Stephen Murphy is an emeritus professor at the University of Southern Maine and a volunteer State Health Insurance Assistance Program (SHIP) counselor.

Medicare’s annual open enrollment period is ending soon. Until Dec. 7, beneficiaries will be urged to review, compare and, if necessary, change their health and/or drug plans for 2026.

If past is prologue, about 70% of all Medicare recipients will do nothing. Why? 

Satisfaction with their plans is often cited as a reason for beneficiary inaction. But this is hardly the case. Medicare coverage has become dominated by private insurance plans that can change their costs, networks, health and drug coverages, etc. every year. 

Increasingly, these coverage options have become more expensive, but too complicated and frustrating for most people to deal with.  

Hidden costs, confusing enrollment periods and a dizzying array of Medicare Advantage (MA) plans have made beneficiary choices nearly impossible to understand and compare. And making a mistake can be costly, resulting in a permanent penalty, loss of a valued specialist or denial of an expensive prescription. 

Adding to the confusion are predatory marketing campaigns that fill mailboxes, voice messages and TV screens with ads promoting primarily Medicare Advantage plans. Using celebrities to pitch misleading claims about “zero premium” plans and “free” extra benefits, these ads lack transparency, omitting any hint of possible coverage restrictions, out-of-pocket costs and treatment denials and delays.  

Medicare could offer far more impartial beneficiary assistance, especially for people who are the most vulnerable and least likely to review their coverage. The Medicare Cost Report notes that some recipients turn to family and friends, who may be well intentioned, but tend to recommend their own plan and are likely unfamiliar with coverage options that better fit a person’s medical needs. 

KFF, a health policy research foundation, has reported that most people comparing coverage options consult agents or brokers who often give the impression of impartiality. However, they are paid higher commissions and bonuses by steering people to the Advantage plans they represent, frequently prioritizing profit over health needs. 

This year, doing nothing will be especially risky. Kiplinger recently issued warnings to its readers, advising them not to stand pat for 2026 due to the drastic changes to Medicare and Medicaid. President Trump’s One Big Beautiful Bill Act will have a devastating impact on beneficiary finances and health.  

The act’s impact on low-income people is particularly devastating, hindering enrollment in the Medicare Savings Program and making Medicare unaffordable for 25% of recipients nationwide — individuals with incomes of $24,600 or less, with total savings below $18,950, and no home equity. KFF describes this group as older and more seriously ill who have weaker language proficiency, cognitive impairments and less internet access and skill. These are also the people least likely to review their coverage. 

According to the Congressional Budget Office (CBO), a nonpartisan federal agency, approximately 1.38 million individuals receiving both Medicare and Medicaid may lose their Medicaid benefits between 2025 and 2034. According to KFF (2024), this includes almost 7% of Mainers, nearly 100,000 residents, who are dually enrolled in Medicare and Medicaid (MaineCare). Losing their Medicaid will force people to rely on Medicare only, losing coverage of critical services such as long-term care and dental.   

CBO also estimates that the One Big Beautiful Bill Act will trigger mandatory spending cuts to Medicare of $45 billion for fiscal year 2026. This will make health care more unaffordable, restrict access to more medical services and precipitate rural hospital service reductions or closures in regions already reeling from personnel shortages and loss of services. 

There are available impartial sources of information and help such as 1-800-Medicare,
Medicare.gov/plan-compare and the Medicare Handbook. Unfortunately, these resources, while informative, come without the support and follow-up needed for people who need help the most.

Perhaps the most intensive, impartial and flexible resource is the State Health
Insurance Assistance Program (SHIP). This free service offers individualized counseling
and follow-up, and is offered online, in-person and by phone. In 2022, SHIP reported
assisting 4.3 million beneficiaries, family members and caregivers nationwide.

Despite its merits, KFF reported that SHIP has been underfunded, underused and unfamiliar to most of the 70 million Medicare recipients. Inaccurately described by the Trump administration as “wasteful and bloated,” SHIP’s 2025 funding was cut, moved to an obscure place within the Department of Health and Human Services and now faces likely elimination in 2026. 

Accessing and controlling health care options is vital as we age and our health needs change. Private Medicare plans have become pervasive and dominant, especially Advantage plans that now control 54% of the Medicare market.

Due to lax federal regulation and oversight, health care companies have created an overly complicated system where they can change virtually any aspect of their coverage annually with minimal restrictions. Consequently, beneficiary choices have become more complicated and confusing and less transparent and accessible. 

Our lack of attention to and participation in annually inspecting our health care coverage is inconsistent with our medical and financial interests, and signals indifference to legislators, regulators and policy makers. 

Unless we demonstrate individually and collectively to these decision-makers how deeply we care about this issue, we risk losing more control of the conversation to change things while giving away without a fight the critical health care control and access we need more than ever.