Major 2026 Medicare Plan Changes: How Merck Retirees Can Prepare

Healthcare Provider Update: Healthcare Provider for Merck Merck & Co., Inc., commonly known as Merck, is a global leader in the healthcare sector, renowned for its innovative pharmaceuticals, vaccines, and biologic therapies. As a prominent healthcare provider, Merck delivers a wide array of health solutions targeting various health conditions, particularly in areas such as immunology, oncology, and infectious diseases. Potential Healthcare Cost Increases in 2026 In 2026, healthcare costs are projected to rise significantly, primarily driven by the anticipated expiration of enhanced federal premium subsidies associated with the Affordable Care Act (ACA) and growing medical expenses. Faced with an average premium increase of 18%, healthcare consumers may experience out-of-pocket costs climbing by over 75%. This situation is exacerbated by surging medical care prices, as hospitals and providers seek to balance inflationary pressures while maintaining profitability. As a result, many individuals may find themselves priced out of adequate health coverage, prompting essential discussions on the need for policy interventions. Click here to learn more

'With sweeping Medicare changes ahead, Merck employees should start comparing plan options early, carefully reviewing provider networks as well as total annual costs to help maintain long-term health care flexibility and stability.' — Paul Bergeron, a representative of The Retirement Group, a division of Wealth Enhancement.

'Merck employees navigating the 2026 Medicare changes should take a proactive approach—reviewing their Annual Notice of Change and verifying provider access now to make confident, cost-effective health care decisions.' — Tyson Mavar, a representative of The Retirement Group, a division of Wealth Enhancement.

In this article, we will discuss:

1. The significant structural and cost-related changes coming to Medicare in 2026.

2. How Merck retirees can adjust to fewer plan options and shrinking provider networks.

3. Practical steps to evaluate new coverage, handle rising premiums, and maintain access to quality care.

Significant Updates to Medicare Plans in 2026: Key Information for Merck Retirees

As 2026 approaches, Merck retirees should prepare for one of the most impactful Medicare open-enrollment periods in recent memory. Insurers are narrowing plan choices, removing once-popular benefits, and increasing out-of-pocket exposure, which will force many retirees to rethink their health care coverage and long-term medical cost strategy.

“A new perspective on Medicare coverage is needed as we approach the year,” says Brent Wolf, CFP® of Wealth Enhancement. The coming changes will deeply affect premiums, provider access, and treatment costs—much more than superficial plan tweaks.

Rising Costs, Narrower Margins, and Insurer Pullbacks

The current strain stems from higher utilization, regulatory burdens, and medical inflation. These forces are pushing some insurers to raise coinsurance, deductibles, and out-of-pocket costs in Medicare Advantage plans. Major carriers such as UnitedHealthcare, Aetna, ¹  and Elevance Health ²  are restructuring plan designs—often shifting risk toward retirees. For Merck retirees, grasping these dynamics is critical, since plans that look affordable may incur steep costs during hospital stays or chronic care events.

Careful comparison of the Annual Notice of Change (ANOC) is crucial. This document details cost-tier changes, updated copays, and network revisions. Cross-referencing the ANOC with the Evidence of Coverage and Summary of Benefits can help retirees avoid unpleasant mid-year surprises, such as discovering essential medications have moved into higher cost tiers or that new referral rules for specialists have been adopted.

Shrinking Networks and Transition Planning

The 2026 updates will include both provider-network contractions and plan exits. ³  Insurers are consolidating offerings—with many eliminating preferred provider organizations (PPOs) in favor of health maintenance organizations (HMOs)—to curb costs. This may leave many retirees, including those from companies like Merck, without access to their preferred doctors or hospitals. Because provider directories are often outdated, retirees should call medical offices directly to confirm that they remain in-network.

For those who prefer maximum flexibility, pairing Original Medicare with a Medigap (supplemental) plan may be an option. But this path can carry higher monthly premiums and underwriting limitations for those who miss their initial Medigap eligibility window. Once the guaranteed-issue period closes, reapplying later may be difficult or costly.

Prescription Drug Coverage Overhaul

Part D prescription coverage will see the most visible changes. The number of standalone Part D plans is expected to fall from 464 in 2025 to about 360 in 2026. ⁴  Many remaining plans are shifting from fixed copays to percentage-based coinsurance, increasing cost exposure for retirees dependent on high-cost medications. Deductibles are also expected to climb, while out-of-pocket drug costs for covered medications will be capped at $2,100 per year. ⁵  

These changes make it important to use the Medicare.gov Plan Finder to review every medication before enrolling. The tool compares not only monthly premiums but also total annual drug costs. Retirees who make the right selection or use pharmacy discount programs may consequently reduce their drug spending.

Reduced Ancillary Benefits

To sustain margins, many insurers will trim supplemental benefits previously available under Medicare Advantage, such as life insurance, funeral planning expenses, and certain cosmetic surgeries. ⁶  These extras were once heavily promoted but will be scaled back in 2026. Wolf suggests retirees distinguish between “essential” and “nice-to-have” benefits when choosing new coverage.

Broker Compensation and Transparency

Some carriers are reducing or eliminating commissions on certain plan types, which could affect broker recommendations. Retirees should remain vigilant and compare any suggestions against the Medicare Plan Finder. Independent organizations like the Medicare Rights Center or SHIP (State Health Insurance Assistance Program) can provide neutral support in evaluating plan options.

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Policy and Cost Adjustments on the Horizon

Several policy-level updates will shape the 2026 Medicare landscape:

• - The CMS 2026 final rule introduces changes to appeals procedures and standardization requirements.

• - Government payments to Medicare Advantage plans are expected to increase by about 5.06 % in 2026. ⁷

• - Original Medicare will pilot prior authorization in six states—potentially slowing access to some services. ⁸

• - The Part B monthly premium is expected to rise by roughly 11.6 %, from $185 to about $206.50 in 2026. ⁹

• - By 2034, Part B premiums and deductibles could increase by nearly 188% compared to 2025 levels. ¹⁰

• - Small increases are also expected in Part A deductibles and coinsurance, especially for those lacking sufficient work credits.

Practical Steps for Merck Retirees

1. Mark Your Calendar:  Open enrollment runs from October 15 to December 7, 2025, with changes effective January 1, 2026.

2. Review All Notices:  Compare your Annual Notice of Change, Summary of Benefits, and Evidence of Coverage.

3. Compare Total Costs:  Use the Medicare.gov Plan Finder to evaluate full annual costs—not only premiums.

4. Verify Providers:  Call hospitals and doctors' offices to confirm network participation in advance.

5. Reassess Medigap Eligibility:  Understand guaranteed-issue rights and underwriting rules in your state.

6. Cross-Check Broker Advice:  Match broker suggestions against Plan Finder data.

7. Seek Neutral Help:  Reach out to the Medicare Rights Center or SHIP for unbiased assistance.

8. Prepare for Premium Increases:  Budget for rising Part B and IRMAA-related costs.

9. Re-evaluate Prescriptions:  Run simulations of alternate plans under coinsurance vs. copay models.

10. Act Early:  Delaying until December may reduce access to support and limit flexibility.

Conclusion

By 2026, Medicare’s landscape will shift: networks will narrow, perks will diminish, and cost exposure will grow. However, Merck retirees who plan ahead, compare options thoroughly, and seek trusted guidance can still preserve their access to care and manage expenses.

Under upcoming rules, Medicare Advantage providers will need to update CMS with changes to their network directories within 30 days, and confirm directory accuracy annually. Beneficiaries who discover incorrect listings after enrollment may qualify for a Special Enrollment Period to change plans.

Navigating the 2026 Medicare reforms is like steering through changing tides—familiar routes will shift, and preparation is key. With informed choices, Merck retirees can chart a clearer course toward dependable and cost-efficient health care coverage.

Sources:

• 1. Kiplinger. ' Major Insurers Scale Back Medicare Advantage and Part D Plans for 2026 ,' by Donna LeValley. Oct. 7, 2025.

• 2. Modern Healthcare. ' Medicare Advantage plans edge away from supplemental benefits ,' by Nona Tepper. Sep. 25, 2025.

• 3. Fierce Healthcare. “ Stable Premiums, Plan Exits: A Look at the Current State of Medicare Part D ,” by Paige Minemyer. 7 Oct. 2025.
• 4. PhRMA. ' Part D premiums are going up, while choices are going down ,' by Matthew Norawong. Oct. 8, 2025.
• 5. AP News. “ Medicare Part D Prescription Drug Plans Options Are Shrinking. Here’s What to Know ,” by Tom Murphy. 12 Oct. 2025.
• 6. AARP. ' 7 Changes Coming to Medicare in 2026 ,' by Tony Pugh. Oct. 10, 2025.
• 7. Webull. ' Medicare Advantage Rates Expected To Climb Over 5% In 2026, Easing Pressure On Managed Care ,' Benzinga. Apr. 8, 2025.
• 8. Becker's Payer Issues. ' 6 things to know bout the Medicare prior authorization pilot program ,' by Elizabeth Casolo. Oct. 23, 2025.
• 9. AARP. ' Medicare Part B Premium Expected to Top $200 a Month in 2026 ,' by Tony Pugh. Sep. 9, 2025.
• 10. Kiplinger. ' Your Medicare Costs Are Set to Soar: What to Expect Over the Next Decade ,' by Donna LeValley. Oct. 7, 2025.