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.
The Biggest Medicare Change in 2026: Part D Drug Cost Cap
Starting January 1, 2026, Medicare fully implements a $2,000 annual out-of-pocket cap on Part D prescription drug costs. This is the most significant Medicare drug benefit change in decades, made possible by the Inflation Reduction Act.
What it means for you: once you’ve paid $2,000 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 ($257 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.
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 ($257 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.
If you’re tempted to ditch Medicare Advantage, you’re not alone. Millions of Americans switch away from Medicare Advantage plans every year — and the numbers are growing. Here’s when it makes sense to leave, how to do it, and the critical timing issue most people miss.
Why More People Are Choosing to Ditch Medicare Advantage
The most common reasons people decide to ditch Medicare Advantage:
Their doctor left the plan’s network
Prior authorization denied necessary care
Out-of-pocket costs were higher than expected after a serious illness
Benefits were cut at the annual renewal
Moving to a different part of Arizona or another state
Wanting access to Mayo Clinic, which doesn’t accept most Advantage plans
According to CMS data, Medicare Advantage enrollment has seen increasing churn as plan benefits change annually and major insurers pull back from markets.
The Critical Warning Before You Ditch Medicare Advantage
Here’s what stops many people from leaving: the one-way door problem. If you ditch Medicare Advantage and want to switch to a Medicare Supplement (Medigap) plan, you may need to pass medical underwriting — especially if you’ve been on Advantage for more than a year.
That means insurance companies can review your health history and potentially deny you Medigap coverage or charge more based on pre-existing conditions. The longer you stay on Medicare Advantage, the more health conditions you may accumulate — and the harder it becomes to qualify for Medigap.
This is why timing matters: if you’re thinking about leaving, do it sooner rather than later.
When You Can Ditch Medicare Advantage Without Penalty
There are two main windows to leave Medicare Advantage:
Medicare Advantage Open Enrollment Period (MA OEP): January 1 – March 31. You can switch to Original Medicare, with coverage starting the first of the following month.
Annual Enrollment Period (AEP): October 15 – December 7. Changes take effect January 1.
What to Do After You Ditch Medicare Advantage
Once you return to Original Medicare, you’ll want a Medicare Supplement Plan G to cover your out-of-pocket costs. With Plan G, after the Part B deductible ($257 in 2026), you pay nothing for covered services for the rest of the year — no networks, no prior authorization, no surprises.
Ready to Make the Switch?
I’m Andy Orlikoff, an independent Medicare broker in Surprise, AZ. I help Arizona seniors who want to ditch Medicare Advantage navigate the process and enroll in the right Medigap plan — even when medical underwriting is required.
If you watch any amount of television, you’ve seen them — flashy ads promising misleading Medicare Advantage ads will get you free dental, free vision, free gym memberships, and more. New federal rules aim to crack down on the most deceptive marketing practices. Here’s what changed and what Arizona seniors need to know.
If you watch any amount of television the old-fashioned way—live—it would be hard not to notice the onslaught of Medicare ads. Faded comedy stars and sports heroes flood the airwaves each year between October 15 and December 7, the Medicare Annual Enrollment Period (AEP). During nearly every commercial break, seemingly low-budget, high-pressure ads urge Americans over 65 to check their options and make sure they’re getting all the benefits to which they’re entitled.
With 65 million Americans on Medicare, it’s no wonder that health insurers and brokers are falling all over themselves to reach Medicare beneficiaries. The AEP is the only time many people on Medicare have the option to make coverage changes, such as joining or switching Medicare Advantage (MA) or prescription drug plans or moving between Original Medicare and MA.
Those ads aren’t just annoying; historically, many of them have been misleading, according to an analysis by KFF. That may be changing this year thanks to new Medicare rules.
Inundating, Misleading Ads KFF analyzed 650,000 airings of Medicare ads that appeared on air between October 1 and December 7, 2022. While the ads promoted all types of Medicare plans, including Part D prescription drug plans and Medigap supplemental plans, MA ads dominated with 85% of all airings.
More than one-quarter (27%) of the MA ads showed images of government-issued Medicare cards or images that closely resembled the official Medicare card. Most (83%) ads sponsored by brokers or other third parties pointed people to call a private Medicare hotline rather than the official Medicare line (800-MEDICARE). More than 50,000 airings used messaging that warned viewers they might be missing out on benefits, suggesting their current coverage could be incomplete.
The vast majority of MA ads (92%) focused on extra benefits, such as dental, vision, hearing, and prescription drug benefits, which most enrollees can get. However, 67% of third-party or broker ads promoted financial benefits such as getting a rebate for Part B premiums known as the “give back” benefit despite just 17% of plans offering such a rebate.
KFF also conducted focus groups to understand how consumers experience the process of choosing a Medicare coverage. The research found that many Medicare beneficiaries were unclear on their Medicare coverage options and the trade-offs between them. Focus group participants noted feeling overrun with often-misleading ads. Despite—or perhaps because of—the abundance of messages, participants reported feeling confused or unclear about the options.
At a September briefing on KFF’s findings, Lindsey Copeland, director of federal policy at the Medicare Rights Center, a national nonprofit organization, said that her organization often receives calls about misleading Medicare marketing. Copeland said that consumers often report feeling unsure who to trust. They may feel pressure to take action based on TV ads or direct mail, even if they are happy with their current coverage. Some report being confused about who is sending them official-looking mail and questioning if offers seem too good to be true are legitimate.
According to Copeland, 20% of calls to the Medicare Rights Center’s helpline about misleading marketing are from people who were enrolled in a plan without their knowledge or consent. Callers report thinking they were talking with Medicare or believing they were providing information to a broker but not consenting to switch plans. They may only realize what has happened weeks later when paperwork arrives, by which time they have little or no recourse. Other callers say they switched willingly but learned their decision was based on inaccurate or incomplete information, and that they failed to understand what they might be giving up.
New Rules To Protect Consumers New CMS rules may be shifting the nature of Medicare advertising. Advertisers can no longer use the Medicare logo, name, or the official Medicare card in a way that could imply that the ads are coming from the official Medicare program. Broker ads will need to specify which plans they are selling and benefits that aren’t available to everyone must be clearly identified as such.
“We are really trying to reign in misleading marketing practices,” Meena Seshamani, M.D., Ph.D., director of the Center for Medicare, said in an interview.
Seshamani said the agency is instituting what she calls common-sense rules and considering the experience of Medicare beneficiaries who are bombarded by ads and confused about their options, which include Medicare Advantage, Original Medicare, and Medicare prescription drug plans.
“These are all important pieces of the Medicare program; they are all important options for people to have,” she said. “But if they are getting confused and if they’re getting misled, then the program’s not working for them.”
In the KFF briefing, CMS administrator Chiquita Brooks-LaSure said that in response to skyrocketing complaints over the last couple of years, the agency will review all television, radio, and web-based ads in advance to make sure they meet the requirements.
“These protections that we put forward are really spurred in large part by the feedbackmthat we have gotten through partners and from the people we serve,” LaSure said.
“What we are focused on is just making sure that people have access to accurateminformation.
Terri Swanson, president of Medicare for Aetna, a CVS Health company with nearly 11mmillion Medicare members, is positive on the new rules.
“We want to make sure Medicare beneficiaries are getting the information they needmand feel supported in their experience,” Swanson said in an interview. “That’s whymAetna fully supports CMS oversight of marketing practices, and we are committed tompartnering with CMS to ensure that beneficiaries receive clear, correct and helpfulminformation about their Medicare plan options.”
Swanson encourages Medicare beneficiaries to take the time to learn about their options and understand what plan is right for them. She recommends starting with a few
basic questions, such as does the plan fit your budget? Are your favorite doctors,,hospitals, and pharmacies in the plan’s network? And does the plan cover your specificmprescriptions?
“As with all things in life, one size does not fit all,” she said. “Your team of doctors and healthcare professionals can also help you understand your health needs, which is important when deciding on a plan.”
According to Seshamani, CMS’ objective is similarly focused on consumers’ needs:
“How can we make sure that people are getting the information that they need, so that they can make the best decision for them?”
Author: Deb Gordon I am co-founder and CEO of Umbra Health Advocacy and co-director of the Alliance of Professional Health Advocates. I’m the author of The Health Care Consumer’s Manifesto: How to Get the Most for Your Money, based on research I conducted as a Senior Fellow in the Harvard Kennedy School’s Mossavar-Rahmani Center for Business and Government. For nearly a decade, I served as Chief Marketing Officer for a health plan during Massachusetts health reform and the ACA implementation. I am an Aspen Institute Health Innovators Fellow and an Eisenhower Fellow, for which I traveled to Australia, New Zealand, and Singapore to explore the role of consumers in high-performing health systems. I hold a BA in bioethics from Brown University and an MBA with distinction from Harvard Business School.
When you turn 65, the biggest Medicare decision you’ll face is this: Original Medicare vs Medicare Advantage — which one is right for you? The differences are significant, and one expert says one of those options is clearly the worse choice for most seniors. Here’s the full breakdown.
As you approach age 65, you’ll have some decisions to make about medical coverage. On one hand, you can enroll in Medicare. But you may be tempted to choose another option instead: a Medicare Advantage (MA) plan instead. If you’ve seen the advertisements for MA plans, you might think they’re more cost-effective and comprehensive than Medicare. But according to Keith Armbrecht, Founder of Medicare education company, Medicare on Video, that’s not necessarily true.
“I would never choose a Medicare advantage plan,” he says in a YouTube video entitled “Why Medicare Advantage Is The Worst Choice For Seniors.”
Here’s why he’s not a fan of these plans.
What is a Medicare Advantage plan?
Medicare Advantage plans are alternative insurance plans to Medicare, and they’re offered by Medicare-approved private companies. These plans are sometimes called “Part C” or “MA,” and they include Medicare Part A (hospital insurance) and Part B (medical insurance).
Those interested in MA have more than 40 different plans to choose from. The main
reasons to explore them include:
The potential for lower premiums compared to Medicare. In 2022, the average premium was $58, according to 2022 data from the U.S. Senate Committee on Finance.
Out-of-pocket costs may be capped. In 2023, the maximum was $8,300 for approved services.
Most plans include dental, vision, hearing and fitness benefits.
That being said, there are a few downsides to Medicare Advantage plans. Here are some important things to consider before locking into an MA plan.
Limited choice
If you opt for an MA plan, your choice of doctors can be limited and you’re likely to face obstacles in getting approved for procedures or seeing specialists. “The primary reason I would absolutely choose original Medicare and would never choose Medicare Advantage is because I want control over what I do,” says Armbrecht. With an MA plan, he warns, you can face wait times of “weeks, even months,” to get referrals or have procedures authorized.
You’re typically limited to doctors in the plan network and service area, as well,
according to the government’s Medicare website.
Deceptive marketing
The Medicare Advantage plan industry has a history of deceptive practices. In 2022, the Majority Staff of the U.S. Senate Committee on Finance found that Medicare beneficiaries were being inundated with aggressive marketing tactics, false and misleading information and overall predatory marketing from MA providers. According to the report, deceptive Medicare Advantage marketing practices are, “widespread, not isolated events.”
According to a 2022 review from the New York Times, four out of five of the largest MA providers (UnitedHealth, Humana, Elevance and Kaiser) have faced federal lawsuits for fraud and at least eight providers overbilled, according to the U.S. Department of Health and Human Services Office of the Inspector General.
Denied claims
Multiple studies have shown MA plans have a pattern of denying claims that should be covered.
A 2022 review from the Inspector General’s office found that MAs denied 13% of prior authorization requests that met Medicare coverage rules. Essentially, these claims would have been approved under original Medicare. The most commonly denied requests were imaging services, stays in post-acute facilities and injections.
Go to the source
“Medicare is probably the only government program that does exactly what it’s supposed to do and does it very well,” says Armbrecht. In other words, original Medicare is likely your best choice. If you’re nearing 65 and considering your options, you can visit Medicare.Gov for accurate and up-to-date information so you can make the right decision for your health insurance needs.
For most Arizona seniors, Original Medicare with Plan G provides better protection when you need care most. Call Andy Orlikoff at (623) 742-3878 for a free, no-pressure comparison.
Andy Orlikoff • NPN #7558435 • Licensed in Arizona, North Carolina & South Carolina
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