Perhaps the biggest news for 2026 is the full implementation of the Inflation Reduction Act (IRA) provisions regarding prescription drugs. This change affects both those on Original Medicare with a stand-alone Part D plan and those with a Medicare Advantage plan. Starting January 1, 2026, the annual out-of-pocket cap for Part D drugs is $2,100. This means once you spend $2,100 on covered prescriptions in a calendar year, you will pay $0 for your covered drugs for the remainder of that year.
Key points to remember about the drug cap:
This change is a major win for seniors with high-cost medications, but it has caused some insurance carriers to adjust their premiums and plan structures to compensate for the higher coverage they are now required to provide.
For many in Eastern North Carolina, Medicare Advantage plans have been the "go-to" choice because of their $0 or low monthly premiums and extra perks like dental and vision. However, 2026 brings some local challenges you need to be aware of before the Annual Enrollment Period begins.
A major point of concern for residents in areas like New Bern, Jacksonville, and Wilmington involves hospital networks. In late 2025, UNC Health notified several major insurance carriers that they would no longer be "in-network" for certain Medicare Advantage plans. This specifically affects some plans from WellCare, Humana, and Cigna. If your favorite doctor or local hospital is part of the UNC Health system, you must verify that they are still in your plan's network for 2026. If they are not, you could face significantly higher out-of-network costs or be forced to find a new provider.
For years, Medicare Advantage plans have competed by offering "flex cards" for groceries or utilities. Due to federal funding changes and the ending of certain value-based care pilots, many experts predict that these "extra" benefits may be scaled back or eliminated in 2026. The gym memberships and over-the-counter allowances that drew you to a plan could look very different next year.
Pros of Medicare Advantage in 2026:
Cons of Medicare Advantage in 2026:
While Medicare Advantage plans are changing rapidly, Medicare Supplement plans in North Carolina offer a sense of stability. These plans work alongside Original Medicare (Part A and Part B) to pay for the "gaps" in coverage, such as coinsurance and deductibles.
With the network issues surrounding UNC Health, many seniors are looking back at Original Medicare + Medigap. Because Medigap plans do not have "networks," you can see any doctor in the United States who accepts Medicare. This includes every major hospital system in North Carolina, including UNC, Duke, and ECU Health. You never have to worry about a prior authorization denying a treatment your doctor recommends.
Pros of Medicare Supplement in 2026:
Cons of Medicare Supplement in 2026:
| Feature | Medicare Supplement (Medigap) | Medicare Advantage (Part C) |
|---|---|---|
| Monthly Premium | Higher (Plan G + Part D) | Often $0 (plus Part B) |
| Network | No networks (see any Medicare doctor) | Strict HMO/PPO networks |
| Out-of-Pocket Max | None (Plan G covers everything after Part B deductible) | Yes (capped at $9,250 or lower in 2026) |
| Drug Coverage | Must buy separate Part D plan | Usually included |
| Extra Benefits | No dental/vision/hearing built-in | Often includes dental, vision, gym |
| Stability | Benefits rarely change year-to-year | Plan benefits, networks, and costs change annually |
| Best For | Frequent travelers, those with chronic conditions, peace of mind | Budget-conscious, relatively healthy individuals |
Choosing the right plan depends entirely on your health, your budget, and how you like to access care.
You might prefer Medicare Advantage if:
You might prefer Medicare Supplement if:
Living in Eastern North Carolina presents unique insurance needs. Whether you are a retired veteran near Camp Lejeune or a beach lover on Topsail Island, your proximity to specific providers matters. For 2026, we are seeing a shift where some "national" Medicare Advantage plans are losing their grip on local providers.
If you live in New Bern or Hampstead, you should pay close attention to the Annual Notice of Change (ANOC) that arrives in your mail every September. This document will list exactly how your specific plan is changing for the following year. Given the UNC Health situation, this is not the year to throw your ANOC in the trash. In Jacksonville, the relationship between Onslow Memorial Hospital and local MA networks is critical for maintaining access to care. In Wilmington, the shift toward Novant Health means seniors previously seeing providers at New Hanover Regional need to check if those arrangements remain in place for their specific 2026 plan. A simple provider lookup online can save you thousands of dollars and a lot of heartache next year. If you are feeling overwhelmed, remember that you don't have to navigate this alone. An independent agency can look at multiple carriers to find the best Medicare supplement plans in North Carolina or the most robust Advantage networks for your specific zip code.
The decisions you make during the upcoming enrollment period will have a direct impact on both your wallet and your access to doctors. The open enrollment period runs from October 15th to December 7th. This is your only chance to switch between Medicare Advantage and Original Medicare (with or without a Medigap plan), or switch from one Advantage plan to another. Missing this window means you are locked into your current choice for the entire 2026 plan year. Here are four steps you should take right now to prepare:
Ready to get a personalized comparison? The "best" plan is the one that gives you peace of mind. At Bartley Insurance Services, we specialize in helping North Carolina seniors navigate these complex changes. Whether you are in Jacksonville, Wilmington, or New Bern, we are here to provide clear, honest advice tailored to your life.
Contact Bartley Insurance Services today to schedule a free 2026 Medicare review.