UnitedHealthcare Updates Medicare Advantage Options for 2026 Amid Rising Costs and Policy Changes

UnitedHealthcare announced its 2026 Medicare Advantage plans, showcasing expanded access, lower out-of-pocket costs and new supplemental benefits designed to help members stay healthy and save money.

The new plans were announced as Medicare faces a number of regulatory and funding shifts, including changes to telehealth coverage and ongoing policy discussions in Congress.

Open enrollment for 2026 Medicare Advantage and Part D plans runs from October 15 through December 7, 2025, giving beneficiaries a window to review coverage options and adjust plans as needed.

UnitedHealthcare said in the announcement that its 2026 offerings preserve access to affordable coverage despite programmatic funding pressures and rising healthcare costs. The company noted there would be $0 premiums for many plans, $0 copays for primary care visits and preventive services and expanded access to dental, vision and hearing benefits—which are not typically covered under traditional Medicare.

Most members will continue to have $0 copays on Tier 1 prescriptions at any network retail pharmacy and Tier 2 prescriptions through home delivery with slightly improved Tier 2 retail copays for most members.

During a July earnings call, UnitedHealth Group executives said rising medical costs and lower-than-expected earnings led the company to exit particular Medicare Advantage plans for 2026 that currently serve 600,000 members, most of them being preferred provider organizations (PPOs).

Bobby Hunter, CEO of UnitedHealthcare Government Programs, shared his input in the recent announcement on what this year's change means for their members.

“We’re modernizing our offerings in response to rising healthcare costs while preserving what matters most to our members,” Hunter said. “From $0 copays to enabling access to high-quality care, we’re helping people live healthier lives with confidence and support.”

UnitedHealthcare also announced they are expanding their HMO, Dual Special Needs Plan (D-SNP) and Chronic Special Needs Plan (C-SNP) options. HMO plans, now available to 92% of eligible beneficiaries, focus on coordinated care through primary care providers while offering cost stability and stronger care management.

D-SNPs, which serve dual-eligible beneficiaries, will include over-the-counter, healthy food and utilities credits, with many members retaining $0 copays for critical prescriptions. C-SNPs offer low out-of-pocket costs and tailored benefits for those with complex health needs, including $0 diabetic supplies and low-cost insulin copays.

These 2026 expansions build on the group’s 2025 efforts to respond to federal policy changes and member needs. Last year, the company adjusted Part D plans under the Inflation Reduction Act (IRA) by adding deductibles on certain tiers while keeping most Tier 1 and Tier 2 copays stable.

UnitedHealthcare also expanded its Dual Special Needs and Chronic Special Needs Plans last year to more states and counties and introduced new plan options such as CareFlex, Essentials and Extras, reinforcing its focus on affordability, chronic care management and tailored coverage.

This year’s plan expansions reflect a much more significant shift in the Medicare market.

Federal policies stemming from the Inflation Reduction Act (IRA), including drug price negotiations and caps on insulin and other high-use medications, are reshaping what beneficiaries can expect from coverage. These changes put pressure on insurers to manage costs while staying attractive to members.

UnitedHealthcare is responding by expanding $0 premium plans, offering supplemental benefits and improving prescription coverage. These efforts were made in order for UnitedHealthcare to remain competitive, keep care affordable for members and maintain engagement in preventive care and chronic condition management.

At the same time, recent guidance from CMS revealed potential changes for telehealth and claims processing in Medicare Fee-for-Service. In another announcement made today, CMS reminded providers that when certain legislative payment provisions are set to expire, Medicare Administrative Contractors can implement temporary claims holds, typically lasting up to ten business days.

This hold, or pause, will stop Medicare from having to redo many claims if Congress makes changes after deadlines pass. Providers can still send in claims, but payments will not go out until the pause is over, CMS noted.

Beginning October 1, 2025, some telehealth rules that were eased during COVID-19 will come back for services other than mental and behavioral health.

These updates include limitations on home-based services and hospice recertifications that require face-to-face encounters. Providers offering telehealth services not covered by Medicare may also need to issue an Advance Beneficiary Notice of Noncoverage and monitor Congressional action for updates.

However, clinicians in certain Medicare Shared Savings Program Accountable Care Organizations (ACOs) can still bill for covered telehealth services no matter where the patient is located.

CMS also shared that Medicare fee-for-service claims processing and payment functions will continue despite the temporary holds, ensuring routine operations remain for most providers.

For beneficiaries, UnitedHealthcare’s 2026 Medicare Advantage updates and new CMS guidance highlight how Medicare is evolving. Plans are being updated to keep care affordable and easy to access as the government changes drug pricing rules and telehealth policies.

With open enrollment approaching in mid-October, Medicare beneficiaries have the opportunity to evaluate their coverage options, consider supplemental benefits and make changes that align with their health needs and budgets.