Written By

Greg Wohl

Licensed Medicare Specialist

Every October, Medicare sends enrollees an Annual Notice of Change (ANOC) detailing how their plan is changing for the upcoming year. Most people set it aside without reading it. That is a costly mistake.

For 2026, Medicare Advantage plans across Florida have made significant changes to premiums, out-of-pocket limits, drug formularies, provider networks, and extra benefits. Some plans have exited markets entirely, leaving enrollees who do not act defaulted back to Original Medicare.

This guide covers the most important changes affecting Florida Medicare Advantage enrollees in 2026 and what you should do before the Annual Enrollment Period (AEP) closes on December 7.

Key Takeaways

The out-of-pocket maximum increased to $9,350: CMS raised the maximum allowed out-of-pocket limit for in-network services to $9,350 in 2026, up from prior years. Many plans set their limits at or near this cap, increasing financial exposure for heavy users.
Several carriers reduced or eliminated extra benefits: Dental, vision, OTC allowances, and fitness benefits were reduced or eliminated by multiple carriers in 2026 as plans adjusted to tighter margins under new CMS payment rules.
Part D out-of-pocket cap is $2,100 in 2026: A major positive change: the Inflation Reduction Act capped annual out-of-pocket drug costs for Medicare Part D, with the cap rising to $2,100 in 2026 (up from $2,000 in 2025). This is a significant benefit for people with high drug costs.
Some plans exited Florida markets: Several Medicare Advantage plans discontinued coverage in specific Florida counties for 2026. Affected enrollees received notice and must actively choose a new plan or they will be defaulted to Original Medicare.
Network changes may affect your doctors: Provider networks are renegotiated annually. Even if your plan is continuing, your doctors may have been dropped from the network. Verify your providers are still in-network for 2026.
AEP runs October 15 through December 7: The Annual Enrollment Period is your main window to review and change your Medicare Advantage or Part D plan. Coverage changes take effect January 1.

The $2,100 Part D Out-of-Pocket Cap in 2026: A Major Win

One of the most significant positive changes in 2026 is the $2,100 annual out-of-pocket cap for Medicare Part D drug costs, introduced by the Inflation Reduction Act (up from $2,000 in 2025).

Before this cap was introduced, there was no limit on what Medicare beneficiaries could spend on prescription drugs in a year. People with expensive specialty medications could face tens of thousands of dollars in annual drug costs.

Now, once you have spent $2,100 out of pocket on covered drugs in a calendar year, your cost-sharing drops to $0 for the rest of the year. This applies whether you have a standalone Part D plan or a Medicare Advantage plan that includes drug coverage.

What this means for Florida enrollees:

If you take expensive specialty drugs, your maximum annual drug cost is now $2,100 regardless of the drug's list price
The Medicare Prescription Payment Plan (M3P) allows you to spread your drug costs across monthly installments throughout the year rather than paying large amounts early in the year
Extra Help (Low Income Subsidy) recipients have even lower caps

This change is particularly significant for Florida seniors with cancer, diabetes, rheumatoid arthritis, or other conditions requiring high-cost specialty medications.

Extra Benefits: What Was Cut and What Remains

Extra benefits have been one of the main selling points of Medicare Advantage plans for years. In 2026, many carriers pulled back on these benefits in response to tighter CMS payment rates and higher medical cost trends.

Benefits commonly reduced or eliminated in 2026:

Over-the-counter (OTC) allowances: Many plans reduced quarterly OTC allowances from $100-$150 to $50-$75, or eliminated them entirely for certain plan tiers.
Dental coverage: Some plans reduced comprehensive dental benefits (crowns, dentures) while maintaining preventive-only coverage. Maximum annual dental benefits were reduced on several plans.
Transportation benefits: Non-emergency medical transportation trips were reduced on several plans.
Meal delivery: Post-hospitalization meal delivery benefits were cut on some plans.

Benefits that generally remained stable or improved:

Vision: Most plans maintained annual eye exam and eyewear allowances.
Hearing: Hearing aid benefits remained on most plans, though allowance amounts varied.
Fitness: SilverSneakers and similar fitness programs remained on most Humana and UnitedHealthcare plans.
Telehealth: Telehealth benefits expanded on most plans following pandemic-era adoption.

The key takeaway is that you cannot assume prior-year benefits carried over to 2026. Review your Annual Notice of Change carefully and compare your current plan against alternatives during AEP.

Out-of-Pocket Maximums: What Changed

CMS raised the maximum allowed out-of-pocket limit for Medicare Advantage in-network services to $9,350 in 2026. This is the ceiling, not the floor. Individual plans set their own limits at or below this cap.

The concern for 2026 is that many plans moved their out-of-pocket maximums higher, closer to the $9,350 ceiling. A plan that had a lower out-of-pocket maximum in prior years may now have a $6,500 or $7,500 maximum in 2026.

This matters most if you have significant healthcare needs. Consider this comparison:

Scenario	Plan A (Low OOP Max)	Plan B (High OOP Max)
Monthly premium	$45/month	$0/month
In-network OOP max	$3,500	$8,500
Annual premium cost	$540	$0
Worst-case annual cost	$4,040	$8,500

For someone who stays healthy, Plan B saves $540/year. For someone who has a serious illness or hospitalization, Plan A saves up to $4,460. The right choice depends on your health history and risk tolerance.

See our guide to the best Medicare Advantage plans in Florida for a full breakdown of current plan options.

Plan Exits and Network Changes in Florida

Several Medicare Advantage carriers reduced their Florida footprint for 2026, exiting specific counties or discontinuing certain plan types. If your plan was discontinued, you should have received a notice from your insurer.

If your plan was discontinued:

You have a Special Enrollment Period (SEP) to enroll in a new plan
If you do not actively choose a new plan, you may be defaulted to Original Medicare (Parts A and B only) without drug coverage
Act promptly to avoid a gap in coverage or late enrollment penalties

Network changes even when your plan continues: Provider networks are renegotiated each year. Even if your plan is continuing in 2026, your primary care physician, specialists, or preferred hospital may have been removed from the network. Before assuming your coverage is unchanged:

Call your doctors' offices and confirm they are in-network for your specific plan in 2026
Check the insurer's online provider directory, but also verify by phone as directories can lag behind actual network changes
If key providers are no longer in-network, compare alternative plans during AEP

Our advisors can run a network check for your specific doctors across all plans available in your county. Schedule a free consultation to get a personalized comparison.

What to Do Before AEP Closes

The Annual Enrollment Period runs from October 15 through December 7. Changes take effect January 1. Here is your action checklist:

Read your Annual Notice of Change (ANOC): This document, mailed in late September, details every change to your plan for the coming year. Review it carefully, especially the sections on premiums, out-of-pocket limits, drug formulary, and extra benefits.
Update your drug list: If your medications changed during the year, update your list and run a new comparison on Medicare Plan Finder (medicare.gov/plan-compare) to see if a different plan covers your drugs more affordably.
Verify your providers: Confirm your doctors and preferred hospitals are still in-network for 2026 under your current plan.
Compare alternatives: Even if your plan seems fine, it takes only 15 to 20 minutes to compare it against other plans in your area. You may find a plan with better benefits or lower costs.
Act before December 7: Do not wait until the last week. Processing times and high call volumes near the deadline can cause delays.

For a full overview of your plan options, see our guide to the best Medicare plans for seniors.

Key 2026 Medicare Advantage Changes at a Glance

Here is a quick summary of the most important 2026 changes for Florida Medicare Advantage enrollees:

Part D $2,100 out-of-pocket cap in 2026 — a major benefit for anyone with high drug costs (up from $2,000 in 2025)
In-network OOP maximum raised to $9,350 — many plans moved their limits higher; compare carefully
Extra benefits reduced on many plans — OTC allowances, dental, and transportation were cut by multiple carriers
Some plans exited Florida counties — if your plan was discontinued, act immediately to avoid defaulting to Original Medicare
Provider networks changed — verify your doctors are still in-network before assuming your coverage is unchanged

Do not let the AEP deadline pass without reviewing your plan. Schedule a free consultation with our licensed specialists for a personalized plan comparison.