What to Know About Medicare Advantage Open Enrollment Period in 2026 MEDICARE
Remember that Health Maintenance Organization (HMO) plans may require a referral from a PCP to see specialists, while Preferred Provider Organization (PPO) plans typically do not. HMO Point-of-Service plans may have flexibility in some parts of their coverage. Check with the plan directly for accurate information. Drug Formulary: Make sure that you are getting cost-effective coverage for your prescription medications. This year’s prescription out-of-pocket costs are capped at $2,100, which is a $100 increase from last year. Your medications must be in the drug plan’s formulary for you to benefit from this $2,100 cap. Prescription Payment Plan Program: If you were enrolled in this program last year, which allowed you to set up a payment plan for your medications, you will be automatically re-enrolled unless you choose to opt-out. Once enrolled in either Medicare Advantage or Standalone Part D Plan, coverage will take effect on the first of the month following enrollment. ◆
Upcoming Presentations Wednesdays January 28 & February 25 2:00–5:00 pm Murphy-Wilmot Library Topics include: • Understand the difference between Original Medicare and Medicare Advantage. • Learn about Medigap and Prescription Drug Plans. • Questions to ask before you enroll. • How and when to enroll. • Learn about Medicare Savings Programs and getting help with paying Part B premium and/or Part D drug costs for those who qualify. • How to find plans that offer the lowest cost for prescriptions you take. 530 N. Wilmot Dr. Tucson, AZ 85710 REGISTRATION REQUIRED visit Medicare2026-Murphy WilmotLibrary.eventbrite.com or call (520) 546-2011 to register.
Medicare Advantage (MA) plans (also known as Part C) and standalone Prescription Plans (also known as Part D) are run by private companies. For Medicare beneficiaries enrolled in Medicare Advantage, Open Enrollment resumes from January 1–March 31, 2026. During this period Medicare Advantage beneficiaries can: • Switch to another (MA) plan with or without drug coverage. In 2026, Pima County has eighty-two MA plans including Special Needs Plans. • Drop the MA plan and return to Original Medicare. This also allows you to join a Part D plan. You will have a choice of ten Part D plans to choose from. However, Original Medicare enrollees may not switch to Medicare Advantage at this time. Some important factors to consider when switching to a Medicare Advantage Plan include: Maximum Out of Pocket (MOOP) costs: This is the maximum amount you will ultimately be responsible for before the plan picks up the total cost of your care. MOOP amount varies by plan. In 2026, MOOP costs for Pima County MA plans range from $2,000 to $13,900. Plan Network: Check with your existing providers to make sure that they are in network before switching plans.
FOR MORE INFORMATION Contact your local State Health Assistance Program (SHIP) at 1-800-435-4040. Pima Council on Aging is the local SHIP for Pima
County. Contact us at SHIP@pcoa.org or call (520) 546-2011.
Page 12 | January & February 2026, Never Too Late
Pima Council on Aging
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