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In the coming year, there will be a number of changes to Medicare Advantage plans and Medicare Part D.
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Those changes include differences in prescription out-of-pocket costs, new pricing on certain prescription drugs and an updated out-of-pocket drug cost limit.
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Providence partners with American Senior Resources to provide free Medicare counseling and information for seniors, including a help line.
Get ready for the Medicare Annual Enrollment period
If you’re 65 or older, Medicare coverage is a topic of discussion that comes up a lot — especially if you’re battling chronic health conditions or anticipating surgery or a hospital stay.
This fall, it’s particularly important that you have a focused conversation with a licensed insurance agent about your Medicare health insurance, since there are a number of changes that will be taking effect in 2026. Providence is making it easier to find information by putting all the resources you need in one place.
Changes to Medicare Part D
Next year, there are several major changes to Medicare Part D. They include:
- An out-of-pocket cap – You will pay a maximum of $2,100 for prescription drugs.
- Elimination of the coverage gap – The coverage gap, which is often referred to as the “donut hole,” will no longer exist.
- Spreading out-of-pocket payments – You will have the option to spread your out-of-pocket costs throughout the year instead of paying them all at once.
- Reduced prices for drugs – Medicare is introducing 10 new negotiated price-reduced drugs.
Additionally, during your review, you may find that you have qualified for additional cost savings on out-of-pocket and prescription drug costs.
“We understand these updates can be overwhelming, which is why we encourage you to speak with someone who can walk you through your 2026 options,” says Carol Repasky, senior outreach manager for Providence’s Community Care Alliance. “A licensed insurance agent can help you make the most informed decision for your needs.”
Meet with a licensed insurance agent
It’s important to review your plan with a licensed professional before the Medicare Annual Enrollment Period ends on Dec. 7. Doing so can help you stay informed, avoid surprises and potentially save money. Here's why a personalized consultation matters:
- Plan changes – Medicare plans can change every year, including premiums, deductibles and plan coverage options. An agent can help you understand how these changes affect you.
- New plan options – Each year, the government introduces new Medicare Advantage and Part D plans. Your agent can help you compare options.
- Cost savings – Your agent can help you find health plans that offer better coverage at a lower cost.
- Penalty avoidance – If you miss the enrollment period (Oct. 15 to Dec. 7), you may have to pay late enrollment penalties, especially for Medicare Part D. An agent can make sure you finish your paperwork on time.
- Personalized advice – Agents can look at your specific circumstance before giving advice.
- Help with complex issues – Because Medicare can be difficult to understand, working with an agent can be a good way to make sure you’re doing everything correctly.
- Prescription drug coverage updates – Prescription drug plans change often, with drugs sometimes moving to higher tiers or increasing their out-of-pocket charges.
How can you find an agent?
Now that you understand the importance of meeting with an insurance agent this fall, it’s time to find the right person. Providence can help.
American Senior Resources* is our Medicare partner. This organization offers unbiased workshops, personalized consultations and a Medicare Help Line at no cost to seniors across Providence, Swedish and PacMed locations.
“Working with license insurance agents through American Senior Resources provides an impartial review and presents available options for health care needs,” says Repasky. “And the best part is these services are provided at no cost.”
You can find help through the following resources:
Medicare Help Line – 815-315-3279
Pacific Medical Centers website
*Note: American Senior Resources is a licensed health insurance agency that sells insurance to supplement Medicare and is not affiliated or connected with Medicare or any other government program or agency. American Senior Resources offers plans from several insurance companies.
Medicare Annual Enrollment Q&A
Q: What major Medicare Part D changes are coming in 2026?
A: Starting in 2026, there will be a $2,100 out-of-pocket cap for prescriptions, the elimination of the current coverage gap (“donut hole”) and the option to spread payments throughout the year.
Q: Why should I meet with a licensed insurance agent during the Annual Enrollment Period?
A: Agents can help you understand plan changes, compare new options, find cost savings, avoid late penalties and navigate the complexities of Medicare.
Q: When is the Medicare Annual Enrollment Period?
A: It runs from Oct. 15 to Dec. 7 this fall.
Q: How can I find a licensed Medicare insurance agent through Providence?
A: Providence partners with American Senior Resources, which offers free workshops, consultations and a Medicare Help Line (815-315-3279), along with resources on the Providence, Swedish and Pacific Medical Centers websites.
Contributing caregiver
Carol Repasky is the senior outreach manager for Community Care Alliance with Providence.
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This information is not intended as a substitute for professional medical care. Always follow your health care professional’s instructions.
