2026 Medicare Changes: What Hampton Roads Residents Need to Know

If you're on Medicare in the Hampton Roads area, 2026 brings significant changes that will affect both your costs and coverage options. While some changes will benefit certain seniors, others will face higher expenses – and it's crucial to understand how these changes affect YOUR specific situation.

As your local Medicare broker serving Norfolk, Chesapeake, and Virginia Beach, I've been analyzing these changes to help my clients prepare. Here's what you need to know and what actions you should take.

The Big Picture: What's Driving These Changes

These changes continue the implementation of the Biden Administration’s Inflation Reduction Act of 2022, which aimed to make prescription drugs more affordable for seniors while also addressing rising healthcare costs. However, insurance companies are adjusting their plans in various ways to manage these new requirements and you may be impacted.

The Bottom Line: Some seniors will benefit from new protections, while others will pay more for basic coverage. Everyone needs to review their Medicare options during the 2025 Open Enrollment Period (October 15 - December 7, 2025).

Change #1: Significant Premium Increases for Medicare Part B

What's Changing: Medicare Part B premiums are expected to rise 11.6% in 2026 to $206.50 monthly, up $21.50 from 2025. This represents nearly double the 6% increase we saw in 2025.

What This Means for Hampton Roads Residents:

• Most Medicare recipients will see this premium automatically deducted from their Social Security checks

• The Part B deductible is projected to increase to $208.00

• This affects everyone with Medicare Part B, regardless of whether you have Original Medicare or Medicare Advantage

Action Required: Budget for these higher costs when planning your 2026 healthcare expenses. If you're on a tight budget, this makes finding the right supplemental coverage even more important.

Change #2: Higher Prescription Drug Deductibles and Caps

What's Changing: The Medicare Part D prescription drug deductible is increasing to $615 in 2026, up from $590 in 2025. However, the annual out-of-pocket prescription drug cap will be $2,100 in 2026, up from $2,000 in 2025.

What This Means for Local Residents:

• You'll pay more upfront before your prescription coverage kicks in

• If you take expensive medications, the slightly higher cap still provides significant protection

• The cap applies to all Medicare Part D plans, whether standalone or part of Medicare Advantage

Why This Matters: If you currently spend more than $2,100 per year on prescriptions, this cap will save you money. However, if you take only generic medications, the higher deductible might increase your costs.

Change #3: Medicare Prescription Payment Plan Becomes Automatic

What's Changing: Beginning in 2026, if you participate in the Medicare Prescription Payment Plan (MPPP), you will be automatically re-enrolled the following year unless you opt out.

What This Means: If you've been using the payment plan to spread your prescription costs over 12 months instead of paying large amounts upfront, you won't need to re-enroll each year.

Action for Hampton Roads Residents: If you haven't used this payment plan but struggle with high prescription costs, consider enrolling. It can help manage cash flow by spreading annual drug costs into monthly payments.

Change #4: Medicare Advantage Plans May Cut Extra Benefits

What's Changing: Some Medicare Advantage plans may begin trimming their extra benefits, such as dental and transportation options, to save money and offset increases elsewhere.

What I'm Seeing Locally:

• Some plans are reducing dental coverage or increasing copays for dental services

• Transportation benefits may become more limited

• Gym membership and wellness benefits could be scaled back on some plans

Critical Action: Don't assume your current Medicare Advantage plan will offer the same extra benefits in 2026. Review your Annual Notice of Change carefully when it arrives.

Change #5: New Star Rating Measures Affect Plan Quality

What's Changing: Medicare will update how it scores plans with new measures, including a kidney health evaluation for people with diabetes, and the return of physical and mental health maintenance measures.

What This Means for Local Residents:

• Plans with better Star Ratings often offer more benefits or lower costs

• Changes in ratings could affect which plans are available in our area

• Some plans may focus more on preventive care to improve their ratings

Change #6: Continued Network and Formulary Changes

What's Changing: Insurance companies regularly update their provider and pharmacy networks for the new year, and 2026 will be no exception.

What I'm Seeing in Hampton Roads:

• Some Medicare Advantage plans may change their relationships with local hospitals

• Pharmacy networks continue to evolve, which could affect where you can fill prescriptions

• Specialist networks may be adjusted

• The Plans have reduced the ability of Brokers to serve the Medicare community in favor of the Medicaid community.

Action Required: Verify that your preferred doctors in Norfolk, Chesapeake, or Virginia Beach are still in-network with your plan for 2026. This is especially important if you have ongoing relationships with specialists.

Special Considerations for Hampton Roads Residents

Local Hospital Networks: Changes to plan networks could affect your access to Sentara, Bon Secours, or other local hospital systems. Make sure your preferred facilities are covered.

Pharmacy Access: With pharmacy chains continuing to evolve, verify that your neighborhood pharmacy is still in your plan's network.

Specialist Access: Hampton Roads has excellent specialists, but availability varies by plan. If you see specialists regularly, confirm they're covered before making plan changes.

What You Should Do Right Now

Step 1: Review Your Current Plan's 2026 Changes Your insurance company will send you an Annual Notice of Change explaining how your specific plan is changing for 2026.

Step 2: Calculate Your Total Costs for 2026 Don't just look at premiums – add up premiums, deductibles, and expected prescription costs to get your true annual cost.

Step 3: Compare Your Options During Open Enrollment October 15 - December 7, 2025 is your opportunity to change plans if your current plan no longer meets your needs.

Step 4: Verify Provider and Pharmacy Networks Make sure your doctors, hospitals, and pharmacy are still covered by any plan you're considering.

How I Help Hampton Roads Residents Navigate These Changes

As your local Medicare broker, I'm monitoring all these changes and how they specifically affect plans available in our area. Here's how I can help:

• Personalized Analysis: I'll review your specific medications, doctors, and health needs to determine how 2026 changes affect you personally

• Plan Comparisons: I'll show you all available options and calculate your real-world costs for each plan

• Local Knowledge: I understand which plans work best with Hampton Roads healthcare providers

• Ongoing Support: I'll help you navigate any issues that arise after enrollment

Don't Let These Changes Catch You Off Guard

Medicare changes can be confusing, but they don't have to be overwhelming. With proper planning and local expertise, you can navigate these changes and find the best possible coverage for your needs and budget.

Call Retha Rish Insurance Agency at 757-692-8388 or 757-213-6910 to schedule your 2026 Medicare review.

The deadline for Medicare Open Enrollment is December 7, 2025. Don't wait until the last minute to review your options – call today to ensure you have the best possible coverage for 2026.