Q&A - Changes to Medicare
Q: What should Idaho dentists and patients know about upcoming Medicare changes for 2026? I have heard that Blue Cross dropped 75,000 Medicare subscribers. In addition, I've heard that Blue Cross brokers may be steering these subscribers toward HMO plans without dental coverage.
A: Thank you for reaching out and sharing your concerns regarding the 2026 Medicare changes.
The ISDA is aware of the significant restructuring taking place in the Medicare Advantage marketplace and is working to ensure Idaho dentists and patients have accurate, timely, and practical information as we approach the transition.
As you may know, the figure of 75,000 dropped subscribers reflects national changes among Blue Cross organizations. Here in Idaho, Blue Cross of Idaho is also making major adjustments to its Medicare Advantage offerings for 2026, which will have meaningful impacts on Idaho seniors.
What Is Changing in Idaho
- All existing Blue Cross of Idaho Medicare Advantage plans will terminate on December 31, 2025.
- New Medicare Advantage plans will be introduced for 2026, but availability will vary by county.
- Blue Cross of Idaho is withdrawing from seven counties, requiring affected beneficiaries to select new coverage.
- Premiums, benefits, and provider networks may change, even for individuals remaining in counties with ongoing plan availability.
- Regence BlueShield of Idaho is fully discontinuing its Medicare Advantage plans, affecting roughly 6,000 Idaho beneficiaries who must select new coverage for 2026.
These changes are consistent with broader national trends, as multiple insurers reassess Medicare Advantage participation due to rising health care and administrative costs.
Medicare Dental Coverage in 2026
- Original Medicare will continue to provide only limited dental coverage, and only when dental services are medically necessary and integral to approved medical procedures.
- CMS is not expanding its examples of medically necessary dental services in the 2026 Physician Fee Schedule, but the existing rules remain in place.
- Most Medicare Advantage plans are expected to maintain, and in some cases enhance, dental benefits in 2026, though benefits will vary by carrier and by county.
Impact on Idaho Seniors
Because of these changes, beneficiaries in Idaho will need to review and confirm new coverage during the Annual Enrollment Period (October 15–December 7, 2025). Free, unbiased assistance is available through the Senior Health Insurance Benefit Advisors (SHIBA).
A Personal Example
A dentist I contacted personally reviewed the Blue Cross changes in detail. Blue Cross notified current subscribers of the plan terminations and advised them to work with Blue Cross or an independent broker to evaluate new options. The dentist contacted both, and neither attempted to steer them toward plans without dental benefits.
Blue Cross is introducing four new Medicare Advantage plans for 2026:
- Two zero-premium plans offering dental benefits similar to current coverage but without Part D (drug) benefits, which many beneficiaries may find insufficient unless they carry additional coverage.
- Two plans that include both drug and dental benefits but have higher premiums, approximately $29 per month for dental, with total premiums now up to $59 per month.
Subscribers may also opt for standalone individual dental coverage from carriers such as Delta Dental. Both representatives were candid in explaining the reason for the changes: Blue Cross lost money on its Medicare Advantage products last year, which was compounded by another large carrier exiting the market, resulting in Blue Cross absorbing many new high-cost members. For many plans, deductibles, copays, and annual out-of-pocket maximums have also increased.
What ISDA Is Doing
- Keeping dentists informed about potential implications for coverage, billing, and patient continuity of care.
- Providing timely updates as CMS and carriers release new plan information.
- Continuing to track marketplace developments to support members through the 2026 transition.
That said, it is important to be realistic about the scope of ISDA’s influence. While the ADA advocates at the national level on Medicare issues, at the state level we have limited authority over insurer business decisions. We can and do communicate with carriers where appropriate, but we are not in a position to prevent large-scale restructuring in the Medicare market. Unfortunately, Idaho seniors simply have fewer market alternatives today, aside from more expensive Medicare Supplement plans.
