Your health plan is more than coverage for doctor visits; it’s a partner in your wellness journey. Whether through a SilverSneakers membership or a fitness incentive program, these benefits are opportunities to stay active, reduce health risks, and feel your best. By taking the time to understand and use what’s already available to you, you can turn everyday movement into long-term health gains. The first step is simply getting started and your health plan may already be there to support you. If you aren’t sure what your plan has to offer, contact our office at 706-257-5073 and we may be able to check that for you.