Every fall, Medicare beneficiaries can review and change their Prescription Drug Plan or Medicare Advantage Plan during the Open Enrollment Period (OEP) from October 15 to December 7. With this year’s OEP underway, thousands of Iowans are turning to Medicare and SHIIP-SMP for help navigating options with major plan changes expected in 2026.
Medicare Prescription Drug Plan and Medicare Advantage Plan costs, benefits, covered prescriptions and provider networks can change each year. Following the 2025 cap on prescription drug copayments and new price negotiations on 10 high-cost sole-source drugs starting in 2026, many plans are adjusting their benefits and coverage options.
Some of the biggest changes that Medicare beneficiaries in Iowa should look out for this OEP:
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Medicare Advantage Plan Cancellations: UnitedHealthcare and Wellmark have significantly reduced the number of plans offered. UnitedHealthcare is canceling 8 of their 10 AARP Medicare Advantage plans in Iowa, and Wellmark is canceling 3 of 4 Medicare Advantage plans in Iowa with drug coverage. The UHC changes alone are estimated to impact 36,494 enrollees in canceled plans who will be left without healthcare coverage unless they enroll in a new plan beginning January 1st. (see list below)
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Medicare Advantage Service Area Reductions: Additionally, 22 other Medicare Advantage plans have reduced their service area coverage. If a member’s current plan is no longer available in their county, they would be without coverage starting January 1st if they do not enroll in an alternative option. (see list below)
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Provider Network Changes: Providers can change their contracts with Medicare Advantage plans to be in-network, out-of-network or to not accept plan coverage entirely. Several large providers are limiting the Medicare Advantage plans they accept, making it increasingly important to confirm provider networks for the upcoming year.
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Negotiated Drug Prices: Lower costs have been negotiated for Eloquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, and Novolog/Fiasp. Unlike the $35 cap on insulins, the cost for these drugs will vary by plan – but beneficiaries should see significantly lower prices compared to last year.
Kristin Griffith, Director of the Iowa Insurance Division’s Senior Health Insurance Information Program (SHIIP) and Senior Medicare Patrol (SMP), wants to remind beneficiaries about Guaranteed Issue Rights. “Anyone with a plan that has been canceled or is no longer offered in their county has a right to either switch to another Medicare Advantage plan or return to Original Medicare and purchase a Medicare Supplement without going through health underwriting, being denied or charged a higher premium. This is called a ‘guaranteed issue’ opportunity and is only available until February 28, 2026.” However, beneficiaries should still strive to make changes before the end of this year to ensure continuity of coverage starting January 1st.
It is time individuals on Medicare to read all mail from their plan or provider and stay informed of possible changes. Medicare beneficiaries receive an Annual Notice of Change (ANOC) each September from their Prescription Drug Plan or Medicare Advantage Plan. This is a summary of any changes in the plan that will take effect on January 1 of the next year (i.e. premium cost, coverage, copays, and service area). If a Medicare beneficiary receives notice in their ANOC that their plan has been canceled or is no longer offered in their zip code, that letter is the proof required to secure the guaranteed issue right to enroll in a Medicare Supplement.
If a Medicare beneficiary is happy with current coverage after reviewing plan changes and options for the year ahead, no action is necessary during Open Enrollment. They will automatically be re-enrolled for the following year if their Part D or Medicare Advantage plan has not been canceled. However, it is smart to always compare the current plan to other options available for the year ahead.
“Navigating the Open Enrollment Period can seem daunting, but you don’t have to do it alone,” said Griffith. “We have well-trained and certified SHIIP-SMP counselors across the state equipped to help you with this process. The SHIIP-SMP program has a track record of saving Iowans money and helping with Medicare questions and problems.”
Local resources are available to help compare plan options- but appointments are filling up quickly. The Senior Health Insurance Information Program (SHIIP) and Senior Medicare Patrol (SMP) provide free, confidential, and unbiased one-on-one Medicare counseling through the Iowa Insurance Division with the support of federal funding. SHIIP-SMP can be reached by calling 1-800-351-4664. In 2024, the program served more than 52,000 Medicare beneficiaries and saved clients in Iowa tens of millions of dollars.
2026 plan details can be found at: Medicare.gov/plan-compare. Through the Medicare.gov Plan Finder, Medicare beneficiaries can see and compare plan options available in 2026. Once all Iowa SHIIP/ SMP counselor appointments are full, you can still get assistance from Medicare service representatives. Medicare service representatives are available 24/7 to provide support at 1-800-MEDICARE (1-800-633-4227).
Guidance on how to compare your own plans or how to find a SHIIP-SMP counselor for an appointment can be found on the SHIIP-SMP website (www.shiip.iowa.gov):
