Financial pressures and shifting reimbursement rates have caused many carriers to reduce service areas or terminate some of their Medicare Advantage plans for 2026. The result is that more than one million Medicare beneficiaries may need to seek new coverage. Texas is no exception to this national trend. As a Medicare agent you should expect to be busy with clients and prospects who are surprised and confused by these changes. They will need your expertise to help guide them in making the right coverage decisions during this time of uncertainty.
What is Causing This Disruption
A combination of funding cuts, rising medical and drug costs, and higher utilization has created the perfect financial storm for insurance carriers. Insurers face difficult decisions as to which plans they will continue to offer and which areas they will continue to operate in.
What Changes to Look For
It’s particularly important to pay attention to the details this year. Here are some significant changes to look for:
- Service area reductions or market exits– certain insurance carriers may leave specific counties or leave the state completely.
- Fewer plan choices– carriers who remain in your area may be offering fewer plans. There will be fewer $0 premium plans on the market and fewer PPO plans offered.
- Increased out of pocket costs– insurers will be passing more of the costs to enrollees in 2026. This could mean higher monthly premiums, deductibles for medical and prescription services, higher copays, and coinsurance.
- Network changes– insurers may choose to not include certain providers and hospitals in their network as way to control costs. Or they may have a tiered provider network that only offers access to certain providers through higher priced plans.
- Pharmacy formulary changes– medications may have changed tiers or been dropped from a formulary altogether. Some insurers have created tiered formularies such as a standard and enhanced formulary. Those willing to pay higher premiums will have access to a more robust formulary.
- Benefit reductions- MA plans have become very popular in part due to the supplemental benefits they offer. One way that insurers will be cutting back on costs is by eliminating or reducing these benefits. Plans may no longer offer extras such as transportation, home delivered meals or over the counter benefits. Or they might only be offered with higher premium plans. Plans with dental, vision and hearing coverage may have reduced their coverage limits.
Due to these changes, it is anticipated that more Medicare beneficiaries will be interested in Medicare Supplement plans for 2026, ending the trend that saw a growing number of seniors enrolling in MA plans.
More People May Need Financial Assistance
As out of pocket costs increase more Medicare beneficiaries may need financial assistance. You can help educate your clients on the programs available for those who qualify including Medicare Savings Programs, Extra Help, and Texas Cares Pharmacy Assistance Program.
Key Enrollment Dates To Remember
While AEP runs from October 15th to December 7th. During this enrollment period beneficiaries can join, switch, or drop a Medicare Advantage or Part D plan. They can also switch from Medicare Advantage to Original Medicare.
Individuals whose plans are terming and don’t take action during AEP still have from December 8 through February 28, 2026, to make a change. Changes will be effective the first of the following month. It’s important to note that current plans end on December 31, 2025, and if they don’t make a decision by then they will automatically be enrolled in Original Medicare for January.
It is in challenging times like these that you prove your value to clients and prospects alike. Make sure you have sent out your retention letters and encourage your clients to set up a meeting with you ASAP since this will be a busy AEP and your calendar will fill up quickly. Your clients will appreciate knowing you are here to help them through this challenging time.
The dedicated team at PTT Financial here to answer your questions and support you during AEP. Contact us today.