Answer: I’m predicting that Advantage Plans will have no choice but to continue some combination of increasing premiums, co-pays, and/or MOOP while decreasing the generosity of ancillary benefits, aka, “extras” or “free stuff.” The reason is the cost and usage of medical care and prescription drugs are rising faster than the payments Advantage Plan companies get from Medicare. 

Recent history, and future, of Advantage Plans in Western PA

Here in Western Pennsylvania, we’ve been blessed to have some of the best overall Advantage Plans in the entire country. That will remain true in 2026, and plans will still be better than they were in 2018, right before what I call the “Golden Age” of Medicare Advantage began. From 2019 to 2024, premiums and co-pays went down almost every year, the “free stuff” got more and more generous, there were no prescription deductibles, and all plans had Tier 3 drug co-pays around $45 for a 30-day supply. 

In 2025, drug deductibles and the 25% coinsurance for Tier 3 drugs were introduced on some plans, but that was the only significant change we saw. In 2026 the majority of plans will have increased costs for Tier 3 drugs along with slightly higher premiums and medical co-pays.  Some plans may also significantly reduce ancillary benefits. It’s my professional opinion that 2026 will still offer very good value in Advantage Plans for Western Pennsylvanians, but I also think we’re going to continue to see more changes in 2027 and beyond which will result in plans more closely resembling those prior to the “Golden Age,” when the most popular had monthly premiums of $50 to $80 or medical deductibles as high as $1,200. Before 2019, the “extras” were almost non-existent, nothing resembling how generous they are today. 

I also foresee a time in the not so distant future when in order to get a lower cost plan with the best co-pays, people may need to choose an HMO with a smaller network that will limit access to one or the other of our two biggest health care systems, UPMC and AHN. Those who want or need an Advantage Plan with a larger network will likely be forced to pay more premium for a plan with higher co-pays.  

Options moving forward

If my predictions become reality, what are the options for people like Cathleen who have serious medical conditions? 

Supplements will almost certainly become more popular again. But under the current Pennsylvania laws that allow Supplement companies to discriminate on who they accept into their plans based on the applicant's medical history, many people won’t qualify. Which means those who can’t get a Supplement will have to choose from Advantage Plans that likely won’t be as good as 2026 or nearly the value they were in 2023 and 2024, the best years ever for HMOs and PPOs.

It’s why those who currently have an Advantage Plan and are healthy enough to get approved for a Supplement might want to consider moving to one this Annual Enrollment Period (AEP). If you would like to get pre-screened to see if you qualify, we can send you a sample list of questions that companies ask to determine eligibility, get you quotes, and discuss the pros and cons of Supplements versus Advantage Plans. 

Will any plans have lower drug costs in 2026?

As far as Cathleen’s question about available Advantage Plans that will have lower out of pocket drug costs in 2026, there are a select few that will have a $0, or a lower deductible, as well as flat Tier 3 co-pays instead of 25% coinsurance. If you would like to compare those to your current plan, we can do that as well. 

To get prescreened for Supplement underwriting or to make an appointment for a no cost consultation to compare your current Advantage Plan to others this AEP, give us a call at 724-603-3403 or email me personally at Aaron@GetYourBestPlan.com.