Medicare Changes Coming in 2026: What Florida Seniors Need to Prepare For

As we enter the final days of 2025, Florida seniors are facing significant Medicare changes that will take effect on January 1, 2026. These upcoming modifications will impact your premiums, out-of-pocket costs, drug coverage, and available plan options across the Sunshine State. Understanding these changes now will help you navigate the year ahead with confidence and ensure you're getting the most value from your Medicare coverage.

The 2026 Medicare landscape reflects broader shifts in healthcare costs, federal reimbursement formulas, and insurance company strategies. While some changes may increase your expenses, others present new opportunities for better coverage. Let's break down exactly what you need to know about Medicare changes coming to Florida in 2026.

Understanding the Premium Increases

Medicare Part B premiums are experiencing a notable increase for 2026. The standard monthly premium will rise from $185.00 in 2025 to $202.90 in 2026: that's an increase of $17.90 per month, or approximately $215 more per year. For many Florida seniors living on fixed incomes, this represents a meaningful budget adjustment that requires advance planning.

If you're among the Medicare beneficiaries who need to purchase Part A coverage, you'll also see increases. The reduced premium rate climbs to $311 monthly (up $26 from 2025), while the full premium reaches $565 monthly (up $47 from 2025). These increases reflect rising healthcare costs and adjustments to federal funding formulas.

High-income Medicare beneficiaries will face additional surcharges in 2026. The income thresholds have been adjusted to $109,000 for single filers and $218,000 for married couples filing jointly. If your modified adjusted gross income exceeds these thresholds, you'll pay additional monthly amounts on top of the standard premiums.

Major Medicare Advantage Plan Changes in Florida

Medicare Advantage plans are undergoing substantial restructuring throughout Florida for 2026. Some plans that were available in 2025 will disappear entirely, while others are implementing significant changes to premiums, benefits, and provider networks. These modifications are largely driven by the CMS Star Ratings system and changing reimbursement rates from the federal government.

Provider Network Changes

One of the most critical changes affecting Florida Medicare Advantage beneficiaries involves provider networks. Your current primary care physician, specialists, or preferred hospitals may no longer be included in your plan's network for 2026. If your healthcare providers drop from your plan's network, you'll face a choice: switch to new providers within the network or pay significantly higher out-of-network rates for continued care.

Before January 1st, verify that your current healthcare team remains in your plan's network. If not, you may want to consider switching to a different Medicare Advantage plan that includes your preferred providers, or explore switching to Original Medicare with a Medigap supplement plan.

Prescription Drug Formulary Updates

Every Medicare Advantage plan maintains a formulary: an official list of covered medications: that's updated annually. For 2026, many plans are making significant changes to their drug coverage. Medications you currently depend on may move to higher cost-sharing tiers, require prior authorization, or be removed from coverage entirely.

Review your plan's 2026 formulary carefully, especially if you take multiple prescription medications. A drug that costs you $20 per month in 2025 could jump to $200 or more per month if it moves to a higher tier or loses coverage altogether.

Changes to Extra Benefits

Many Medicare Advantage plans in Florida have offered attractive extra benefits like dental coverage, vision care, hearing aids, gym memberships, and transportation services. For 2026, these supplemental benefits are often the first to be reduced or eliminated as insurance companies work to control costs.

Don't assume that the dental, vision, or wellness benefits you enjoyed in 2025 will automatically continue in 2026. Review your plan's Summary of Benefits carefully to understand what's changing.

Out-of-Pocket Cost Limits and Drug Coverage

The out-of-pocket maximums for Medicare Advantage plans may increase for 2026. While the exact limits vary by plan, many Florida seniors could face higher caps before their plan covers 100% of additional costs. This change is particularly important for those managing chronic conditions or facing potential health emergencies.

For prescription drug coverage under Medicare Part D, the catastrophic coverage threshold is rising to $2,100 in out-of-pocket costs for 2026, up from $2,000 in 2025. Once you reach this threshold, you'll pay minimal amounts for covered drugs for the remainder of the year.

Special Enrollment Opportunities

While the Annual Open Enrollment Period ended on December 7, 2025, you may still have opportunities to make changes to your Medicare coverage for 2026. If your current Medicare Advantage plan is being discontinued or making significant changes to benefits, networks, or service areas, you qualify for a Special Enrollment Period.

During a Special Enrollment Period, you can:

• Switch to a different Medicare Advantage plan
• Return to Original Medicare and add a Medigap supplement plan
• Add or change your Part D prescription drug plan
• Make these changes without waiting for the next open enrollment period

Additionally, Medicare Advantage Open Enrollment runs from January 1 through March 31, 2026. During this window, if you're enrolled in a Medicare Advantage plan, you can make one change: switch to a different Medicare Advantage plan or return to Original Medicare and add Part D coverage.

What Florida Seniors Should Do Now

With Medicare changes taking effect in just days, it's crucial to take immediate action to protect your healthcare coverage and budget. Start by thoroughly reviewing any notices you've received from your current Medicare plan about 2026 changes. Pay special attention to changes in premiums, deductibles, provider networks, and drug formularies.

Review Your Healthcare Team

Contact your primary care physician, specialists, and any other healthcare providers you see regularly to confirm they'll remain in your plan's network for 2026. If key providers are leaving your network, research which Medicare plans in your area will include them.

Check Your Prescription Coverage

Review your plan's 2026 formulary for all medications you take regularly. If any of your drugs are moving to higher tiers or losing coverage, calculate the potential impact on your annual drug costs. You may find that switching to a different plan could save you hundreds or even thousands of dollars annually.

Consider Your Options

For many Florida seniors, 2026 may be an ideal time to reconsider whether Medicare Advantage or Original Medicare with Medigap supplementation better meets your needs. Medicare Advantage plans often offer lower premiums and extra benefits, but Original Medicare with Medigap typically provides more predictable costs and broader provider choice.

Budget for Changes

With premium increases and potential changes to out-of-pocket costs, review your healthcare budget for 2026. Factor in the higher Part B premium, any changes to your Medicare Advantage or Medigap premiums, and potential increases in drug costs.

Professional Guidance Makes the Difference

Navigating Medicare changes can feel overwhelming, especially when facing multiple moving parts like premium increases, plan modifications, and network changes. The Medicare landscape in Florida offers numerous options, but identifying the best fit for your specific healthcare needs and budget requires expertise and careful analysis.

At Borde & Associates, we've been helping Florida seniors navigate Medicare decisions for over a decade. We understand the unique healthcare landscape in Florida and can help you evaluate your options objectively. Whether you're considering switching plans, exploring Medicare Supplement options, or simply want to understand how the 2026 changes affect your current coverage, our team is here to provide personalized guidance.

Don't let Medicare changes catch you off guard. The decisions you make now will impact your healthcare costs and access for the entire year ahead. We're committed to helping you understand your options and make informed decisions that protect both your health and your budget.

For personalized assistance with your Medicare coverage decisions, visit our Medicare options page or contact our team directly. We're here to ensure you have the coverage and peace of mind you deserve as you navigate the Medicare changes ahead.

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