Florida’s 5 million Medicare beneficiaries will experience notable changes regarding their premiums, deductibles, and plan options come 2026.
“It’s vital to pay attention to the annual change notifications,” suggests Jenny Chamblee Hogue, an expert in health insurance and a contributor to medicareresources.org.
In Florida, similar to many other areas, Medicare Advantage plans are either diminishing, altering, or exiting the market. Some current plans might not be available next year, could see price hikes, or may include fewer healthcare providers.
“If you have specific doctors or healthcare providers you rely on, don’t depend solely on online directories,” Hogue advises. “It’s best to call to find out what plans they will participate in for 2026.”
In Broward County, numerous enrollees from Humana, CarePlus, and AvMed have been informed that their plans will not continue in 2026, as noted by Gloria Iron, a liaison officer for SHINE. Others learned that the local hospital system and its doctors would no longer be part of the network. This has led many to seek assistance from SHINE, which offers free support to Medicare beneficiaries.
“In just the past month, we’ve received 254 calls,” Ayan shared.
While switching plans can seem daunting, this enrollment period offers a chance to find a plan that better suits your needs and potentially offers more benefits.
When considering a hospital, it’s essential to examine its coverage. Some Medicare Advantage plans may raise the total copay for inpatient care or increase the costs related to hospitalization.
“It wouldn’t be unusual for hospital costs to rise by $75 a day, especially if a person stays for four days,” Louise Norris, a health policy analyst, mentions. “That’s definitely not the kind of info you want to deal with when you’re in the hospital.”
To entice new members, Medicare Advantage plans often provide perks like grocery cards, transportation to appointments, and fitness programs. However, in 2026, there may be limitations on spending for these benefits or reduced offerings.
“During the open enrollment period, you really need to shop around,” Norris advised.
Dental and vision benefits offered by some Medicare Advantage plans could see a decline in comprehensiveness starting in 2026.
“This year’s plans might impose caps on dental benefits or alter the network of dentists available,” noted Tricia Newman, KFF’s executive director for Medicare policy programs. “That can affect your dental care expenses, but evaluating this during the enrollment period can be tricky. To anticipate future costs, you’ll need to thoroughly review the details regarding coverage and its limitations.”
Original Medicare premiums increase
Those enrolled in Original Medicare will face some cost adjustments in 2026.
Expect Medicare Part B premiums to see a significant jump, projected to rise by 11.6% to $206.50 per month.
“Premiums correlate with spending; when spending goes up, premiums follow suit,” Newman of KFF explained.
Despite this increase, Newman pointed out that “considering the tradeoffs is crucial. Evaluate how your Medicare Advantage plan changes, and if you’re unhappy, think about switching to traditional Medicare, which permits you to see any doctor across the country without prior authorization.”
Drug plans supplementing Original Medicare or Medicare Advantage plans will likely become pricier in 2026. The maximum out-of-pocket limit for drug plans (Part D) is set to increase by $100. The positive side is that once you hit a $2,100 cap in 2026 (up from $2,000 in 2025), covered medications will be fully paid for during that year—a significant improvement from prior years that lacked any caps.
Nevertheless, costs are still climbing, so it’s important to closely examine your drug plan’s structure to calculate total medication expenses rather than only focusing on the monthly premium.
Medicare will maintain its no-cost coverage for all adult vaccines recommended by the CDC in 2026, which includes shingles, pneumonia, influenza shots, and a COVID-19 booster, without any deductibles or copayments involved.
Premiums for Original Medicare and drug plans are adjusted based on personal income. Individuals earning above a set threshold will face premium costs for Medicare. In 2026, this threshold will rise by $3,000 to $109,000. Norris highlighted that this is based on 2024 tax filings, meaning any significant income changes would require going through an appeals process.
Changes to prior approvals
A common frustration voiced by seniors involves the pre-approval steps. A few upcoming adjustments aim to alleviate these issues. If inpatient care requires authorization, it will remain in place until discharge, eliminating the need for re-authorization during hospitalization. Plans must respond to requests within 14 business days, and any denial must come with a clear clinical rationale. Those whose plans are denied can seek an independent external review.
Additionally, the federal government is trialing a system that employs AI for approving or denying care for Original Medicare recipients. Starting January 1st, a five-year pilot program will launch in six states, though Florida is not included. There’s a lot of speculation about whether this will save Medicare funds or exacerbate issues linked to prior authorization.
Evaluation system enhancements
Medicare’s star rating system has been updated, raising the standards for achieving high ratings while putting a greater emphasis on patient satisfaction and plan quality. By 2026, it’s supposed to be easier to identify plans that provide good value and dependable coverage.
A 5-star rating signifies top quality.
“You don’t necessarily have to rely on star ratings as your starting point when selecting a plan,” Norris from KFF Health Policy Research noted. “Evaluation is more useful after you narrow down options based on what matters most to you.”
Medicare changes for Florida residents
For those on Medicare in Florida, the anticipated changes for 2026 are as follows:
Medicare Advantage
- The average monthly premium for a Medicare Advantage plan will decrease to $2.11 in 2026 from $4.09 in 2025.
- In 2026, there will be 611 Medicare Advantage plans, down from 613 in 2025.
- All Medicare enrollees will have access to a Medicare Advantage plan.
- There will be plans available with a minimum monthly premium of $0.
- All Medicare enrollees will have access to a plan with $0 monthly premium.
Medicare Part D:
- Ten separate Medicare prescription drug plans will be available in 2026, down from 16 in 2025.
- Everyone with Medicare can access a prescription drug plan.
- All individuals enrolled in standalone Medicare prescription drug plans will have access to a plan that offers lower premiums compared to 2025.
- 24.43% of those with standalone Medicare prescription drug plans will receive additional assistance.
- Standalone Medicare prescription drug plans will also have a minimum monthly premium of $0.
