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Medicare Advantage OEP 2026: What Beneficiaries Need to Know

As in previos years, the Medicare Advantage OEP 2026 runs from January 1 to March 31, giving Medicare beneficiaries a valuable second chance to fine-tune their health coverage. While the Annual Enrollment Period (AEP) in the fall gets the most attention, OEP is just as important; especially with the growing number of changes expected in Medicare Advantage benefits, Star Ratings, utilization management, and supplemental offerings in 2026.

Here’s an overview of what OEP is, how it works, and why 2026 may be an especially important year to review plan choices.

What Is the Medicare Advantage OEP

The Medicare Advantage OEP is a once-per-year enrollment window designed specifically for people already enrolled in a Medicare Advantage plan. It allows beneficiaries to:

• Switch to a different Medicare Advantage plan (with or without drug coverage)
• Drop Medicare Advantage and return to Original Medicare
• Enroll in a stand-alone Part D prescription drug plan if switching back to Original Medicare

However, OEP does not allow someone on Original Medicare to join a Medicare Advantage plan. It is strictly for current MA members who want to make a change.

Why OEP Matters in 2026

Medicare Advantage plans are expected to see continued adjustments in 2026, including:

More Care Management Controls

Many carriers are tightening prior authorization, utilization management, and cost-sharing rules. Some beneficiaries may find their 2026 MA plan more restrictive than expected once the new year begins.

Shifts in Supplemental Benefits

Non-medical extras like dental, vision, hearing, transportation, and OTC allowances are being closely reviewed by CMS. Some plans reduced benefits for 2026 to balance rising medical costs.

Watch a quick video on the differences between Medicare Advantage vs Medicare Supplements

Star Rating Modifications

With CMS proposing changes to the Star Ratings program, some plans entered 2026 with lower ratings than previous years. Lower ratings can mean reduced rebates, resulting in trimmed benefits or higher out-of-pocket costs for members.

Provider Network Adjustments

Every year brings hospital and physician network changes. Beneficiaries often don’t notice these changes until January, making OEP their opportunity to switch to a plan with more compatible providers.

With these shifts, OEP 2026 will be especially important for those who discover their new coverage doesn’t meet their expectations.

Who Should Consider Making a Change

A Medicare Advantage member may want to explore options during OEP if:

• Their plan dropped key doctors or specialists for 2026
• Prescription costs or formularies changed
• Supplemental benefits were reduced or removed
• Prior authorization requirements increased
• Their total out-of-pocket costs are higher than anticipated
• They enrolled in a new plan during AEP but are experiencing “buyer’s remorse”

Even a small change; like a different tier placement for a medication can significantly impact annual healthcare expenses.

How to Review Medicare Advantage Options During OEP

During OEP, beneficiaries should:

1. Review their 2026 Evidence of Coverage (EOC) to understand changes.
2. Compare local plan alternatives, focusing on doctors, drug coverage, and copays.
3. Check Star Ratings, but also evaluate real-world factors like provider access.
4. Consider switching back to Original Medicare if they prefer provider flexibility; though Medigap underwriting rules may apply depending on the state.

Working with a licensed Medicare agent is the quickest way to compare plans side-by-side and avoid unexpected coverage gaps.

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The Medicare Advantage Open Enrollment Period is a valuable opportunity for beneficiaries to correct course after the new plan year begins. With ongoing regulatory changes and shifting benefits in 2026, OEP gives Medicare members the flexibility to ensure their plan still aligns with their healthcare needs, budget, and preferred providers.

Whether it’s a minor adjustment or a full switch, the OEP helps ensure beneficiaries start the rest of 2026 with confidence in their coverage.

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Proposed Medicare Advantage Changes 2027

The Centers for Medicare & Medicaid Services (CMS) recently released a proposed rule for the 2027 contract year that could reshape Medicare Advantage (MA) and Part D prescription drug coverage. The agency aims to “strengthen quality, improve access, and modernize benefits” while reducing administrative burdens on plans.

Here’s what beneficiaries, providers, and policymakers need to know.

Star Ratings Overhaul

CMS proposes removing 12 Star Rating measures that are largely administrative or show little variation between plans. The focus will shift to meaningful metrics, including clinical outcomes, preventive care, and patient experience.

• New focus on outcomes: Plans will be evaluated more on health results than paperwork.
• Mental health measure: CMS plans to introduce a “Depression Screening and Follow-Up” measure for future cycles.
• Health equity bonuses paused: The previously planned “Excellent Health Outcomes for All” bonus is postponed, though CMS invites feedback on equity initiatives.

Impact: Beneficiaries may find it easier to identify high-quality plans, while insurers may redirect resources toward improving actual care.

Enrollment Flexibility

The proposed rule adds a new Special Enrollment Period (SEP) for beneficiaries whose providers leave a plan’s network. This allows mid-year plan changes without waiting for the regular enrollment window. CMS also codifies other existing SEP policies, making the system more consistent.

Impact: This change ensures continuity of care for people with chronic conditions or preferred providers.

Watch a video on the discontinued Medicare advantage plan special enrollment period

Part D and Drug Coverage Updates

The rule formalizes Part D reforms started under prior legislation, including:

• Eliminating the coverage gap (donut hole) phase.
• Maintaining reduced out-of-pocket thresholds.
• Removing cost-sharing in the catastrophic phase.
• Adjusting how True Out-of-Pocket (TrOOP) costs are calculated.

Impact: Beneficiaries gain more predictable and affordable prescription drug coverage.

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Reducing Administrative Burden

CMS proposes measures to reduce paperwork and regulatory complexity, such as:

• Exempting certain account-based plans from creditable coverage disclosures.
• Lifting requirements for mid-year notices about unused supplemental benefits.
• Removing some health-equity reporting mandates for plans.

Impact: Plans may operate more efficiently, but some transparency and oversight could be reduced.

Why It Matters

1. Patient-focused quality: More emphasis on outcomes and experience could improve care.
2. Drug cost protection: Part D reforms continue to protect beneficiaries from high out-of-pocket expenses.
3. Flexible enrollment: The new SEP enhances access to care when providers leave networks.
4. Efficiency vs. oversight: Streamlined administration may improve plan operations but reduce some accountability.
5. Future reform: CMS is constantly making changes to improve MA plans, and stakeholders have the chance to provide input.

CMS’s 2027 proposed rule could bring meaningful improvements for beneficiaries while easing administrative burdens for insurers. The Star Ratings overhaul, enrollment flexibility, and Part D updates are poised to enhance care and reduce costs. However, reduced oversight and postponed equity initiatives highlight areas to watch as the public-comment process unfolds.

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CMS Proposes Star Ratings Change for Medicare Advantage & Part D Plans

Federal regulators are moving to revamp the Medicare Advantage Star Ratings program, signaling a shift in how insurers’ performance is measured and rewarded. The Centers for Medicare and Medicaid Services CMS Proposes Star Ratings Change; they issued a draft regulation, opening the door for public input on potential changes to Medicare Advantage policies, risk adjustment, and even the Medicare Part D prescription drug program.

The proposed overhaul comes as insurers face mounting pressure from prior authorization requirements, audits, and marketing restrictions. By streamlining the Star Ratings system, CMS may offer plans some relief while keeping the focus on high-quality patient care.

Watch a YouTube video on the discontinued Medicare Advantage special enrollment period

What’s Changing in Star Ratings

The Star Ratings program has significant financial implications for insurers. CMS awards Medicare Advantage and Part D plans that score at least four stars with a 5% payment bonus. Under the draft rule, the agency proposes removing a dozen measures that focus on operational performance or administrative processes rather than clinical outcomes.

Of the changes, eight measures would affect only Medicare Advantage plans, two would apply only to Part D, and two would apply to both programs. Examples include removing metrics tied to appeal decision timeliness, customer service, and members’ decisions to leave a plan. CMS notes that these measures “don’t sufficiently convey variations in quality among plans.” Most of the changes would take effect for the 2029 plan year.

Health Equity Index Eliminated

CMS also proposes ending its Health Equity Index, a 2024 initiative that rewarded plans for improving care for marginalized populations. Instead, the agency would continue the existing reward factor that incentivizes high performance across measures.

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New Focus on Clinical Care

The draft regulation highlights CMS’s intent to refocus Star Ratings on meaningful clinical outcomes. For example, the agency plans to add a depression screening follow-up measure to Medicare Advantage, reflecting an emphasis on behavioral health.

“These proposed changes aim to refocus the program on clinical care, outcomes and patient experience where there is meaningful variation in performance across contracts,” CMS said in a news release.

What This Means for Insurers and Beneficiaries

Insurers could benefit from a simpler Star Ratings system, with less emphasis on administrative metrics. For beneficiaries, the changes signal a stronger focus on health outcomes and patient experience rather than operational benchmarks. The public now has a chance to weigh in on the proposals before CMS finalizes the rule.

Agents, stay up-to-date on the our latest webinars an agent events.

Medicare Advantage Compensation Loss – State Regulators Push Back

The tension between state insurance regulators and Medicare Advantage (MA) carriers is reaching a new level. As insurers continue tightening their budgets and limiting new enrollment; often by cutting commissions to brokers and restricting access to online applications. Some state officials are challenging what they view as unfair and potentially unlawful practices when it comes to Medicare advantage compensation loss.

With the 2026 Medicare Annual Enrollment Period (AEP) already underway, this conflict could shape the future of how MA plans are marketed, sold, and regulated.

Why Carriers Are Reducing Broker Compensation

Financial pressures have been building within Medicare Advantage for several years. Rising utilization costs, increased regulatory scrutiny, and shrinking federal reimbursement have pushed Medicare insurers to prioritize profit stability over rapid membership growth.

As part of this shift, some carriers have:

• Eliminated or reduced commissions on specific plans
• Limited access to agent-facing online enrollment platforms
• Discouraged new enrollments that could attract higher-cost members

The carriers intend to use these measures to control risk and protect margins. Although for brokers and agents, the fallout is immediate; lost income, lowered client expectations, and fewer ways to serve Medicare beneficiaries effectively.

Watch a YouTube video on SEPs for discontinued Medicare advantage plans

States Begin to Challenge Commission Cuts

Insurance commissioners in Delaware, Idaho, Montana, Oklahoma, New Hampshire, and North Dakota have taken a firm stance: cutting or withholding commissions to reduce Medicare Advantage enrollment crosses the line into unfair trade practices.

Some regulators have directly warned carriers to stop using marketing tactics that restrict enrollment or disadvantage third-party marketers. Others have gone further:

• Idaho issued cease-and-desist orders against UnitedHealthcare and PacificSource for allegedly violating state insurance standards.
• Additional states have threatened penalties, sanctions, or legal action if insurers refuse to restore fair broker compensation.

State officials argue that if MA plans are sold within their borders, insurers must comply with state marketing and sales laws regardless of the program’s federal oversight.

The Stakes Are High for Both Sides

This conflict puts both insurers and brokers; and ultimately beneficiaries, in a difficult position.

For insurers, compliance with state demands could trigger:

• Tighter pricing
• Fewer $0 premium plans
• Potential consideration of market exits

As one industry expert noted, when carriers feel they cannot adjust compensation or enrollment strategy to manage risk, they may be more likely to scale back or leave smaller markets.

However, carriers also have strong incentives not to leave states completely. If an insurer exits a Medicare Advantage market, it is barred from re-entering for years. This could present a long-term setback few companies want to face.

For brokers, reduced compensation means:

• Inconsistent or unpredictable payment
• Competing against carriers that restrict access to enrollment platforms
• Difficulty supporting clients when carriers remove commissions after applications are already submitted

Marketing groups emphasized that commissions are built into plan pricing and actuarial calculations. In other words; carriers planned for these costs long before selling the product.

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Legal and Regulatory Questions

A key unresolved issue is whether state regulators have the authority to intervene in the sales and marketing of a federal healthcare program like Medicare Advantage.

Many legal experts believe states have more power than carriers acknowledge. They regulate:

• Agent licensing
• Marketing conduct
• Fair business practices within state borders

Some policy analysts argue that states may actually hold more leverage than CMS in enforcing sales and marketing standards; especially when unfair business practices affect consumers or licensed agents.

Idaho’s insurance director has signaled that the state expects legal challenges and is prepared to defend its position. This includes efforts to force insurers to retroactively pay withheld commissions.

On the other hand, insurers may counter-sue states, arguing that Medicare’s federal structure preempts state authority.

Where This Leaves Brokers and Beneficiaries

As this dispute unfolds, brokers remain stuck in the middle. They must comply with evolving state rules while navigating restrictive carrier policies. At the same time, beneficiaries risk losing access to the knowledgeable agents they rely on to explain coverage options, especially in rural or underserved markets.

Let’s Sum it all up

• Medicare Advantage carriers are reducing or eliminating broker commissions to limit new enrollment and protect margins.
• Insurance regulators in at least six states are challenging these tactics and threatening enforcement actions.
• If insurers restore full commissions, they risk enrolling higher-cost or unprofitable members, creating financial strain.
• The question of whether states can regulate MA sales and marketing remains unresolved, setting up likely court battles.

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UnitedHealthcare UCard Benefits 2026

UnitedHealthcare continues to innovate member experience for Medicare Advantage enrollees, and the 2026 UCard remains a standout feature. More than an ID card, the UCard is designed to simplify access to multiple plan benefits, making it easier for members to stay healthy, shop for everyday essentials, and manage their care in one place.

What Is the UCard

The UnitedHealthcare UCard combines functions that traditionally required multiple cards or portals. For eligible 2026 plans, it may serve as:

• Your medical ID card for doctor visits and to fill prescriptions at your local pharmacy
• An over-the-counter (OTC) benefit card
• A healthy food and grocery card (on select plans)
• Access your gym membership
• A rewards and incentive card
• A payment tool for certain utilities and transportation on qualifying plans

By integrating benefits, UnitedHealthcare aims to reduce confusion and help members use the services available to them more easily.

Accessing Your UCard Benefits

Members can check their UCard balance and benefits in a few convenient ways:

• UnitedHealthcare UCard Hub – Log in to view balances, track reward earnings, and see eligible spending categories.
• UHC Mobile App – Scan products, check approved retailers, and track benefit usage in real time.
• UCard Customer Support Line – Speak with a representative for help activating or understanding benefits. Members will find the customer support number on the back of their UCard.

Members can also review benefit details in their plan documents or contact a licensed Medicare agent for assistance.

Watch a YouTube video on the Discontinued Medicare Advantage Plan Special Enrollment Period

Where Can Members Use the UCard

UCard spending benefits can be used at thousands of participating retail and online locations. Depending on the plan and benefit type, members may access approved products and services at:

• Major supermarket chains
• National pharmacy chains
• Big-box retailers
• Convenience and dollar stores
• Local participating grocers
• Online retailers that partner with UHC

At checkout, members simply swipe the card like a debit card for qualified purchases. Items not covered will need a separate form of payment. For select plans offering utility or transportation assistance, members may use funds through approved vendors or billing arrangements.

Why the UCard Matters

The UCard simplifies Medicare Advantage benefits by eliminating multiple cards and making it easier for members to actually use what they’re entitled to. This system supports better health outcomes, encourages preventive care, and adds everyday convenience.

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Using Medicare Advantage Trial Rights: What Beneficiaries Need to Know

Choosing Medicare coverage is a major decision. For some beneficiaries, enrolling in a Medicare Advantage (MA) plan feels like a smart move comprehensive benefits, low or $0 premiums, and added perks like dental, vision, and fitness programs. But what happens if you try Medicare Advantage and realize it’s not the right fit? That’s where using Medicare Advantage Trial Rights can be a valuable safety net.

Medicare built specific protections that allow certain beneficiaries to “test” a Medicare Advantage plan without being locked in forever. Understanding these rights can give you confidence when making your coverage decision.

What Are Medicare Advantage Trial Rights

Medicare Advantage Trial Rights are special protections that allow eligible beneficiaries to switch back to Original Medicare (Part A and Part B) and purchase a Medigap (Medicare Supplement) plan if they decide MA isn’t working for them. These rights prevent beneficiaries from being denied Medigap coverage or charged more due to health conditions during this trial period.

Who Qualifies for Medicare Advantage Trial Rights

You may qualify if:

1. You are new to Medicare and you first enrolled in a Medicare Advantage plan.
If you joined an MA plan when you first became eligible for Medicare at age 65, you have a 12–month trial period. If you decide within that year that MA is not for you, you can switch back to Original Medicare and have Medigap guaranteed issue rights.

2. You dropped a Medigap plan to enroll in Medicare Advantage for the first time.
If you previously had a Medigap plan and switched to an MA plan for the first time, you again have 12 months to change your mind. If you return to Original Medicare, you have the right to get the same Medigap plan you had before (if it’s still available) or a comparable plan.

Watch a YouTube video – Medicare Advantage vs. Medicare Supplements

Why Trial Rights Matter

Trial rights offer peace of mind. Medicare Advantage plans work well for many people, but provider networks, prior authorization rules, and cost-sharing structures may not suit everyone. Trial rights allow beneficiaries to explore coverage options without long-term risk.

For example, someone who values nationwide access to doctors or has upcoming health procedures might discover that Original Medicare plus Medigap better suits their needs. With trial rights, they can make the switch confidently.

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How to Use Your Trial Rights

If you decide to switch back from Medicare Advantage to Original Medicare:

Contact Medicare or your plan to disenroll
Apply for a Medigap plan, citing your trial right
Choose a standalone Part D prescription drug plan (PDP) if needed

Timing is key; make sure you act within your 12-month window to secure guaranteed Medigap eligibility.

Medicare Advantage can be a great choice, but it’s not one-size-fits-all. Medicare Advantage Trial Rights give beneficiaries a valuable opportunity to try MA coverage with a safety net. If you’re unsure which route is best, speak with a licensed Medicare professional who can help evaluate your health needs, budget, and coverage preferences.

Understanding your rights empowers you to make confident, informed decisions about your Medicare journey.

Agents, stay up-to-date on the our latest webinars an agent events.

Deductibles and Other Medical Costs: What They Mean for Your Healthcare Budget

Healthcare terms can feel confusing, especially when it comes to how much you’ll actually pay for medical services. One of the most important pieces to understand when choosing insurance, or reviewing your current coverage, are deductibles and other medical costs.

These costs directly impact what you spend before your insurance steps in and how much you’re responsible for throughout the year. Understanding them helps you plan better, compare plans accurately, and avoid unexpected medical bills.

What Is a Deductible

A deductible is the amount you must pay for covered healthcare services before your insurance begins to share the costs.

For example, if your deductible is $2,500, you pay the first $2,500 of covered medical expenses yourself. After you meet your deductible, your insurance typically starts paying a portion of costs (often through coinsurance).

Think of the deductible as your first layer of financial responsibility in your insurance plan.

What Are Out-of-Pocket Costs

Out-of-pocket costs are expenses you’re responsible for when receiving care. They may include:

• Deductibles
• Copayments (fixed dollar amounts per service)
• Coinsurance (a percentage of the cost of services)
• Non-covered services

When comparing plans, look not only at the deductible but also the overall cost-sharing structure. A low-deductible plan may have higher premiums but lower out-of-pocket expenses when you receive care and vice versa.

Understanding the Out-of-Pocket Maximum

Most health insurance plans also include an out-of-pocket maximum (OOPM). This is the most you’ll pay in a policy year for covered services. Once you reach that limit, your insurance covers 100% of eligible expenses for the remainder of the year.

This limit is an important financial safeguard, especially for individuals with chronic conditions or unexpected medical events.

Watch a Video on Medicare IRMAA & Part B SEP Rules

Why Your Deductible and OOP Spending Matter

Knowing your deductible and out-of-pocket maximum helps you:

• Budget healthcare expenses
• Select a plan that fits your needs
• Avoid surprises when receiving care
• Plan ahead for prescriptions, specialists, or procedures
• Understand how preventive services are covered (This is key; many preventive services are covered before deductible!)

Tips for Choosing the Right Plan

When evaluating health plans, consider:

• How often you visit doctors
• Whether you take ongoing prescriptions
• Expected medical needs (e.g., planned surgery, therapies)
• Monthly premium cost versus potential annual expenses
• Your comfort level with risk and unexpected bills

People who expect regular medical care may benefit from lower deductibles and higher premiums. Those who rarely seek care may prefer a lower-premium, higher-deductible option.

Deductibles and out-of-pocket costs aren’t just insurance jargon; they are vital components of your financial health plan. Understanding them helps you to make smarter decisions and choose coverage that protects both your health and your wallet.

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If you ever feel uncertain about comparing plans or estimating potential costs, don’t hesitate to ask questions. Being informed is the first step to confident healthcare decisions. That is why working with a licensed insurance agent is so important.

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HMO POS Medicare Plans: Flexibility Within a Network

There are many types of Medicare advantage plans to choose from; including HMO POS Medicare plans mentioned. HMO POS stands for Health Maintenance Organization–Point of Service. While it sounds complicated, the carriers designed these plans to provide a balance between affordability and flexibility.

Let’s break down what that means and how it might benefit Medicare beneficiaries.

What Is an HMO-POS Plan

An HMO-POS Medicare Advantage plan is a type of Medicare Advantage (Part C) plan that combines the cost-saving structure of a traditional HMO with some of the flexibility of a PPO (Preferred Provider Organization).

Like a standard HMO, members typically have a primary care physician (PCP) who coordinates their care. They also provides referrals for specialists within the plan’s network. However, the “POS” or Point of Service, feature lets members seek care outside the network in certain situations, though often at a higher cost.

How It Works

Here’s how an HMO-POS plan typically operates:

• In-Network Care: You’ll get the highest level of coverage when you use doctors, hospitals, and specialists within the plan’s network.
• Out-of-Network Care: You may be able to see an out-of-network provider, but you’ll usually pay more for those services.
• Referrals: In most cases, beneficiaries need a referral from their primary care doctor for specialist visits; even if they’re going out-of-network.
• Cost-Sharing: Costs for out-of-network care are higher and may include additional copays or coinsurance, depending on the service.

This design gives members the ability to stay within a coordinated network for predictable costs while maintaining the option to go outside the network if they need extra flexibility.

Watch a video on the Discontinued Medicare Advantage Plan Special Enrollment Period

Benefits of an HMO-POS Plan

• Lower Premiums: Many HMO-POS plans offer competitive premiums compared to PPO plans.
• Coordinated Care: Having a primary care provider manage your overall care helps ensure treatments and prescriptions work together effectively.
• Flexibility for Travel or Specialists: Members who occasionally need to see an out-of-network specialist or receive care while traveling appreciate the added flexibility.

Things to Consider

While HMO-POS plans offer more freedom than a traditional HMO, it’s still important to review the plan’s rules and costs:

• Out-of-network care is not always covered for every type of service.
• You’ll need to confirm what types of care the POS option allows outside the network.
• Costs can add up if you frequently go out-of-network. These plans are best for those who primarily stay within one area but want a flexibility.

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Is an HMO-POS Medicare Plan Right for You?

If you value affordable premiums and coordinated care but want the option to seek care outside your plan’s network, an HMO-POS Medicare Advantage plan may be a great fit. It offers the best of both worlds — structure when you want it, and flexibility when you need it.

Before enrolling, compare the provider networks, out-of-network rules, and total costs to make sure the plan meets your healthcare needs and lifestyle.

Agents, stay up-to-date on the our latest webinars an agent events.

HMO-POS Medicare Advantage plans give beneficiaries a smart blend of structure and freedom; ideal for those who want reliable care coordination with the occasional option to step outside the network.

Medicare SSBCI vs. VBID: What’s the Difference

Two major innovations in the Medicare Advantage (MA) program; special supplemental benefits for the chronically Ill (SSBCI) and the Value-Based Insurance Design (VBID) Model, both aim to improve outcomes for beneficiaries with chronic conditions. However, they differ in purpose, eligibility, benefits, and future outlook. Here’s what you should know about Medicare SSBCI vs VBID and how they compare.

What Is SSBCI

The Special Supplemental Benefits for the Chronically Ill (SSBCI) program was created under the Bipartisan Budget Act of 2018. It allows Medicare Advantage plans to offer non-traditional, non-medical benefits designed to help people with serious chronic illnesses maintain or improve their health and daily function.

To qualify, a beneficiary must:

1. Have one or more complex chronic conditions,
2. Be at high risk of hospitalization or other negative outcomes, and
3. Require intensive care coordination.

Unlike standard Medicare benefits, SSBCI may cover services such as healthy groceries, home air-quality equipment, pest control, transportation, or home modifications. These benefits address social factors that affect health, such as nutrition, housing, and access to care.

Watch a YouTube video on the prescription payment program

SSBCI benefits are optional, meaning not every MA plan offers them. Plans also decide what types of benefits to include and who qualifies. CMS is increasing oversight to ensure these benefits are supported by evidence showing they can improve or maintain a member’s health or function.

SSBCI represents a shift in Medicare Advantage toward whole-person care; addressing more than just medical needs.

What Is VBID?

The Value-Based Insurance Design (VBID) Model, launched by the CMS Innovation Center, allowed participating Medicare Advantage plans to align cost-sharing and benefits with the clinical value of care. The goal was to lower barriers to high-value care (like preventive services or chronic disease management) while discouraging unnecessary spending.

VBID gave participating plans flexibility to reduce copays, expand supplemental benefits, and even test hospice care integration within MA. These features often targeted individuals with chronic illnesses, low income, or those living in underserved areas.

However, VBID was a demonstration model, not a permanent part of Medicare. In 2025, CMS announced it will end the VBID Model after determining that program costs to Medicare were higher than anticipated. While the model is ending, many of its design ideas; like targeted cost-sharing and flexible benefits, are expected to influence future MA benefit structures.

SSBCI vs. VBID: A Quick Comparison

Why It Matters

Both programs reflect a growing focus on integrated, person-centered care in Medicare Advantage.

• For beneficiaries: SSBCI can provide meaningful extra help for daily living and health support, but eligibility rules apply. Not everyone in an MA plan will qualify.
• For VBID participants: The model’s end may change how some plan benefits are structured in 2026, but many innovations are expected to remain.
• For all MA enrollees: When comparing plans, look beyond premiums and copays. Review whether a plan offers SSBCI or other supplemental benefits that fit your personal needs.

Always review your plan’s Summary of Benefits and Evidence of Coverage to see if SSBCI options are available, and confirm your eligibility with the plan.

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SSBCI and VBID have both pushed Medicare Advantage toward smarter, more holistic care. While VBID will conclude in 2025, SSBCI continues to grow; helping address many factors that shape health outcomes. Together, they represent Medicare’s evolving goal: not just to pay for medical care, but to help beneficiaries live healthier, more independent lives.

Humana Medicare 2026 OTC Benefits: How to Use and Access Them

Many Humana Medicare Advantage (Part C) plans include an over-the-counter (OTC) allowance to help members save on everyday health items. Fortunately, Humana Medicare 2026 OTC benefits provides members more ways to maintain their health while managing out-of-pocket costs.

What the OTC Benefit Covers

Humana’s OTC benefit allows members to buy non-prescription health and wellness products at no cost, up to a set allowance. Covered items typically include:

• Pain relievers and cold medicines
• Vitamins and supplements
• Dental care items like toothbrushes and toothpaste
• First-aid and wound-care supplies
• Digestive aids and bladder-control products

Depending on the plan, members may receive a monthly or quarterly allowance to spend. Some plans offer rollover options, while others require that unused funds be used within the benefit period.

Watch a YouTube video on Medicare Advantage vs Medicare Supplements

How to Access Your OTC Benefit

1. Confirm Eligibility – Log into your MyHumana account or review your Summary of Benefits to confirm your plan includes an OTC allowance. You can also call the Member Services number on your Humana ID card.
2. Know Your Allowance – Find out how much you receive and how often it renews. Available benefits vary by plan and region.
3. Shop for Eligible Items – You can use your OTC funds in several ways:
   • Humana Spending Account Card – Many plans load your allowance onto a prepaid card you can use at participating retailers.
   • Mail Order or Online Catalog – Some plans require ordering through CenterWell Pharmacy’s OTC catalog or online store.
4. Use It Before It Expires – Most allowances expire at the end of each benefit period or at year-end. Check your balance often to avoid losing unused funds.

Tips to Maximize the Benefit

• Review Plan Changes Annually: OTC benefits and amounts can change each year. Always read your Annual Notice of Change (ANOC) each fall.
• Shop Early and Smart: If mail order is required, place orders early to allow for shipping time.
• Combine Benefits: Some Humana plans that include Healthy Options or grocery allowances encourage clients to take advantage of all available extras.
• Keep Receipts: If questions arise, documentation helps confirm eligible purchases.
• Ask for Help: Members can contact Humana Member Services or their licensed agent for guidance.

Why This Benefit Matters

Humana’s OTC benefit helps reduce the cost of everyday health items, adding value to Medicare Advantage coverage. For 2026, these allowances highlight Humana’s focus on affordability and wellness. When clients understand and use these benefits fully, they save money, improve their health, and feel more satisfied with their plan.

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