North Carolina Medicare Beneficiaries Face Rising Costs and Plan Complexity in 2026

The 2026 Medicare open enrollment period in North Carolina presents rising costs for beneficiaries, including increases in Medicare Advantage and traditional Medicare premiums, deductibles, and out-of-pocket expenses. The enrollment period, running from October 15 to December 7, is critical for beneficiaries to review plan changes, given that less than 30% nationally actively evaluate their options annually. Traditional Medicare Part B premiums are forecasted to rise nearly 12%, from $185 to $206.50 monthly, with the deductible increasing from $257 to $288. Although Social Security cost-of-living adjustments may offset some increases, retirees will still experience a significant proportion of these hikes impacting their budgets. Medicare Advantage plans, often chosen for their combined coverage convenience and supplemental benefits such as dental and vision, face regulatory changes eliminating mandatory notifications about unused benefits. This lack of standardization can complicate beneficiaries’ understanding of coverage changes, including provider network adjustments and benefit reductions. Notably, network restrictions and insurer-provider contract changes in North Carolina, exemplified by UNC Health's departure from coverage with several Medicare Advantage providers, necessitate plan reviews to ensure continuity of care. Prior authorization requirements and missed appointments contribute to growing provider dissatisfaction with Medicare Advantage plans. Coverage gaps in long-term care facilities and potential surprise costs highlight risks for enrollees with declining health. Additionally, limitations in standalone Medicare Part D drug plans—with fewer options in North Carolina, increased premiums, and a higher annual spending cap—compound financial pressures for seniors, especially those with chronic illnesses requiring multiple medications. Policy changes, including those from the One Big Beautiful Bill Act, alter dual-eligibility criteria and remove eligibility for some immigrant populations, impacting future Medicare enrollment patterns. Assistance from North Carolina’s SHIIP program is recommended to navigate the complex landscape of Medicare options. Switching back to traditional Medicare from Medicare Advantage poses challenges due to Medigap plan enrollment penalties and acceptance issues. As healthcare costs rise and plan complexities increase, beneficiaries are advised to thoroughly review their Medicare coverage annually, ensuring network providers and drug formularies align with their health needs and financial circumstances.