The upshot: Seniors have to be careful, or they might end up with a bad surprise such as higher drug costs or the loss of a favorite doctor.

“This year is a nightmare,” said Marcia Mantell, a retirement-planning consultant. Medicare enrollees “have to know more than they ever have had to know…it’s all the hidden stuff,” she said.

Behind the turmoil are business realities. Medicare insurers have seen their profits squeezed by higher-than-expected medical spending and regulatory changes. Now, some of the biggest are trying to improve their margins by dumping unprofitable products and by controlling costs better.

The moves might make their products less appealing. The industry is projecting that enrollment in private Medicare plans, known as Medicare Advantage, will shrink in 2026. That would be the first time in 15 years, according to the health researcher KFF.

“What many of the companies have talked about is really pricing for profitability rather than for growth,” said Lisa Gill, a senior analyst at J.P. Morgan.

Here’s what you need to know about navigating this year’s Medicare enrollment pitfalls.

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