United Healthcare and Most Likely Other Insurers - Changes Coming in 2026

[GailL1]

I don’t have a ton of time at the moment to discuss this - but I wanted to get this out so that beneficiaries will understand the importance of reviewing any Medicare plan they have now for the annual enrollment period for Medicare Advantage and Part D plan switches for 2026 - occurs later this Fall.

ALL Medicare plan insurers, not just United Healthcare, are looking over their Medicare marketplace exposure - yes, even Medigap or Medicare Supplemental plans - This may produce a lot of changes for 2026 and from what I am reading about most Medicare plan insurers - MAPD, Part D and even Medicare Supplemental plans - there may be lots of changes - from dropping coverage to an increase in premiums to reconstructing their formularies.  

There are also changes that are being made to various programs (as required by law) - The Trump administration is continuing the negotiation for certain drugs as the Biden IRA called for - the Part D out of pocket max will increase to $ 2100 - I will try to post more about all these type changes a little later on. But each Medicare insurer is gonna have to also keep these changes in mind when they come up with their 2026 plans.  So please understand that there is gonna be changes and you need to know if any of them will affect you - or not.  

PLEASE - review ANY correspondence - snail-mail or email - on any changes your insurer may be making in 2026 so that you can make sure you have the best plan to meet your needs.

FierceHealthcare News 07/29/2025 - UnitedHealthcare to exit certain Medicare Advantage markets as co... 

EXCERPTS from the link ~ [ lots more at the link ]

The bulk of the increase in spending is in outpatient care, though the insurer is seeing spikes in inpatient care, orthopedic services and pharmacy infusions to a lesser extent.. . . . 

In addition to Medicare Advantage (MA), he said the insurer is seeing costs rise in Medicare supplement plans, which is a signal for broader trends in the fee-for-service Medicare market.. . . . 

Noel also offered a look at how the insurer is responding to the high-pressure environment. He said UHC has enhanced its auditing and payment integrity processes to identify fraud, waste and abuse while protecting patients from unnecessarily high costs. The team is also looking to identify ways to deploy artificial intelligence to smooth out the patient and provider experiences while also lowering costs.

Noel said that in MA specifically, the team is looking to adjust pricing and benefit designs to account for the cost pressures, which they anticipate will stretch into much of 2026. It has also decided to exit certain markets largely with plans that are more loosely designed, such as PPOs, in a move that will impact 600,000 beneficiaries.

[eventuri24]

One of the biggest changes in the AARP UHC advantage plan is they will begin requiring referrals in 2026 which for me is a real game changer.  I am looking at other plans like Healthfirst 65 plus which not only has a $0 premium but does not require referrals.  

[GailL1]

@eventuri24 

Of course you are free to change your choice of Medicare Advantage plan for the 2026 plan year during the annual OEP 10/15/2025 - 12/07/2025 - that’s one of the advantages of having a MA plan (Medicare Part C).  Change is good since your health care needs change as well as one’s pocketbook changes.  

MA plan insurers have the right to require certain cost saving measures - with  network referral requirements being just one of several.  

Even under traditional Medicare, some specialist are requiring a referral on their own as a result of their own business and time requirement decisions. 

[TRL1111]

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@GailL1 wrote:

ALL Medicare plan insurers, not just United Healthcare, are looking over their Medicare marketplace exposure - yes, even Medigap or Medicare Supplemental plans

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I kind of wish you hadn't mentioned Medigap/supplements because people don't seem to understand that the annual enrollment period at the end of the year has nothing to do with supplements.  Plus, except in the rare cases that they offer "extras," supplements don't have any choices in what/how they cover things.  

The waters are already muddy enough, especially with this particular element.