2026 Open Enrollment Information: Medicare Members

2026 Open Enrollment Information: Medicare Members

Open Enrollment will take place Oct. 13-31, 2025. The choices you make during that time will be for benefits effective Jan. 1-Dec. 31, 2026. 

As a Medicare-eligible member, you continue to have three plan options to choose from: 

  • Humana Medicare Advantage PPO & Prescription Drug Base Plans
  • Humana Medicare Advantage PPO & Prescription Drug Enhanced Plans
  • The 70/30 Plan, administered by Aetna 

For the 2026 benefit year all Medicare-eligible members will remain in the plan in which you are currently enrolled unless you would like to enroll in a different plan during Open Enrollment. You need to TAKE ACTION during Open Enrollment if you want to be enrolled in a different plan or need to make any changes regarding your dependents. 

If you have non-Medicare Primary dependents on your plan, they have different options: the Standard PPO Plan (formerly named Base PPO Plan 70/30), and the Plus PPO Plan (formerly named Enhanced PPO Plan 80/20), both administered by Aetna. If they are currently enrolled in the Plus PPO Plan, they will be moved to the Standard PPO Plan for the 2026 benefit year. You will need to TAKE ACTION during Open Enrollment if you want them enrolled in the Plus PPO Plan for the 2026 benefit year.

An important message from Treasurer Briner

2026 Medicare Primary Monthly Rates

2026 Group Medicare Advantage Plan Resources (More Coming Soon)

Humana Group Medicare (PPO) Plan Notes

  • The Centers for Medicaid & Medicare Services (CMS) made policy changes for 2026 that impact Medicare Advantage Plans. These changes allow Humana to administer medical and pharmacy benefits separately. Splitting the medical and pharmacy benefit is managed by Humana, with members not experiencing a lot of change or noticeable differences.
  • Splitting the medical and pharmacy benefit allows for significant savings to the State Health Plan.
  • There is ONE SLIGHT CHANGE to the pharmacy benefit under BOTH Humana Medicare Prescription Drug Plans in 2026. The change is required by CMS and increases the Pharmacy out-of-pocket maximum from $2,000 to $2,100.
  • Although the pharmacy benefit is separate from the medical benefit, you cannot elect to opt out of the pharmacy benefit.
  • You’ll receive 2 NEW ID CARDS – one for medical, one for pharmacy. These cards will arrive separately in the mail.
  • You’ll receive 2 CONFIRMATIONS OF ENROLLMENT –one for medical, one for pharmacy and some other duplicated CMS required notices.
  • There may be changes to the Humana Medicare Prescription Drug Plan formulary (drug list), so members are encouraged to review that information when it becomes available.

The 70/30 Plan, administered by Aetna Notes

  • There are INCREASES to the deductible and copays in this plan for 2026.
  • For 2026, the Clear Pricing Project is ending and will not be available; however, the Plan will continue to offer lower copays for certain Preferred Providers. If you would like to change your selected Primary Care Provider (PCP) to a Preferred Provider, you will need to wait until after Jan. 1, 2026, to make that change.
  • If your selected PCP is already noted as a Preferred Provider, you do not need to take any action. As a reminder, PCPs can be changed anytime, and ID cards typically arrive 7-10 days after the change is made.
  • The formulary (drug list) for the 70/30 Plan is updated quarterly, so there is always a possibility that your medication could change tier levels or become a non-covered drug.
  • Preferred and non-preferred insulin continues to have a $0 copay for a 30-day supply.

2026 70/30 Plan Resources

CVS Caremark is the State Health Plan’s Pharmacy Benefit Manager.

The State Health Plan utilizes a custom, closed formulary (drug list). The formulary indicates which drugs are excluded from the formulary and not covered by the Plan. All other drugs that are on the formulary are grouped into tiers. Your medication’s tier determines your portion of the drug cost.

These documents and tools include information based on the 2025 formulary and are subject to change prior to January 1, 2026.

Find a Doctor (Humana)

Online resources to help you find a provider in the Humana network.

Find a Doctor (Aetna)

Online resources to help you find a provider in the Aetna network.

Open Enrollment Events

The State Health Plan is hosting several in-person events, webinars and Telephone Town Halls prior to and during Open Enrollment. Click here to view a complete list.

Need Help?

For questions or help regarding your enrollment, call the Plan’s Eligibility and Enrollment Support Center at 855-859-0966.