9. Tightened Authorization & New AI-based Prior Authorization Pilots
In some states, prior authorization under Original Medicare may involve AI-based review tools.
These tools are meant to speed decisions but may also reject or restrict certain services.
💡 What you can do:
- Keep detailed medical records and notes to support authorization requests.
- Appeal decisions promptly if a service is denied; understand your rights.
10. Open Enrollment & Plan Change Windows Remain Critical
Key dates for plan changes in 2026:
Oct. 15 – Dec. 7, 2025 — Annual Open Enrollment for switching Medicare Advantage or Part D plans.
Jan. 1 – Mar. 31, 2026 — Medicare Advantage Open Enrollment (change or drop Advantage plans)
Missing these windows could lock you into a less optimal plan for the year.
💡 What you can do:
- Mark your calendar now for enrollment windows.
- Before enrollment begins, compare at least 3–4 plans, looking at premiums, networks, cost-sharing, Star ratings, and drug coverage.
- Use tools on Medicare.gov, or consult a licensed Medicare adviser or SHIP counselor.
Final Thoughts & Action Steps
- Medicare changes in 2026 will touch premiums, cost-sharing, plan benefits, and coverage access. To minimize surprises:
- Review your plan’s 2026 Summary of Benefits when mailed or posted online.
- Compare alternative plans during open enrollment, focusing on total costs (premium + out-of-pocket).
- Check your provider network and drug formulary under new plan options.
- Plan your budget for expected premium/deductible increases.
- Seek expert help from a Medicare specialist, SHIP office, or trusted insurance agent.
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