What’s Changing in Medicare Advantage for 2026: What SW Ohio Residents Need to Know

The 2026 Medicare Advantage landscape is shaping up to be one of the most significant transition years in recent memory. From carrier exits to contract negotiations with major hospital systems, it’s crucial for beneficiaries — and their brokers — to review coverage carefully before the Annual Enrollment Period (AEP) ends.

Here’s a breakdown of the most important changes affecting Ohio’s Medicare Advantage members in 2026.

1. Hospital System Negotiations Could Impact Your Network

Several major health systems and insurance carriers are in contract negotiations that could affect where members receive care:

- TriHealth and UnitedHealthcare are currently in talks that may impact in-network status for 2026.
- Mercy Health and Humana are also negotiating their contract renewal, which could affect member access starting January 1, 2026.

If you currently see doctors or specialists affiliated with either TriHealth or Mercy Health, double-check your plan’s provider directory before making next year’s enrollment decision.

2. Anthem Drops SilverSneakers

Anthem will no longer offer SilverSneakers fitness benefits with its Medicare Advantage plans beginning in 2026.

3. Medical Mutual of Ohio Exiting Several Counties

One of Ohio’s longest-standing carriers, Medical Mutual of Ohio, is exiting the market in several counties for 2026.

Members affected by this change will receive a non-renewal notice and should compare their options early to ensure uninterrupted coverage.

4. MyCare Ohio Members (Medicare & Medicaid): Review Your New 2026 Plan Options

For dual-eligible individuals enrolled in MyCare Ohio (Medicare + Medicaid), the Ohio Department of Medicaid has launched the Next Generation MyCare Program.

The first rollout affects 29 counties, including several in Southwest Ohio — Butler, Clark, Clermont, Clinton, Greene, Hamilton, Madison, Montgomery, and Warren Counties.

This rollout means members in these counties will have new plan options and updated care coordination teams beginning January 1, 2026. It’s critical to review plan assignments, confirm that preferred providers and pharmacies are still included, and ensure that long-term services remain uninterrupted.

5. Prescription Drug Formularies and Tiers Are Changing

Many carriers have restructured their drug formularies and tier systems for 2026.
What was a Tier 2 preferred brand in 2025 might now fall under Tier 3, leading to higher copays. Review your Annual Notice of Change (ANOC) or speak with your agent to make sure your medications remain affordable next year.

6. UnitedHealthcare Adds Referral Requirements

In 2026, most UnitedHealthcare Medicare Advantage plans will now require referrals to see specialists.

That means members will need a referral from their primary care provider before scheduling specialist visits — a major change for anyone used to open-access HMO or PPO structures.

7. New Qualifications for Grocery, Utility, and Flex Allowances

Many carriers are refining eligibility for supplemental benefits such as grocery cards, utilities assistance, and over-the-counter (OTC) allowances.

In 2026, some of these benefits are only available to members with qualifying chronic conditions (such as diabetes, congestive heart failure, or COPD).

Review the “Special Supplemental Benefits for the Chronically Ill” section in your plan summary to confirm eligibility.

The Bottom Line

Medicare Advantage continues to evolve, and 2026 brings meaningful shifts in networks, benefits, and plan availability.
Before the Annual Enrollment Period ends, take time to:

✅ Review your ANOC letter for plan changes.
✅ Confirm your doctors and hospitals remain in-network.
✅ Verify your drug coverage and copays.
✅ Check if your plan includes the benefits that matter most — and whether you qualify for them.