Spark is releasing a feature that flags clients affected by major plan disruptions heading into the new year. This resource explains the different changes they may experience, talking points, and outreach templates for contacts flagged for specific disruptions.
High-Level Annual Medicare Plan Disruptions
What it is
Each year, Medicare Advantage and Part D plans update their provider networks, drug formularies, and benefits. These updates are required by CMS and take effect January 1 of the following year.
How beneficiaries are affected
Their doctor, specialist, or hospital may no longer be in network.
Prescriptions may change in cost, move to higher tiers, or be removed from the formulary.
Supplemental benefits like dental, vision, hearing, or over-the-counter allowances may be reduced or eliminated.In some cases, entire plans exit the market, requiring a new plan selection.
These changes often increase out-of-pocket costs or reduce coverage compared to the previous year.
How the Medicare agent can help
Proactively review your beneficiary’s current plan to identify any disruptions for the upcoming year.
Compare available plans during the Annual Enrollment Period (AEP) to ensure coverage still matches their healthcare needs.
Help them select and enroll in a plan that balances costs, provider access, prescription coverage, and benefits.
Provide guidance to avoid gaps in care or unexpected expenses in the new year.
Plan Disruption Talk Track
Each year, Medicare Advantage and Part D plans make updates — to their networks, prescription drug coverage, and benefits. Even if you’re happy with your current plan, it may not look the same next year. Doctors can leave the network, prescriptions can cost more, and benefits like dental or vision can change. In some cases, plans even exit the market.
The good news is that the Annual Enrollment Period, from October 15 through December 7, gives us the opportunity to review your plan and compare it against other options in your area. My role is to help you make sure you’re not surprised by higher costs or lost benefits in 2026. Let’s schedule a time to review your plan together and make sure you’re fully covered for the year ahead.
Plan Exit
In addition to this information, Spark offers an automated plan exit retention campaign in the platform that will reach out to your contacts affected by plan exits in the new year.
What it is
The beneficiary’s current Medicare Advantage plan will not be offered in the upcoming year.
How the beneficiary is affected
Their current coverage will end on December 31. If they don’t actively choose a new plan, they will typically be returned to Original Medicare (Parts A & B) and may need to select a standalone Part D plan for prescription drug coverage.
How the Medicare agent can help
Explain the exit process, ensure they don’t experience a gap in coverage, and guide them in selecting a new Medicare Advantage or other plan that best fits their needs for 2026.
Outreach Template
Hi [Client First Name],
I’m reaching out to let you know that your current Medicare plan, [plan name], is exiting the market in 2026. If you don’t choose a new plan, you will automatically return to Original Medicare (Parts A & B) and may be placed into a standalone Part D drug plan.
The Annual Enrollment Period (AEP), which runs from October 15 – December 7, is the best time to:
Review your coverage options in light of this plan exit.
Compare new Medicare Advantage plans available in your area.
Enroll in a plan that ensures you continue to have the doctors, prescriptions, and benefits you need in 2026.
Let’s schedule a time to review your options together before the deadline. Reply to this email or call me at [Your Phone Number].
Sincerely,
[Your Name]
Crosswalk
What it is
A “crosswalk” happens when a Medicare Advantage plan is discontinued, but the carrier automatically enrolls beneficiaries into a new plan from their portfolio for the next year. Unlike a full plan exit, beneficiaries are not returned to Original Medicare — instead, they are mapped (“crosswalked”) into another plan.
How the beneficiary is affected
Their plan ID and benefits will change starting January 1. Premiums, copays, networks, and drug coverage under the new plan may be different — sometimes better, sometimes worse. Beneficiaries may not realize their coverage has changed unless they review the Annual Notice of Change (ANOC).
How the Medicare agent can help
Review the new “crosswalked” plan side by side with the old plan to identify any differences in benefits, costs, or provider access. Help the client decide whether to stay with the crosswalked plan or switch to another plan during AEP. Ensure beneficiaries understand this is an automatic change, but they have the right to compare plans and select the one that’s best for them.
Outreach Template
Hi [Client First Name],
I wanted to let you know about an important change to your Medicare plan for 2026. Your current Medicare plan, [plan name], will not be available next year, and your insurance carrier, [carrier name], will automatically enroll you into a new plan within their portfolio. This process is called a crosswalk.
While this ensures you won’t lose coverage, the new plan may have different premiums, provider networks, prescription coverage, or benefits compared to your current plan.
The Annual Enrollment Period (October 15 – December 7) is the best time to:
Review your insurance coverage needs heading into the new year.
Review the details of the crosswalk plan.
Compare it with other available Medicare Advantage plans in your area.
Here’s what you need to do next:
Schedule time on my calendar so we can talk through your plan options. The sooner we can meet, the better! Use this link [replace with your Scheduling Link].
Best regards,
[Your Name]
PCP Out of Network
What it is
Your Primary Care Physician (PCP) is no longer included in the plan’s provider network.
How the beneficiary is affected
They may not be able to continue seeing their current doctor without higher out-of-pocket costs.
How the Medicare agent can help
Review in-network provider options, or compare alternative plans that include their current PCP.
Outreach Template
Hi [Client First Name],
I’m reaching out to let you know that your current Medicare plan, [plan name], has made changes to their provider network heading into 2026. With this change, your Primary Care Physician (PCP) may no longer be in-network with your plan starting January 1, 2026.
This could affect your ability to continue seeing your current doctor without higher costs. The Annual Enrollment Period (AEP), which runs from October 15 – December 7, is the best time to:
Review how these changes affect your healthcare.
Explore new plan options that may include your doctor in the network.
Ensure you are in the right Medicare plan for your coverage needs in 2026.
Here’s what you need to do next:
Schedule time on my calendar so we can talk through your plan options. The sooner we can meet, the better! Use this link [replace with your Scheduling Link].
Best regards,
[Your Name]
Prescription Removed from Formulary
What it is
A medication the beneficiary currently takes has been removed from the beneficiary’s current plan formulary in the new year.
How the beneficiary is affected
They may need to pay full cost for the prescription or change medications.
How the Medicare agent can help
Identify alternative medications that are covered, or find a plan that continues to cover their current prescription.
Outreach Template
Hi [Client First Name],
I’m reaching out to let you know that your current Medicare plan, [plan name], has made changes to their prescription drug coverage heading into 2026. I want to make sure you’re aware that one of your prescriptions may no longer be covered under your current Medicare plan’s formulary starting January 1, 2026. Without changes, you could be responsible for paying the full cost.
We can work together to:
Explore alternative covered medications, or
Review other Medicare plans that continue to cover your current prescription.
Here’s what you need to do next:
Schedule time on my calendar so we can talk through your plan options. The sooner we can meet, the better! Use this link [replace with your Scheduling Link].
Let’s connect soon to review your options before AEP ends. Reply to this email or call me at [Your Phone Number].
Sincerely,
[Your Name]
Drug Tier Change
What it is
A prescription has moved to a higher tier in the plan’s formulary.
How the beneficiary is affected
Their copay or coinsurance for this medication will increase, leading to higher out-of-pocket costs.
How the Medicare agent can help
Review the cost impact across the year, check if lower-cost alternatives are available, and compare other plan options that may cover the medication at a lower tier.
Outreach Template
Hi [Client First Name],
I’m reaching out to let you know that your current Medicare plan, [plan name], has made changes to their prescription drug coverage heading into 2026. One of your prescriptions I have on file has moved to a higher drug tier, which means your out-of-pocket costs for that medication will increase starting in 2026.
I can help by:
Reviewing the expected increase in your prescription costs.
Checking whether lower-cost alternatives are available.
Exploring plans that may cover your medication at a lower cost.
Here’s what you need to do next:
Schedule time on my calendar so we can talk through your plan options. The sooner we can meet, the better! Use this link [replace with your Scheduling Link].
Best regards,
[Your Name]
Prescription Cost Change
What it is
Even if a prescription remains covered, the plan’s pricing structure has changed.
How the beneficiary is affected
They may face higher out-of-pocket expenses for the same medication.
How the Medicare agent can help
Compare pharmacy pricing across different plans, review mail-order options, or explore alternative coverage that lowers overall costs.
Outreach Template
Hi [Client First Name],
I’m reaching out to let you know that your current Medicare plan, [plan name], has made changes to their prescription drug coverage heading into 2026. One of your prescriptions I have on file is subject to a price increase with your coverage in 2026.
I can help by:
Reviewing the expected increase in your prescription costs.
Checking whether lower-cost alternatives are available.
Exploring plans that may cover your medication at a lower cost.
Here’s what you need to do next:
Schedule time on my calendar so we can talk through your plan options. The sooner we can meet, the better! Use this link [replace with your Scheduling Link].
Best regards,
[Your Name]
Major Benefit Loss
What it is
A supplemental benefit included in the current plan is being reduced or removed.
How the beneficiary is affected
They may lose access to certain services, such as preventive dental care, eyeglasses, or hearing aids.
How the Medicare agent can help
Confirm the priority of any major benefits that may have different coverage in the new year. Present alternative Medicare Advantage plans with stronger benefits, or recommend ancillary coverage (standalone dental, vision, or hearing plans).
Outreach Template
Hi [Client First Name],
Every year, Medicare Advantage plans update their benefits. For 2026, your current plan, [plan name], is reducing or removing some of the supplemental benefits you may have been using — such as dental, vision, or hearing coverage.
With the Annual Enrollment Period (AEP) starting on October 15, I wanted to reach out to connect with you for the following:
Review your current plan’s updated benefits.
Compare new plan options that may offer stronger coverage.
Ensure you are in the right Medicare plan for your coverage needs in 2026.
Let’s schedule a quick review together before AEP ends so you don’t lose important benefits. Please reply or call me at [Your Phone Number].
Best regards,
[Your Name]
Additional Plan Disruption FAQs
Why does my plan change every year?
Why does my plan change every year?
Medicare Advantage and Part D plans update their provider networks, drug lists, and benefits annually to comply with CMS rules and adjust to new costs. These changes take effect on January 1 each year.
Do I have to change my plan?
Do I have to change my plan?
No, but if your doctor, prescriptions, or benefits are affected, staying in your current plan could mean higher costs or lost coverage. Reviewing your options during AEP ensures your coverage still fits your needs.
What happens if I don’t do anything?
What happens if I don’t do anything?
If your plan is continuing in 2026, you’ll stay in it automatically — even if benefits or costs change. If your plan is exiting the market, you’ll be returned to Original Medicare and may be placed into a standalone Part D drug plan. In both cases, you may lose benefits or face higher costs.
Can I keep my doctor if they’re out of network?
Can I keep my doctor if they’re out of network?
You can, but your costs may be much higher. To keep costs down, you may want to switch to a plan that keeps your doctor in-network or choose a new in-network doctor.
Why did my prescription cost go up?
Why did my prescription cost go up?
Plans update their drug formularies every year. Your prescription may have moved to a higher tier, been removed, or had its pricing adjusted. Reviewing your options during AEP helps make sure your medications remain affordable.
Can I change my plan after December 7?
Can I change my plan after December 7?
Generally, no. The Annual Enrollment Period (Oct. 15–Dec. 7) is the main window to change coverage for the upcoming year. However, if your plan exits the market or you qualify for a Special Enrollment Period (SEP), you may have additional opportunities to change your plan.