UBCNews - Business - Medicare Is Changing In 2026: Will Your Oklahoma Policy Be Affected?

Episode Date: January 7, 2026

If you're on Medicare in Oklahoma, you're gonna want to hear this. Big changes are coming in 2026, and some of them are hitting our state differently than others. So, what exactly is happening, and how do you make sure you're prepared? Melia Advisory Group City: Tulsa Address: 5424 S Memorial Dr Website: https://www.meliagroup.com/

If you're on Medicare in Oklahoma, you're going to want to hear this. Big changes are coming in 2026, and some of them are hitting our state differently than others. So, what exactly is happening and how do you make sure you're prepared? Great question. Let's start with an Oklahoma-specific change. Starting January 1, 26, Oklahoma will be among the states where certain medical procedures, under traditional Medicare, will require prior authorization. The goal is to curb medical overuse and detect potential fraud. So prior authorization.

That means you might need approval before getting certain treatments, right? Exactly. It adds an extra step for some procedures. Now, beyond that, there are multiple national changes that will impact every Medicare beneficiary, including Oklahomans. The Part D out of pocket cap is increasing to $2,100 in 2026. This is the limit after which your plan pays 100% for cover drugs for the rest of the year. Mm-hmm. That's important.

And the maximum part D deductible is increasing to $615. However, some plans may offer lower deductibles or no deductible. On the flip side, the $35 monthly insulin cap continues. And ASIP recommended vaccines remain covered at zero-cost sharing. That's good news for folks managing diabetes or needing routine vaccines. What about Medicare Advantage plans? Here's where Oklahoma actually sees some positive. positive movement. The average monthly Medicare Advantage premium in Oklahoma dropped from about

$17.48 in 2025 to $13.62 in 2026. Plus, there are now 82 Medicare Advantage plans available in the state up from 73 last year. So more options and lower average premiums. That sounds like good news, though I guess we could joke that comparing 82 different plans sounds like a full-time job. Not right, it can feel overwhelming. And for standalone Part D plans, Oklahoma has 11 options for 2026 with the lowest monthly premium at $0.00. But remember, even if the premium is low, you still need to look at deductibles and coverage details.

Right. You can't just look at one number. Now, what about the parts A and B changes? I know those affect traditional Medicare. The Part A deductible increased to $1,7,336 for 2026, up. from 1676. The Part B deductible went to $283, up from $257. And if you're hospitalized longer, the daily copay for inpatient day $61 through 90 is now $434 a day. Those are pretty significant jumps. Have you ever talked to someone who was caught off guard

by these kinds of increases? Oh, definitely. I remember one retiree who didn't review their plan annually. They ended up with a much higher deductible and were really stressed when they needed care. It's why reviewing your coverage during open enrollment is so critical. Preparation really makes all the difference. That point about open enrollment really sets up our next piece. Understanding your enrollment window. But first, a quick word from our sponsor. Understanding Medicare changes can feel overwhelming, especially with new rules and costs coming in 2026. Serving Tulsa and the surrounding area, we specialize in retirement planning, IRA management, estate planning, and social security analysis.

Our Medicare advisement helps you compare plans, understand your options, and make informed enrollment decisions. We offer free consultations by phone, Zoom, or in-person. Learn more at meliagroup.com. Picking up on that open enrollment window, uh, how do Oklahomans actually prepare for these changes during the current enrollment period? Well, the Medicare Open Enrollment period runs from October 15th to December 7th each year. Any changes you make during that window take effect January 1st. So if you haven't reviewed your plan yet, now's the time. Now's really the time to act.

What should people be looking at specifically? First, compare your current plans, benefits, and costs with what's available for 2026. Look at premiums, deductibles, out-of-pocket maximums, and the drug formulary if you, take prescriptions. Blue Cross and Blue Shield of Oklahoma, for example, offers Medicare Advantage plans in 58 of Oklahoma 77 counties for 2026. So coverage varies by location too. Absolutely. And here's something new. There's a Medicare prescription payment plan, or MPP, available for all beneficiaries with Part D coverage in 2026. This lets you spread out your drug costs over the year instead of paying large sums up front.

I see makes sense. That could really help with budgeting. There are also other national changes people should know about. Medicare will begin negotiating prices for some high-cost prescription drugs in 2026, which should lower costs for those medications. There are also new advanced primary care management benefits available. And for Medicare Advantage, the annual out-of-pocket limit for in-network services dropped slightly to $9,250, down from $9,350.

So to everyone listening, if you're feeling unsure about which plan is right for you, what's the best step to take? Don't hesitate to get help. The Oklahoma Insurance Department offers free, unbiased assistance through its Medicare assistance program, also called SHIP. Trained counselors can walk you through your options. You can reach them at 800-763-2828 or email map at oid.org. That's a valuable resource. I mean, these decisions can feel really complex, especially with all the moving parts. Exactly. And with Oklahoma facing the prior authorization requirement, plus all the national changes,

it's more important than ever to understand your policy. Rising health care costs and recent policy decisions at the federal level are expected to impact Oklahomans making health insurance decisions for 2026. One more thing. I've heard about improved premium tax credit. expiring. Does that affect Medicare? That's more relevant to marketplace plans. Not Medicare directly, but it's part of the broader health care environment in Oklahoma. Those improved premium tax credits, which started during the pandemic, are set to expire at the end of this year, and that could cause premiums to skyrocket for some Oklahomans on marketplace plans. So the health care environment overall is shifting. Bottom line, if you're a Medicare policyholder in Oklahoma,

review your plan during this enrollment period, understand the new costs and requirements, and don't be afraid to ask for help. That's it. Knowledge is power, especially for your health coverage. Have you looked at your Medicare plan options for 2026 yet? If not, the clock is ticking. Thanks for tuning in, and we'll see you next time.