Medicare Advantage Plans Implement Network Restrictions and Out-of-Pocket Limits for 2026
Medicare Advantage plans are implementing network restrictions and new out-of-pocket limits for 2026. These plans, managed by private companies, utilize restricted networks of doctors, hospitals, and specialists who agree to lower rates. This approach helps reduce monthly premiums and allows for additional benefits like dental, vision, and gym memberships. For 2026, the in-network maximum out-of-pocket (MOOP) limit is set at $9,250, while PPO plans with out-of-network usage can have a combined limit of up to $13,900. New rules also mandate faster and more transparent prior authorization processes, requiring responses within 7 calendar days for standard requests and 72 hours for urgent ones. If a doctor leaves a network mid-year, plans are legally required to provide at least 30 days' notice. Beneficiaries undergoing active, serious treatment may qualify for continuity of care, allowing them to continue seeing their current doctor at in-network prices for up to 90 days. 
