50+ Lifestyles

Your Advocacy Connection

We Solve Long Term Care Problems

By Gail Glockhoff-Long
GolderCare Solutions

Is This the Year to Pay Extra Attention to Medicare Annual Enrollment?

The annual Medicare and Affordable Care Act (ACA) Insurance enrollment periods have begun. Most people are in automatic mode and just renew what they have. The insurance companies count on you doing that. Don’t be lazy this year. Do your due diligence. As of the writing of this article, the government was still shutdown and the ACA subsidies were due to expire.

Let’s start with the basics. Healthcare in the US has gotten crazy expensive for everyone. Insurance premiums have gone up to keep pace with the rising costs from hospitals and other providers. Medicare makes changes each year in co-pay amounts and the Part B premium for everyone on Medicare. Advantage plans also change annually but each insurance company makes their own version of changes to each of their separate plans.

If you are Medicare eligible, you have the option of:

• Traditional Medicare – with or without an additional Medigap insurance plan – plus a separate Part D drug plan; or
• Medicare Advantage Plan that often includes a Part D drug component.

Traditional Medicare –

• Part B premiums for 2026 are expected to increase to $206.50 for most enrollees.
• Medigap policies are private insurance that fill the gaps in Traditional Medicare – they generally pay the co-pays and deductibles for doctors and hospitals. Since the coverage provided by each plan is prescribed by Medicare, the only change to these plans should be in the premium amount.
• Part D private prescription drug coverage 2026 changes may include changes to premiums, co-pays for specific drugs, and increased deductibles. You may also see
  some of the very expensive drugs no longer covered. Are your medications still on the formulary for your plan?

Do you need to change drug plans?

• If you are on Traditional Medicare, review the CMS booklet that was recently mailed to you. Also check your current medication list against your current Part D plan to see what co-pay tier you will have. Consult your health insurance agent to see if a different plan would be a better fit.

Medicare Advantage Plans –

• The Affordable Care Act changed the funding formula by gradually phasing out extra payments or subsidies from the federal government to Advantage plans.
• Advantage plans are given star ratings based on outcome and customer satisfaction. The higher the star rating, the more the company was reimbursed from Medicare. Medicare has been raising the bar to qualify for stars making it harder to receive reimbursements
• Several companies have pulled out of the QC market and other companies are limiting the number and type of plan options. An example is to discontinue all preferred provider plans and only offer HMO type plans to control costs and options.
• Premiums will also be increasing, benefits will be decreasing.
• Advantage plans often add on perks to entice people to pick their plan. Perks can include dental or eye coverage, Part D coverage, over-the-counter medical supply allowance, and gym membership. Watch for changes in these perk benefits.
• Advantage plans contract annually with doctors and medical facilities. Are your doctors still on your

Advantage Plan?

Affordable Care Act

• This insurance pool offers health insurance coverage for individuals not yet eligible for Medicare.
• As of the writing of this article, it is still unclear if the premium subsidies will be continued or be allowed to expire. It is estimated 4 million people will lose their health insurance coverage if the subsidies expire. As many as 7 million people are expected to stop buying insurance because they are unable to afford the premiums.

This is a very important year to review your healthcare options during the open enrollment period that lasts until December 7. What changes is your plan making? Are your medical providers and specialists still in the plan? Your only notice of changes is reading the big book they send you about updates for the next year. Your 2025 plan may have been perfect for you. Will the 2026 version be as good or is it time to look for a better match? Talk to your health insurance agent.

For those on MediCAID, the state has assigned you to a managed care company to cover the Medicaid part of your medical costs. This plan is in addition to the coverage you already have under MediCARE. Medicare pays first, then your supplement if you have one, then the Medicaid plan. GolderCare has expertise in how Medicare coverage impacts our aging journey.

Gail is a Benefits and Insurance Specialist with GolderCare Solutions, helping families navigate the complexities of aging, care, insurance, placement, and public benefits.