NAVIGATING 2026: MEDICARE VS. MEDICARE ADVANTAGE – WHY REDUCED ACCESS COULD COST YOU MORE THAN YOU THINK

Open enrollment kicked off on October 15, so it's time to review your Medicare options for 2026. While both Original Medicare and Medicare Advantage (MA) bring some changes, the real story lies in the trade-offs. Original Medicare continues to offer broad, predictable access to care nationwide, but MA plans – run by private insurers – are facing significant cutbacks including cancelled contracts throughout entire hospital systems, all of which could shrink your provider choices and delay essential treatments. 

Medicare is divided into four key components: A,B,C, and D. Part A is for hospital and acute care coverage. Part B is professional services, laboratory services, and imaging. Part C is a combination of Medicare's Part A and B that is purchased through the marketplace and then sold to a proprietary insurance company. Part D is your drug plan. 

Key Changes in Original Medicare: Stability with a Side of Savings

Original Medicare’s Parts A and B remain the gold standard for flexibility, letting you see any doctor or hospital that accepts Medicare; approximately 98% of non-pediatric physicians nationwide. No networks, no referrals for specialists, no surprise bills in the mail. Here's what's new for 2026:

Premiums are ticking up: Part B standard monthly premium will rise from $185.00 to $206.50. 

Drug Price Wins: Starting January 1, Medicare's negotiated lower prices kick in for 10 high-cost drugs treating conditions like cancer, diabetes, and arthritis. Part D tweaks for easier budgeting: The out-of-pocket cap rises slightly to $2,100 (from $2,000), indexed to drug spending trends, while the max deductible climbs to $615 (from $590).

MA Part C Updates: Lower costs, but at what price? MA plans, which bundle Parts A, B, and often D into one package that is then sold to a private insurer. Good news: Average premiums dip slightly to $16.40/month (from $17/mo in 2025), and the in-network out-of-pocket max drops to $9,250 (from $9,350 in 2025). Over 99% of beneficiaries still have plan access, and 96% can snag a $0-premium option. However, cracks are showing…

Insurer Pullbacks: Big players like UnitedHealthcare are exiting 109 counties, affecting 180,000 people and have almost completely removed all PPO plans for new beneficiaries. Humana is down to insuring 85% of counties from 89%, and Aetna/CVS is cutting Part D in 100 counties. They are shrinking footprints due to 20% lower government reimbursements since 2023 and rising costs. This could force switching to more restrictive HMO-style plans.

End of a Pilot Program: The Value-Based Insurance Design model wraps up, nixing tailored perks (like food delivery or transportation) for 7 million low-income or chronically ill enrollees.

Tighter Rules on Extras: There will no longer be MA-funded alcohol, cannabis, facelifts, or funeral planning. These "supplemental" benefits must now prove health ties for the chronically ill.

Enrollment Dip: Centers for Medicare and Medicaid Services predicts a slight MA enrollment drop amid the various plan and coverage shifts.

Enrollment in Specialized Plans Fell: Plans like institutional Special Needs Plans (for nursing home residents) fell 5%, mostly from insurer exits. While MA shines on paper with bells and whistles, 2026's changes hint at a leaner, less generous future.

The Dark Side of MA – How Reduced Access to Care Hits Hard: MA's allure (often $0 premiums and add-ons) comes with strings that tighten in 2026. Unlike Original Medicare's open-door policy, MA locks you into networks and red tape, and recent trends amplify the risks. Here's why reduced access could derail your health:

Sometimes in healthcare, time is of the essence. The speed at which you can access the correct provider, or any provider at all, can mean life or death. As more and more doctors opt out of these networks, patients will be forced into longer waiting times and extended waitlists to see their provider of choice. Prior authorizations for healthcare in HMO plans greenlight 50 million requests per year (400,000 in original Medicare). That's 49.6 million more, or 99.2% of prior authorization claims come from MA.  Time waiting for prior authorization is time not spent getting timely care. These aren't hypotheticals; delays in care raise risks for chronic conditions. MA plan’s low-cost and shiny extras often mask a system prioritizing profits, leaving you scrambling when access dries up.

Your Action Plan: Choose Access Over Allure

2026 favors Original Medicare for those valuing freedom. Add a Medigap policy for predictable costs, and you're set. If MA tempts you, scrutinize networks on Medicare.gov and chat with your State Health Insurance Assistance Program. Open enrollment ends December 7 — don't wait for an Annual Notice of Change notice to jolt you.