Changes are coming to Medicare Advantage

Highmark encourages consumers to compare coverage during the Annual Enrollment Period

(October 1, 2025) — The Annual Enrollment Period (AEP) for Medicare coverage in 2026 begins on Wednesday, Oct. 15 and consumers are urged to pay close attention to information about their coverage for next year.

As AEP begins, consumers are likely to see many changes to Medicare Advantage coverage from most insurers, including changes to benefits, prescription drug coverage, member cost-sharing and doctor and hospital networks for many plans.

“Over the last several years, hospitals, physician practices and health insurers have all seen healthcare costs increase significantly,” said Ellen Galardy, Highmark’s President of Medicare Business. “Despite these challenges, Highmark is committed to the Medicare Advantage market and will continue to offer Medicare Advantage plans across our footprint in 2026.”

Galardy added that healthcare costs are rising almost three times faster than other costs for families and individuals, driven by expensive new drugs and increased medical utilization, particularly outpatient care. And according to the Milliman Medical Index, outpatient care and prescription drugs contribute to 69 percent of year-over-year healthcare cost increases for the average person.

Highmark is committed to the Medicare Advantage program now and in the future

Galardy said Highmark is making strategic changes to its Medicare Advantage plans for 2026, with a focus on long-term sustainability. This includes changes to some benefits, provider network alterations, changes to prescription drug coverage, and the availability of some plans in certain markets.

Many of Highmark’s 2026 offerings include popular benefits such as $0 copays for PCP visits, lab tests, and generic prescription drugs; dental, vision and hearing coverage and access to the Silver Sneakers** fitness programs.

Highmark is also introducing new HMO plans  to better manage costs for MA members. Highmark’s existing HMO plans for MA consistently receive high scores in member satisfaction and offer affordable access to a broad network of providers. These plans consistently receive some of the highest Star ratings* in the region from the Centers for Medicare & Medicaid Services (CMS) with high member retention. Additionally, Highmark’s new Complete Blue Distinct HMO in western Pennsylvania offers access to a broad network including AHN, UPMC ,and other local community hospitals**.

Highmark also offers Medigap (Medicare Supplement) Plans. Medigap plans help pay for costs like deductibles and copays that Original Medicare does not cover. For 2026, Highmark will introduce new, low cost Medigap plan options in many areas and offer for the first time a full portfolio of Medicare Supplement offerings in Southeastern Pennsylvania.

Like Original Medicare, Medigap plans usually don't include drug coverage, but beneficiaries can obtain a separate Medicare Part D plan for prescriptions. Highmark Medigap enrollees can also take advantage of plans with Whole Health Balance, a program that provides dental, vision, and hearing coverage as well as access to Silver Sneakers fitness programs.

“With all the changes for Medicare Advantage in 2026, it’s more important than ever to compare coverage options during the Annual Enrollment Period from Oct. 15-Dec. 7,” said Tim Clouse, Vice President of Consumer Markets Sales for Highmark. “Highmark is committed to helping our members navigate these changes when choosing their Medicare Advantage plan to make sure you have the most appropriate coverage for your situation.”

For questions about Medicare or Highmark’s 2026 Medicare plans or to enroll in coverage for 2026, consumers can call a Licensed Medicare Adviser at 1-800-318-1487. Consumers can also visit Medicare.gov or call1-800-MEDICARE (1-800-633-4227) 24 hours a day, 7 days a week to learn about all plan options available in their area. To learn more about Highmark’s 2026 Medicare plans or enroll in coverage online, consumers can click here and enter their zip code.  Or, for a brief survey to help consumers find the Highmark plan that is the best fit, click here.

Highmark Blue Cross Blue Shield and Highmark Blue Shield are Medicare Advantage HMO, PPO, and/or Part D plans with Medicare contracts. Enrollment in these plans depends on contract renewal.

Highmark Blue Cross Blue Shield, which serves western and northeastern Pennsylvania, Delaware, West Virginia and western New York, and Highmark Blue Shield, which serves central and southeastern Pennsylvania and northeastern New York, are independent licensees of the Blue Cross Blue Shield Association. 

SilverSneakers is a registered trademark of Tivity Health, Inc. © 2025 Tivity Health, Inc. All rights reserved. Tivity Health Inc. is a separate company that administers the SilverSneakers program. 

*Every year, Medicare evaluates plans based on a 5-star rating system. 
**Other Providers are available in our network.