As Medicare's open enrollment period progresses this year, beneficiaries in North Carolina face a 2026 that will be marked by rising costs.
Those enrolled in both Medicare Advantage and traditional Medicare could see increases in premiums, deductibles, and out-of-pocket expenses, according to data from the Centers for Medicare & Medicaid Services (CMS).
Open enrollment—the period when beneficiaries can review and change their coverage—began on October 15 and will end on December 7. However, less than 30 percent of members nationwide thoroughly review their options each year.
These increases could translate into hundreds or even thousands of dollars in additional annual healthcare expenses if users do not carefully examine their plans.
Medicare Part B
Medicare Part B covers medical services, diagnostic tests, outpatient care, preventive care, certain medical equipment, and some medications administered in doctors' offices. Under traditional Medicare, Part B involves direct costs to the enrollee: an annual deductible, a 20 percent coinsurance, and a fixed monthly payment.
The standard monthly premium is projected to increase from $185 in 2025 to $206.50 in 2026, an increase of nearly 12 percent. The annual Part B deductible is also projected to rise from $257 to approximately $288. (These figures are from projections by the [unclear]) Medicare Trustees Annual Report.)
For most members, the monthly fee is automatically deducted from their Social Security benefits. The cost-of-living adjustment provided by Social Security will add about $56 per month to the average retirement check, which could offset some of the increase.
Even so, the highest premium would absorb almost 40 percent of the average cost-of-living increase, leaving retirees with only about 60 percent of the increase to cover other expenses, from housing to food and medicine.
Medicare Advantage plans will also be subject to multiple changes this year.
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Medicare Advantage
The complexity of traditional Medicare — with supplemental policies and separate drug plans — may make Medicare Advantage attractive.
“It’s the path of least resistance,” said David Lipschutz, co-director of law and policy at Center for Medicare AdvocacyDuring a panel discussion, she said, “They tend to offer lower premiums thanks to the excessive payments they receive from the federal government. They often include supplemental benefits, such as dental, vision, and hearing plans. But they are not standardized.”
This lack of standardization can be confusing and, in practice, even misleading. Recent regulatory changes no longer require insurers to notify members about benefits they are not using. Although beneficiaries are required to receive an Annual Notice of Change (ANOC) by September 30, it is easy to miss.
The notice details changes to the provider network, the formulary of medications, supplemental benefits, and out-of-pocket expenses. Many of the additional benefits that attract users may be reduced or eliminated within a given year, so it's crucial to review the plan before it automatically renews.
In addition, some benefits aimed at people with chronic illnesses or vulnerable populations will no longer be available. after the completion of an experimental program that paid for care based on value.
Affiliates should also carefully consider network restrictions and pre-authorization rules.
“More and more health systems are abandoning Medicare Advantage plans due to frustration with missed appointments, service denials based on prior authorizations, and lower reimbursements,” Lipschutz said. “Just because your current provider is in-network this year doesn’t guarantee they’ll be next year.”
That also happens in North Carolina. For example, UNC Health recently reported which will no longer be in-network for Medicare Advantage plans from WellCare, Health Care Service Corporation (formerly Cigna), and Humana, with the exception of State Health Plan retirees enrolled in the Humana plan.
“People enrolled in a Medicare Advantage plan should verify that their doctors, providers, and hospital will remain in-network next year,” said Melissa Munden, deputy commissioner of the North Carolina Health Insurance Information Program for Seniors (SHIIP)“There are many changes in contract negotiations. In the Triangle area, some hospital systems will not accept certain Medicare Advantage plans next year.”
“Beneficiaries should now review their coverage and ensure their providers are in-network.”
Beyond the network, activists recommend thinking about the future when considering a Medicare Advantage plan.
“It seems like a fixed monthly cost, but it’s fixed as long as you’re healthy,” said Gina Upchurch, chief executive of Senior PharmAssist in Durham. “It stops being fixed when your health starts to decline.”
Upchurch explained that unexpected costs can arise if a member needs an extended stay in a specialized care facility, such as rehabilitation, skilled nursing, or home health services.
“Many of those centers do not have contracts with Medicare Advantage plans,” he said.
This can translate into significant expenses for the member.
Changes in drug formularies and costs
In addition to the adjustments in Part B, the changes in drug coverage are further increasing the financial burden for traditional Medicare enrollees.
In 2026, there will be two fewer standalone (Part D) drug plans available in North Carolina, and several of the other plans will increase their monthly premiums, according to Munden.
In addition, the annual spending limit for Part D prescription drugs will increase from $2,000 to $2,100.
“It may not seem like much, but twelve plans remain available, and two of them have increased their premiums by $50,” Munden noted. “For example, a plan that cost $28 last year will now cost $78. Another that cost $40.20 will go up to $90.20—just the premium.”
Part of the increase in premiums is explained by the fact that the Trump administration cut a program designed to keep Part D premiums stable After Biden's Inflation Reduction Act, which eliminated the "donut hole"—a tier where patients paid the full cost of their medications—insurers can once again pass on the increased cost of prescription drugs to members through higher premiums.
Even small changes in co-payments or coverage can add up to hundreds of dollars annually for seniors with chronic illnesses who take multiple medications.
That's why Munden insists on the importance of reviewing the plans.
“There is nothing worse than arriving at the pharmacy after January 1st and discovering that an essential medicine is no longer covered, or that it has gone up a lot in price, or that the pharmacy with which you had a trusted relationship is no longer in the network,” he said.
Munden recounted the recent case of a woman whose pharmacy would have been dropped from the network if she remained on her current plan. Although her medications would still be covered, the local pharmacy delivered them to her because she was unable to travel. Staying on that plan would have cost her an additional $19,000.
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Stay informed about your Medicare
One of the biggest challenges of the open registration period is the sheer number of elements at play, and this year there are more changes than usual.
The recently passed One Big Beautiful Bill Act complicated eligibility for those who could also qualify for Medicaid. analysis by the Congressional Budget Office He estimated that more than 1.3 million people will no longer meet the “dual eligibility” requirements between now and 2034.
The OBBBA also eliminates eligibility for legal permanent residents and asylees who previously qualified. Undocumented immigrants have never been eligible for Medicare.
One of the best ways to understand the available options is to refer to North Carolina Health Insurance Information Program for Seniors (SHIIP)There are trained volunteers in every county and counselors on the Department of Insurance's main line (1-855-408-1212) who can provide information. Inquiries can also be sent to ncdoi.ncshiip@ncdoi.gov.
Those who try to leave Medicare Advantage and return to traditional Medicare may face difficulties accessing a Medigap planMedigap covers expenses not included in Medicare. If you don't enroll in a Medigap plan by age 65, you'll accrue a penalty for each year without coverage. Furthermore, there's no guarantee of acceptance outside the initial enrollment period.
“It’s difficult for many people to think about the future when they come here for help,” Upchurch said. “They’re thinking about what they need right now, how healthy they are at this moment.”
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