Got the paperwork and read through it.

A lot of MAJOR REDUCTIONS IN BENEFITS and INCREASES IN REQUIRED PAYMENTS BEFORE THE INSURANCE COMPANY PAYS.

1. Monthly premium is still $0.
2. Maximum IN-NETWORK PART A&B out-of-pocket expenses from $3700 to $6750.
3. Personal care physician (PCP) IN-NETWORK visit $0 (no change).
4. Changes in pharmacies in/out of network. No time to check now. CVS *only*?
5. All co-pays for medical costs increase, amount varies by service.
6. Dental: $750/yr to cover full year dropped to $500/yr for full year. Dentist of your choice as long as a licensed dentist.
7. In-hospital care $355 co-pay/day increased to $550/day (days 1-5) IN-NETWORK.
8. OTC drugs/supplies $75 dropped to $40 per 6 months.
9. Specialist co-pay IN-NETWORK $40 increased to $65 per visit.
10. Eyeglasses/contacts/etc $200/yr dropped to $150/yr.
11. Drug costs. Initial deductible/payment from $495 to $615.
Tier 1 drugs: $0 and $0 (no change = cheapest drugs/generics)
Tier 2 drugs: $15 and $9 ($6 reduction)
Tiers 3-5: Full cost until hit initial deductible.
Drug tiers changed. No time to check now.
Catastrophic Coverage limit is $2100/yr. NOT YOUR OUT-OT-POCKET, but the "cost" based on some figure the insurance company uses. You are NOT told those amounts. After that, $0 co-pay or 5% (doesn't say as it depends on the drug).
Maintenance medications (i.e. variety of drugs taken for long-term conditions) can NOT be ordered for 30-day refills from the insurance company's mail-order pharmacy (CVS) starting in 2026. Must get from a local pharmacy for 30-day refills.

Above is partial summary of cuts to Advantage plans. Will be looking at other companies to see if I can find a better policy with higher dental benefits and other lower costs. One insurer in this market has already dropped ALL Advantage plans for 2026 (posted previously).

US Policy FAQ

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