What Retirees Need to Know About Existing Plans
When it comes to Medicare Advantage (MA), the costs you’ll face in 2026 aren’t just about premiums — they include deductibles and the Maximum Out-of-Pocket (MOOP) limit. A new review of plans that already existed in 2025 and are continuing into 2026 shows that many beneficiaries will see noticeable cost shifts. That means it’s more important than ever to compare options before locking in coverage.
Why This Matters
These numbers are not for new offerings—they are based on existing plans. If you’re already enrolled in one of these plans, you may see higher costs next year even though you haven’t changed coverage. That’s why the Annual Enrollment Period (October 15 – December 7, 2025) is critical: retirees should shop around, compare costs, and make sure their plan still works for both their health needs and their budget.
Key Findings by Plan Type
Health Maintenance Organization (HMO)
- National average cost rose from $5,833 in 2025 → $6,112 in 2026 (+5.7%).
- Some states saw dramatic swings, such as Connecticut (+47%) while D.C. dropped (-22%).
Breakdown per State:
| Existing PPO Plan Change from 2025 to 2026 | |||||||
| State | 2025 Total Cost | 2026 Total Cost | Change | State | 2025 Total Cost | 2026 Total Cost | Change |
| AL | $6,875 | $7,078 | 2.95% | FL | $3,701 | $4,048 | 9.39% |
| AR | $5,797 | $6,093 | 5.11% | GA | $7,025 | $7,150 | 1.79% |
| AZ | $4,582 | $4,646 | 1.39% | HI | $7,245 | $8,138 | 12.33% |
| CA | $2,979 | $3,212 | 7.81% | IA | $4,814 | $5,147 | 6.91% |
| CO | $4,999 | $5,741 | 14.84% | ID | $6,150 | $6,891 | 12.05% |
| CT | $4,900 | $7,200 | 46.94% | IL | $3,996 | $4,417 | 10.52% |
| D.C. | $5,500 | $4,250 | -22.73% | IN | $4,594 | $5,334 | 16.10% |
| DE | $6,587 | $7,511 | 14.02% | KS | $6,572 | $6,474 | -1.49% |
| State | 2025 Total Cost | 2026 Total Cost | Change | State | 2025 Total Cost | 2026 Total Cost | Change |
| KY | $5,341 | $5,201 | -2.61% | MO | $5,289 | $5,224 | -1.24% |
| LA | $5,201 | $5,089 | -2.15% | MT | $6,400 | $6,531 | 2.05% |
| MA | $5,534 | $5,953 | 7.56% | NE | $4,495 | $4,733 | 5.28% |
| MD | $9,637 | $8,975 | -6.88% | NH | $6,490 | $7,179 | 10.62% |
| ME | $8,504 | $7,734 | -9.05% | NJ | $8,902 | $7,496 | -15.79% |
| MI | $4,795 | $5,409 | 12.82% | NM | $4,094 | $4,407 | 7.63% |
| MN | $5,153 | $5,905 | 14.59% | NV | $2,669 | $2,677 | 0.29% |
| MS | $6,165 | $6,596 | 6.98% | NY | $9,390 | $9,748 | 3.82% |
| State | 2025 Total Cost | 2026 Total Cost | Change | State | 2025 Total Cost | 2026 Total Cost | Change |
| NC | $5,267 | $5,660 | 7.46% | TX | $4,836 | $5,104 | 5.54% |
| OH | $5,495 | $5,744 | 4.54% | UT | $5,625 | $5,856 | 4.11% |
| OK | $4,772 | $5,369 | 12.51% | VA | $7,983 | $7,553 | -5.38% |
| OR | $6,567 | $6,965 | 6.06% | WA | $5,966 | $6,182 | 3.62% |
| PA | $6,249 | $6,772 | 8.36% | WI | $5,131 | $6,034 | 17.61% |
| SC | $7,334 | $7,444 | 1.50% | WV | $6,946 | $8,218 | 18.31% |
| TN | $5,929 | $5,959 | 0.50% | ||||
| National Avg | $5,833 | $6,112 | 5.70% | ||
Preferred Provider Organization (PPO)
- The biggest increases overall: from $6,725 → $7,298 (+9.2%).
- Many states had double-digit hikes, including Iowa (+23%) and Florida (+20%).
Breakdown per State:
| Existing PPO Plan Change from 2025 to 2026 | |||||||
| State | 2025 Total Cost | 2026 Total Cost | Change | State | 2025 Total Cost | 2026 Total Cost | Change |
| AK | $7,347 | $7,726 | 5.17% | GA | $8,609 | $9,309 | 8.13% |
| AL | $7,157 | $7,486 | 4.60% | HI | $6,971 | $7,624 | 9.37% |
| AZ | $6,231 | $6,708 | 7.65% | IA | $4,869 | $6,005 | 23.32% |
| CA | $5,616 | $6,490 | 15.56% | ID | $7,152 | $7,838 | 9.59% |
| CO | $6,276 | $6,732 | 7.27% | IL | $5,916 | $6,393 | 8.07% |
| CT | $7,027 | $7,751 | 10.31% | IN | $6,633 | $6,714 | 1.23% |
| D.C. | $7,636 | $7,907 | 3.55% | KS | $5,195 | $6,016 | 15.81% |
| DE | $8,175 | $8,341 | 2.02% | KY | $7,090 | $7,278 | 2.64% |
| FL | $5,887 | $7,081 | 20.28% | LA | $7,199 | $7,523 | 4.50% |
| State | 2025 Total Cost | 2026 Total Cost | Change | State | 2025 Total Cost | 2026 Total Cost | Change |
| MA | $6,054 | $6,701 | 10.68% | NC | $6,849 | $7,208 | 5.24% |
| MD | $8,473 | $8,566 | 1.09% | ND | $5,592 | $6,759 | 20.87% |
| ME | $7,068 | $8,088 | 14.43% | NH | $6,947 | $8,022 | 15.47% |
| MI | $5,999 | $6,275 | 4.59% | NJ | $8,874 | $9,481 | 6.84% |
| MI | $7,445 | $7,972 | 7.08% | NM | $5,942 | $6,587 | 10.85% |
| MN | $5,484 | $6,519 | 18.88% | NV | $6,357 | $6,599 | 3.81% |
| MO | $5,255 | $6,143 | 16.90% | NY | $9,093 | $9,814 | 7.93% |
| MT | $6,687 | $7,585 | 13.43% | OH | $6,714 | $6,992 | 4.14% |
| NE | $5,092 | $6,047 | 18.76% | OK | $6,248 | $6,887 | 10.22% |
| State | 2025 Total Cost | 2026 Total Cost | Change | State | 2025 Total Cost | 2026 Total Cost | Change |
| OR | $6,605 | $7,434 | 12.54% | UT | $6,415 | $6,987 | 8.91% |
| PA | $7,355 | $7,629 | 3.72% | VA | $8,220 | $8,314 | 1.14% |
| RI | $6,589 | $6,855 | 4.03% | VT | $5,595 | $6,895 | 23.24% |
| SC | $7,781 | $8,478 | 8.95% | WA | $7,708 | $8,000 | 3.79% |
| SD | $4,497 | $5,326 | 18.44% | WI | $5,591 | $6,115 | 9.37% |
| TN | $6,022 | $6,313 | 4.83% | WV | $7,648 | $8,013 | 4.77% |
| TX | $7,293 | $7,520 | 3.11% | WY | $7,784 | $7,855 | 0.91% |
| National Avg | $6,725 | $7,298 | 9.16% | ||
HMO-POS (Point of Service)
- Costs climbed the fastest on average: $5,774 → $6,405 (+11.6%).
- Minnesota and New Mexico each saw 30–45% jumps.
Breakdown per State:
| Existing HMO-POS Plan Changes from 2025 to 2026 | |||||||
| State | 2025 Total Cost | 2026 Total Cost | Change | State | 2025 Total Cost | 2026 Total Cost | Change |
| AL | $5,761 | $6,653 | 15.48% | FL | $4,351 | $4,765 | 9.52% |
| AR | $6,889 | $7,490 | 8.72% | GA | $7,231 | $8,347 | 15.43% |
| AZ | $4,298 | $4,774 | 11.07% | IA | $4,613 | $5,795 | 25.62% |
| CA | $3,036 | $3,341 | 10.07% | ID | $6,073 | $7,282 | 19.90% |
| CO | $4,558 | $5,457 | 19.73% | IL | $4,497 | $5,248 | 16.69% |
| CT | $7,337 | $7,718 | 5.20% | IN | $5,724 | $5,890 | 2.90% |
| DC | $7,361 | $7,916 | 7.54% | KS | $4,616 | $5,146 | 11.48% |
| DE | $6,330 | $6,478 | 2.33% | KY | $5,730 | $6,432 | 12.25% |
| State | 2025 Total Cost | 2026 Total Cost | Change | State | 2025 Total Cost | 2026 Total Cost | Change |
| LA | $5,322 | $5,832 | 9.60% | MT | $5,944 | $5,980 | 0.61% |
| MA | $5,908 | $6,676 | 13.00% | NC | $6,744 | $7,195 | 6.68% |
| MD | $6,284 | $6,826 | 8.62% | NE | $5,855 | $6,925 | 18.27% |
| ME | $7,015 | $8,310 | 18.47% | NH | $7,000 | $7,250 | 3.57% |
| MI | $5,427 | $5,946 | 9.57% | NJ | $7,860 | $8,510 | 8.27% |
| MN | $5,090 | $7,365 | 44.70% | NM | $4,800 | $6,500 | 35.42% |
| MO | $4,236 | $4,863 | 14.79% | NV | $2,224 | $2,407 | 8.23% |
| MS | $6,274 | $6,728 | 7.24% | NY | $8,114 | $8,937 | 10.13% |
| State | 2025 Total Cost | 2026 Total Cost | Change | State | 2025 Total Cost | 2026 Total Cost | Change |
| OH | $5,352 | $5,898 | 10.20% | TX | $5,710 | $6,051 | 5.98% |
| OK | $5,007 | $5,377 | 7.38% | UT | $5,706 | $6,125 | 7.34% |
| OR | $5,565 | $6,393 | 14.89% | VA | $5,699 | $6,648 | 16.66% |
| PA | $6,747 | $6,975 | 3.39% | WA | $6,061 | $6,413 | 5.81% |
| RI | $5,517 | $6,161 | 11.68% | WI | $5,422 | $5,817 | 7.28% |
| SC | $6,316 | $6,857 | 8.56% | WV | $8,800 | $8,300 | -5.68% |
| TN | $5,410 | $6,231 | 15.17% | ||||
| National Avg | $5,774 | $6,405 | 11.55% | ||
Private Fee-for-Service (PFFS)
- Still the most expensive baseline, but more stable: $7,385 → $7,520 (+1.9%).
- Increases were smaller, though states like Texas (+8.5%) saw notable rises.
Breakdown per State:
| State | 2025 Total Cost | 2026 Total Cost | Change | State | 2025 Total Cost | 2026 Total Cost | Change |
| Arkansas | $8,646 | $8,851 | 2.37% | Kentucky | $7,460 | $7,715 | 3.42% |
| Georgia | $7,040 | $7,639 | 8.51% | Michigan | $8,046 | $7,859 | -2.32% |
| Illinois | $8,046 | $7,859 | -2.32% | Missouri | $8,046 | $7,859 | -2.32% |
| Indiana | $4,726 | $4,694 | -0.68% | Montana | $8,113 | $8,288 | 2.16% |
| Iowa | $8,046 | $7,859 | -2.32% | New York | $4,762 | $5,077 | 6.61% |
| Kansas | $8,113 | $8,288 | 2.16% | North Carolina | $8,116 | $8,249 | 1.64% |
| State | 2025 Total Cost | 2026 Total Cost | Change | State | 2025 Total Cost | 2026 Total Cost | Change |
| Ohio | $4,726 | $4,694 | -0.68% | Virginia | $7,859 | $7,772 | -1.11% |
| Oklahoma | $8,046 | $7,859 | -2.32% | West Virginia | $7,460 | $7,715 | 3.42% |
| Pennsylvania | $7,460 | $7,715 | 3.42% | Wisconsin | $8,046 | $7,859 | -2.32% |
| South Carolina | $7,040 | $7,639 | 8.51% | Wyoming | $8,179 | $8,716 | 6.57% |
| Texas | $7,106 | $7,713 | 8.54% | ||||
| National Avg | $7,385 | $7,520 | 1.95% | ||
What This Means for You
Even if you stay in the same plan, you may face hundreds of dollars in extra costs next year. Since most retirees are on fixed incomes, shifts in premiums, deductibles, and MOOP can dramatically affect affordability.
➡️ Bottom line: Don’t assume your 2025 plan will be the best choice in 2026. Use the Annual Enrollment Period to review all your options and shop for coverage that balances both cost and care.
Go shopping
Dan McGrath
The Integrity Life Brokerage
📞 617-894-8043 (text preferred)
✉️ dan@theintegritylb.com
