Medicare is changing significantly in 2026, and Arizona seniors need to understand what’s new. From prescription drug cost caps to shifts in Medicare Advantage, the state of Medicare 2026 looks different from previous years. Here’s your complete guide to what changed and how to avoid surprise bills.
Part D Drug Cost Cap Rises to $2,100 in 2026
The annual out-of-pocket cap on Part D prescription drug costs, which began at $2,000 in 2025 under the Inflation Reduction Act, is $2,100 in 2026.
What it means for you: once you’ve paid $2,100 in out-of-pocket drug costs in a calendar year, your Part D plan covers 100% of covered drug costs for the rest of the year. Previously, there was no true cap — catastrophic coverage kicked in at a much higher threshold.
Medicare Advantage Changes in 2026
The state of Medicare 2026 includes significant Medicare Advantage turbulence. Several major insurers reduced benefits, raised copays, or exited markets entirely. According to CMS, payment pressures on Medicare Advantage plans have forced carriers to make tough tradeoffs.
Key changes affecting Arizona Medicare Advantage enrollees in 2026:
UnitedHealthcare significantly reduced its Medicare Advantage footprint nationwide
Many plans cut extra benefits like dental allowances and OTC credits
Prior authorization requirements continue to expand
Out-of-pocket maximums for many plans increased
How to Avoid Surprise Bills in 2026
Surprise bills remain a major concern for Medicare beneficiaries. Here’s how to protect yourself:
Verify your doctors are still in-network — Medicare Advantage networks change every January 1
Review your Annual Notice of Change (ANOC) — sent in September, it shows every change to your plan
Check your drug formulary — your medications may have moved to a higher tier
Consider Original Medicare with Plan G — no networks, no annual surprises, predictable costs
Medicare Supplement Plan G in 2026
For many Arizona seniors, the simplest way to avoid surprise bills is Medicare Supplement Plan G. After the Part B deductible ($283 in 2026), Plan G covers 100% of Medicare-approved costs. No networks. No prior authorization. No annual benefit changes to review.
Get Help Navigating Medicare in 2026
I’m Andy Orlikoff, an independent Medicare broker in Surprise, AZ. I help Arizona seniors understand the state of Medicare 2026 and choose coverage that won’t surprise them when they need care.
The ACA subsidy cliff is one of the most frustrating aspects of health insurance for middle-income Arizona residents. If your income is just slightly above the subsidy threshold, you could face full unsubsidized premiums — a financial cliff that makes coverage unaffordable for many. Here’s how the ACA subsidy cliff works and what your options are in 2026.
If you get your health insurance through the Affordable Care Act (ACA) Marketplace, you might be facing sticker shock during this year’s Open Enrollment. While the underlying cost of health coverage is undeniably rising, a massive policy change—the expiration of crucial pandemic-era subsidies—is set to hit millions of Americans’ wallets with a significant increase in 2026.
Here is a summary of the expected increases and what is driving them:
1. The Shocking Rise in Premiums
Insurance companies are proposing major premium hikes for ACA plans. The base cost (gross premium) for coverage on the Marketplace is increasing by an estimated 26% on average for 2026 plans.
However, the real blow for many will come from the net premium—the amount enrollees pay after financial assistance.
2. The Expiration of Enhanced Subsidies (The “Subsidy Cliff”)
The main catalyst for the massive increase in out-of-pocket costs is the scheduled expiration of the enhanced Premium Tax Credits (PTCs) at the end of 2025.
Massive Cost Shift: If Congress does not renew these enhanced subsidies, the average subsidized enrollee’s monthly premium payment is estimated to more than double, increasing by about 114% on average.
Real-World Impact: An analysis suggests the annual out-of-pocket premium for the average subsidized household could jump from approximately $888 to over $1,900 for 2026 coverage.
The Loss of the “No Cliff” Rule: Before the temporary enhancements, individuals with incomes above 400% of the federal poverty line were ineligible for any subsidy (a “subsidy cliff”). The enhanced credits removed this cliff. If they expire, these higher-income enrollees will face the full, unsubsidized cost of their plan, potentially paying tens of thousands of dollars more a year.
3. The Problem of High Deductibles
While monthly premiums capture attention, high deductibles remain a core issue for many ACA enrollees. Even with subsidized premiums, many families still face very high out-of-pocket maximums. For some lower-income families, deductibles can be set as high as $14,700 for a family of four.
Furthermore, as insurers and employers look for ways to offset rising gross costs, there is concern that a new wave of rising deductibles will be implemented to keep premium costs down, shifting more financial risk onto the consumer.
4. Why Are Underlying Costs Rising?
The subsidy expiration only exacerbates a pre-existing trend of rising healthcare costs. Key drivers include:
Inflation & Labor Costs: General economic inflation and rising costs for healthcare workers and services.
Specialty Medications: The increasing use and high price of expensive specialty drugs, particularly weight-loss medications like GLP-1s, are cited by insurers as a significant factor in premium increases.
Anticipation of Risk: Insurers are factoring in a higher-risk pool, anticipating that healthier individuals—who will see the sharpest price increases—will drop their coverage, leaving the Marketplace with a higher concentration of older and sicker people.
What to Do Next: As the Open Enrollment period is underway, it is critical for consumers to check their new premium costs and shop for plans, as the best value plan may have changed significantly from the previous year. Lawmakers continue to debate solutions, including proposals to extend the subsidies or redirect the funding directly to patients to help offset high out-of-pocket costs.
As a health insurance broker in Surprise, AZ I can help. Plans off exchange and outside the ACA are available.
Contact Andy Orlikoff Today! 623-742-3878 andy@azhealth.us
Struggling with the ACA subsidy cliff in Arizona? I compare all your options — ACA marketplace, off-exchange PPO plans, and short-term coverage. Call Andy Orlikoff at (623) 742-3878 or fill out the contact form. My help is free.
If you’ve experienced ACA sticker shock when shopping for health insurance, you’re not alone. Millions of Americans — especially those who earn just above the subsidy threshold — face premium prices that seem impossible to afford. Here’s why ACA premiums are so high, what the subsidy cliff means for Arizona residents, and what your alternatives are.
ACA Sticker Shock: Why Premiums Are So High
The annual Open Enrollment period for the Affordable Care Act (ACA) Marketplace is here, and for many Americans, this year is bringing an unpleasant surprise: sticker shock. While the ACA remains a vital source of coverage for millions, the underlying cost of health insurance is rising, and a major federal policy decision is poised to make things even more difficult for consumers in the near future.
The conversation this year revolves around two critical factors: rising premiums and the looming expiration of the enhanced federal subsidies.
The Current High Cost of Coverage
Health insurance premiums across the board are on the rise. Several factors contribute to this:
General Inflation and Healthcare Costs: The cost of medical services, drugs, and hospital care continues to climb, naturally pushing up the price of the insurance designed to cover them.
Insurer Rate Hikes: Insurers are proposing and receiving approval for some of the largest rate increases seen since the ACA’s early days.
Even with these increases, the true bombshell for many enrollees isn’t just the price of the plan itself—it’s what happens when you remove the financial cushion of the expanded tax credits.
The Critical Role of Enhanced Subsidies (and the Looming Cliff)
The federal government provides Premium Tax Credits (PTCs) to make Marketplace coverage affordable. This assistance is critical for the vast majority of ACA enrollees.
In 2021, Congress temporarily passed enhanced premium tax credits as part of the American Rescue Plan Act, which were later extended through the end of 2025 by the Inflation Reduction Act. These enhancements achieved two major things:
They eliminated the “Subsidy Cliff”: They removed the previous income cap (400% of the federal poverty level, or FPL) for subsidy eligibility. This meant that middle- and higher-income families who faced very high-cost premiums could still receive help, ensuring no one paid more than 8.5% of their household income for a benchmark Silver plan.
They made subsidies more generous: They lowered the percentage of income that all eligible households had to pay toward their premiums.
What Happens Next? The 2026 Subsidy Cliff
Unless Congress acts soon, the enhanced subsidies are scheduled to expire on December 31, 2025. This expiration will have dramatic consequences, reverting the system back to the original, less generous ACA subsidy structure for 2026.
According to health policy analysts, the changes will hit millions of Americans hard:
Household Income Category
Pre-Expiration Reality (Through 2025)
Post-Expiration Reality (Scheduled for 2026)
Above 400% FPL
Subsidies available if the benchmark plan costs more than 8.5% of income.
Lose ALL subsidies (The “Subsidy Cliff” returns).
Below 400% FPL
Pay a smaller percentage of income toward the premium.
Subsidy amounts will shrink; consumers will pay a higher percentage of their income toward the premium.
The average subsidized enrollee is projected to see their net annual premium payments more than double if the enhanced tax credits are allowed to expire. For a middle-aged couple earning just over the 400% FPL threshold, the annual premium shock could be in the tens of thousands of dollars.
Navigating Your Options in a High-Cost Environment
If you’re shopping on the Marketplace now, here is what you need to know:
The Enhanced Subsidies are Still in Effect for Your 2025 Plan: You can still benefit from the lower caps and expanded eligibility for this year’s coverage.
Shop Around, Every Year: Don’t auto-renew! Plans and prices change significantly year to year. You may find that a different plan—even from a different metal level (Bronze, Silver, Gold)—offers a lower net premium thanks to how the subsidy calculation works.
Know Your Income Estimate: Your subsidy is based on your expected household income for the year you are seeking coverage. A slight overestimate or underestimate can greatly affect your eligibility and monthly premium amount.
The clock is ticking on the enhanced subsidies. For the millions who rely on the Marketplace, the affordability of health insurance in the coming years rests on a looming legislative decision.
If you’ve experienced ACA sticker shock and been priced out of the marketplace, we can help find alternatives.
How to Avoid ACA Sticker Shock in Arizona
Struggling with ACA sticker shock? I compare ACA marketplace plans, off-exchange PPOs, and short-term options for Arizona residents — at no cost to you. Call Andy Orlikoff at (623) 742-3878 or fill out the contact form.
Every fall, millions of seniors face the same decision: Medigap vs Medicare Advantage — which is right for me? Despite Medicare Advantage’s heavy marketing, a significant number of seniors deliberately choose Medigap over Medicare Advantage. Here’s why.
The Core Reason Seniors Choose Medigap Over Medicare Advantage
The fundamental difference: Medicare Advantage is cheaper at enrollment but can cost far more when you’re sick. Medigap vs Medicare Advantage comes down to predictability. With Medigap Plan G, after the Part B deductible ($283 in 2026), you pay nothing for covered services all year. With Medicare Advantage, copays, coinsurance, and prior authorizations can add up to thousands.
Nurses, doctors, and hospital administrators — people who see how insurance affects patients — consistently prefer Medigap for themselves and their families. The reason: when a serious illness hits, Medicare Advantage plans frequently require prior authorization, restrict networks, and deny claims that Original Medicare would cover.
According to Medicare.gov, Medigap plans work alongside Original Medicare and cover most of the gaps Original Medicare leaves — without network restrictions or prior authorization requirements.
Five Reasons Seniors Choose Medigap Over Medicare Advantage
Any doctor, anywhere: Medigap works with any provider who accepts Medicare — no networks, no referrals
No prior authorization: Your doctor decides your care — not an insurance company algorithm
Mayo Clinic access: Mayo Clinic Arizona accepts Original Medicare and Medigap — not most Advantage plans
Predictable costs: One deductible per year, then nothing for covered services
Stable benefits: Medigap benefits don’t change annually — no ANOC to review every September
When Medicare Advantage Might Still Make Sense
If you can’t afford Medigap premiums or qualify for low-income assistance programs, Medicare Advantage may be your best available option. However, the one-way door risk remains: if you later want to choose Medigap over Medicare Advantage, you may need to pass medical underwriting.
Get a Free Comparison in Arizona
I’m Andy Orlikoff, an independent Medicare broker in Surprise, AZ. I help Arizona seniors understand the real Medigap vs Medicare Advantage tradeoffs — and I don’t sell Advantage plans.
As 2026 open enrollment approaches, millions of Americans are bracing for significant health insurance cost increases. Enhanced ACA subsidies that dramatically reduced premiums may expire, and the political debate over their renewal has left many consumers uncertain about what to expect. Here’s what Arizona residents need to know heading into 2026 open enrollment.
Why 2026 Open Enrollment Costs Are Rising
The enhanced premium tax credits introduced by the American Rescue Plan made marketplace coverage affordable for millions who previously couldn’t qualify. If those subsidies expire, premiums could spike dramatically for people who earn between 100% and 400% of the federal poverty level — the group that benefits most from ACA subsidies.
According to healthcare.gov, 2026 open enrollment runs November 1 through January 15. Changes made during this window take effect January 1, 2027.
What Arizona Residents Should Do Before 2026 Open Enrollment
Don’t assume your current plan is still the best option — carriers adjust premiums, networks, and benefits every year
Check your subsidy eligibility — income changes could mean larger or smaller subsidies than last year
Compare all plan types — ACA marketplace plans, off-exchange PPOs, and short-term options all have different price points
Use an independent broker — a broker compares all options at no extra cost to you
Off-Exchange Options Worth Considering
If you earn too much for meaningful ACA subsidies, 2026 open enrollment is a good time to compare off-exchange PPO plans. Some carriers offer private PPO plans with broader networks — including Mayo Clinic Arizona — at competitive prices for healthy individuals.
Free Help With 2026 Open Enrollment in Arizona
I’m Andy Orlikoff, an independent health insurance broker in Surprise, AZ. I help Arizona residents compare all their options during 2026 open enrollment — marketplace plans, off-exchange PPOs, and more. My help is always free.
