Here’s what to watch—and how to plan.

Part D Reform Under the Inflation Reduction Act (IRA)

The Inflation Reduction Act gives Medicare unprecedented authority to negotiate drug prices—set to go into full effect in 2026. The first wave of 10 high-cost drugs, including Eliquis, Jardiance, and others, will benefit from these negotiated prices. According to projections, beneficiaries may see cost reductions of at least 38% per negotiated drug, saving the program billions and cutting out-of-pocket costs substantially. (Verywell Health, Wikipedia)

Deductible, OOP Cap, and Insulin Cost

For 2026, expect changes to Part D cost structure:

• Deductible increases to $615 (up from $590). (Kiplinger)
• Out-of-pocket cap rises to $2,100 (from $2,000). (Kiplinger)
• Insulin costs capped at $35/month, now a permanent feature under Part D and B starting in 2026

Another consumer-friendly feature: expanded vaccine coverage at zero or reduced cost.

Additionally, the Drug Price Negotiation Program is rolling out and includes selected drug subsidies—a portion of negotiated prices will be subsidized by CMS during the initial coverage phase, reducing sponsor liability. (Centers for Medicare & Medicaid Services)

Premium Trends and Subsidy Shifts

Despite these benefits, Part D premiums could climb due to plan design shifts and reduced federal subsidies. A recent Wall Street Journal report anticipates a rise—stemming from reduced insurer subsidies and tighter protections. (Wall Street Journal)

Finalized Guidance & Plan Design Overhaul

CMS has released the Final CY 2026 Part D Redesign Program Instructions, which codifies IRA provisions into plan structure changes. This includes updated cost-sharing phases and the mechanics for the new subsidy program. (Centers for Medicare & Medicaid Services, Medicare & Medicaid Portal)

These updates aim to enhance affordability and reflect the richer benefit design. (Medicare & Medicaid Portal)

Changes in Medicare Advantage Plans

Payment Rates and Risk Adjustments

CMS has also finalized 2026 changes affecting Medicare Advantage (MA):

• MA plan payment rates are increasing by approximately 5.06%, injecting new resources into plans.(MedStates)
• Risk adjustment models for both MA and Part D are being updated, refining how plans are paid based on patient acuity.(MedStates, Applied Policy)

These changes may influence service areas, benefit levels, and plan availability during open enrollment.

Final Rule and Consumer Protections

CMS’s final CY 2026 rule strengthens policies across MA and Part D, incorporating IRA mandates and codifying new protections, including those relating to insulin and vaccines.(Federal Register, Sheppard Health Law)

Additionally, proposed MA and Part D reforms—such as expanded access to anti-obesity medications, behavioral health services, and tighter marketing rules around AI and prior authorization—were not all finalized.(Centers for Medicare & Medicaid Services, Sheppard Health Law)

What This Means for Beneficiaries During Open Enrollment (Oct 15–Dec 7, 2025)

Part D: Evaluating Plans Under a New Structure

With Part D’s new design in effect beginning January 2026, beneficiaries may want to:

• Compare plans based on new deductibles and OOP caps
• Check if their prescriptions are on the negotiated drug list, which may reduce their costs
• Budget for potentially higher premiums—but significant savings on medications may offset the increase

Medicare Advantage: Plan Choice and Benefit Design

If you’re using an MA plan:

• Check if your current plan’s network and benefit structure remain stable given new CMS payment rules and risk scores
• Explore alternate MA plans that might offer lower cost-sharing or expanded benefits funded by the increased payments

Particularly Important for Dual-Eligibles and Low-Income Beneficiaries

• CMS’s updates could change benefit packages and enrollment rules—especially for D-SNPs (Dual-Eligible Special Needs Plans) and those receiving low-income subsidies (LIS). The risk adjustment and subsidy changes may impact plan availability and cost-sharing.(Federal Register, MedStates)
• Keep an eye on modifications to Low-Income Subsidy rules and premium expectations.(Wikipedia)

Medigap and Other Supplemental Coverage Considerations

While much attention is on Medicare Advantage and Part D, and those are the plans that utilize this annual election period (When is Medicare Supplement Open Enrollment?), beneficiaries who are on Original Medicare must also prepare for 2026.

• Medigap Availability: Medigap (Medicare Supplement) plans remain standardized, but premiums may shift due to healthcare inflation and demographic changes. Beneficiaries should compare carriers and consider switching if premiums become unaffordable. Get a list of current Medigap rates by email.
• Standalone Dental & Vision Plans: Since Original Medicare generally does not cover routine dental or vision care, standalone policies are expected to remain an important option in 2026.

Summary Table: Major Changes for 2026 Enrollment Period

Expert Perspective on 2026 Medicare Open Enrollment

Policy experts emphasize the significance of this upcoming period:

“The 2026 Medicare Enrollment Period is not just another year of minor updates—it represents a fundamental shift in how Medicare operates, particularly for prescription drug coverage,” notes Tricia Neuman, Executive Director of the Medicare Policy Program at KFF.

Beneficiaries who are prepared will be best positioned to take advantage of these changes and avoid getting stuck in a plan that does not serve their needs due to increased premiums or reduced networks/coverage.

Final Thoughts

The 2026 Medicare enrollment period, running from October 15 to December 7, 2025, will be one of the most complex in recent years.

Thanks to the Inflation Reduction Act, prescription drugs are becoming more affordable for many Medicare Part D enrollees—with caps on out-of-pocket costs, insulin price limits, and negotiated drug savings. However, this is also likely to lead to increased premiums. Medicare Advantage plans will also see funding boosts and structural changes that may benefit enrollees but could also lead to reduced service areas or other restrictions.

With change comes complexity:

• Comparison shopping is more important than ever—don’t assume your current plan remains optimal. Be on the lookout for your Annual Notice of Change (ANOC) that will come in late September/early October.
• Understand coverage phase changes. New deductibles and negotiating savings will affect finances differently depending on medication usage.
• Watch for changes in plan availability, benefit offerings, and provider networks due to revised MA payments and risk scores.

Getting ahead by reviewing available options starting October 1—and acting promptly—can make a big difference in both coverage and cost.

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65Medicare.org is a leading, independent Medicare insurance agency for people turning 65 and going on Medicare. If you have any questions about this information, you can contact us online or call us at 877.506.3378.

• Insurance Company of North America (INA) Medigap: What You Need to Know
• Medicare’s Hidden Costs (2026): The Bill You Never Saw Coming
• Pennsylvania Medigap Plans: A Complete Guide to Medicare Supplement Coverage in PA
• Wisconsin Plan G: Why Doesn’t It Exist?
• The Issue-Age Medigap Myth: Why “Age Doesn’t Matter” Isn’t the Whole Story

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While this can be unsettling to some, there are protections in place, and you do still have options. Read on to learn more about what to do when your Medicare Advantage drops you.

What Type of Plan Can You Get When Your Medicare Advantage Non-Renews?

When your Medicare Advantage plan drops you, you have two options for coverage moving forward. We’ve detailed both of those options below:

A New Medicare Advantage Plan: One option that you have when your Medicare Advantage plan non-renews is to choose a new Medicare Advantage plan that IS going to be offered in your county for the following calendar year. You can do this during the annual election period (October 15-December 7) and it would take effect on January 1 of the following year. The transition would be seamless in that the current plan will cover you through the end of the calendar year, and the new plan would start on 1/1. 

It is very important, when considering/comparing Advantage plans, that you do your due diligence to make sure that the plan you are choosing is accepted by your doctors, covers your medications and just altogether meets your medical coverage needs. There are many variables to consider when comparing this type of plan.

Return to “Original” Medicare with a Medigap Plan: The 2nd option that you have when your Medicare Advantage plan non-renews is to return to “original” Medicare (Part A – hospital coverage; Part B – doctor/outpatient coverage) and add a Medigap plan, sometimes called a Medicare Supplement. Medicare gives you a mandated “guaranteed issue” right into certain Medigap plans, when your Medicare Advantage drops you through no fault of your own. So, many Medicare beneficiaries take the opportunity, when dropped by their Advantage plan, to get the comprehensive Medigap coverage that they may have not otherwise qualified for. 

Normally, to switch from an Advantage plan to a Medigap plan, you would have to go through medical underwriting and get approved. However, this is one of the few instances that would allow you to make this change with no medical underwriting or restrictions. Medigap plans pay the 20% that Medicare does not cover, and the most comprehensive Medigap plans (Plan F and Plan G) essentially pay all of your medical costs with no co-pays or out of pocket (with the exception of the Medicare Part B deductible of $240/year on the Plan G). Moreover, the Medigap plans do not ever non-renew and don’t change from year to year. They also do not have networks so you can go anywhere in the country that accepts Medicare. 

How Do You Get Another Plan After Your Medicare Advantage Plan Drops You?

So, if your Medicare Advantage drops you for 2025, you have options to get another plan. Here are a few tips:

• You should save all documentation that comes to you via mail regarding your plan’s changes, as you may need it to prove your eligibility for another plan.
• Make sure you read any documentation carefully and observe all deadlines and requirements.
• When choosing a new Advantage plan, make sure that the Advantage plan is accepted by your doctors/hospital. Also, make sure that your medications are covered under it and review any restrictions on coverage. 
• If choosing a Medigap plan, the plans are standardized (same coverage with every company) so you should compare the rates and pick the one with the best rates and ratings. A Medigap broker can provide you with a list of all the options. 

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65Medicare.org is a leading, independent Medicare insurance agency for people turning 65 and going on Medicare. If you have any questions about this information, you can contact us online or call us at 877.506.3378.

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Although the Social Security offices are currently closed to walk-in visitors, there are, fortunately, still options for enrolling in Medicare online. These options have been expanded in recent months with a revamped and improved enrollment tool for signing up for Medicare Part B. 

If you are already getting Social Security benefits, or Railroad Retirement Benefits, you will automatically be enrolled in Original Medicare Part A and Part B.  The effective date will be the first of the month you turn 65.  If your birthday falls on the 1^st of the month, then your Medicare benefits will start on the first day of the previous month. If you are under 65 and disabled, you will automatically get Part A and Part B if you have gotten disability benefits from Social Security (or from the RRB) for at least 24 months.  If you have ALS, you’ll get Part A and Part B automatically the month your Social Security disability benefits begin.  Note: If you are a resident of Puerto Rico or reside abroad, you will not get Part B automatically and must apply for it.

You should sign up for Medicare online:

• If you are in your IEP (Initial Enrollment Period), you can sign up three months before your 65^th birthday
• During the “General Enrollment Period” – If you haven’t enrolled in Medicare Part B during your initial enrollment period, you can still sign up each year from January 1 through March 31. Your coverage will start July 1 of the year in which you enroll.
• If you are in a Special Enrollment Period (SEP) – you may enroll for Part B:
  • in any month you remain covered under the group health plan and your, or your spouse’s, employment continues (in other words, while you or your spouse are still working); or
  • in the 8-month period commencing with the month after your group health plan coverage or your or your spouse’s employment ends, whichever comes first.

What are the benefits of signing up for Medicare online?

• You do not have to make an appointment at your local Social Security office (during the COVID pandemic, Social Security offices are not seeing walk-in visitors). During busy times of the year, your wait to get in to see someone may be up to 3 or 4 weeks;
• The application online process can be started immediately;
• You can save your application and go back to it later, without losing any of your information;
• You can sign up in the comfort of your own home, using your own computer;
• You will save time and money by not having to travel to your local Social Security office.
• You can rest assured that the technology used to input your personal information is secure.

Here are some tips that will help you complete your online application:

• Prior to enrolling online, go to the “Checklist for Online Applications” at www.ssa.gov/hlp/isba/10/isba-checklist.pdf. This information will help you to prepare for the process
• Visit www.socialsecurity.gov/medicare/apply.html and choose “Apply for Medicare Only.”
• If you need further information, click on “Related Information”.
• The normal application process online usually takes from 10 to 30 minutes to complete.
• Click on “Submit Now” and your application will electronically go to Social Security.

Once you have submitted your application, a receipt will be generated which you can print for your records.  You will then be assigned an application number that will be necessary in case you want to check the status of your application.  During the review process, if clarification is needed, including additional documentation, Social Security will contact you.  A letter will be sent to you by mail with the decision (usually 7-10 days). Then, within 3-4 weeks, your Medicare card will arrive.

Although Social Security offices are not providing service to walk-in visitors, they are still available by phone.  You can call your local office by using the Field Office Locator, under “Social Security Office Information”.  Alternatively, you can call the toll-free national number at 1-800-772-1213.  If you are hard of hearing or deaf, the TTY number is 800-325-0778.  A staff member is available from 7:00 am to 7:00 pm, Monday through Friday.

At this time, Social Security is requesting that you should access their online services before reaching out by phone.  That said, it’s understandable that if you don’t have a computer or are not computer savvy, you can always call them!  Otherwise accessing their online services is the most practical way to contact them.  Some advantages of using the online system are:

• Applying for benefits
• Getting useful information
• Find publications
• Get the answers to FAQs

You can create a My Social Security account, which will give you additional options, i.e. review your Social Security statement, verify earnings, print a Benefit Verification Letter, or modify your direct deposit information.  If you need a replacement Medicare card or Social Security card (if there are no changes and your state participates), or a duplicate SSA-1099/1042S, you can request those as well.

Important note: If you are enrolling in Medicare Part B for the first time, that generates your initial open enrollment window for Medicare Supplement (Medigap) and Medicare Advantage plans as well. It is crucial to be aware of this and not miss any deadlines for enrolling.

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65Medicare.org is a leading, independent Medicare insurance agency for people turning 65 and going on Medicare. If you have any questions about this information, you can contact us online or call us at 877.506.3378.

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On March 11, 2020, the CMS (Centers for Medicare and Medicaid Services) announced the “Part D Senior Savings Model (“the Model”).  This 5-year model will make it mandatory for participating plans to limit cost-sharing for a 30-day supply of insulin to a maximum of $35. As of January 1, 2021, Part D sponsors that participate in the Model will be able to offer Medicare beneficiaries prescription drug plans which provide supplemental benefits for insulin during the coverage gap stage of the Part D benefit. Those pharmaceutical manufacturers who participate will pay the discount (70%) in the coverage gap for all types of insulin that are included in the Model.  This effort to reduce out-of-pocket drug costs for Medicare beneficiaries is a huge step in the right direction to lowering drug costs for seniors. It will give seniors additional choices of enhanced alternative Part D plan options which offer lower out-of-pocket costs for insulin.

For the first time, CMS is recommending that Part D plans offer fixed copays for seniors. This would eliminate the need for seniors of having to pay the 25 percent for drug costs in the coverage gap.  Thus, Medicare beneficiaries who use insulin, will be able to reap the benefits in this fight to lower drug costs.  More specifically, Medicare beneficiaries who take insulin and are enrolled in this type of plan will potentially save $446 in out-of-pocket costs.  In other words, they would be paying 66 percent less for their insulin.  This discount will be funded partly by the drug manufacturers during the 5 years that this model will be in effect.

The response by Part D plan sponsors for Part D Senior Savings Model for the 2021 plan year has been overwhelmingly positive.   More than 1,750 Medicare Advantage plans and Medicare Part D prescription drug plans with prescription drug coverage have voluntarily agreed to be part of this model.  They will now be able to offer insulin at lower costs.  As a result of this move, CMS hopes there will be availability to seniors for this plan model in all 50 states, including the District of Columbia, and Puerto Rico. This will be accomplished via a stand-alone prescription drug plan (PDP) or through a Medicare Advantage plan which includes prescription drugs. The roll out of the Part D Senior Savings Model will be during the annual open enrollment from October 15 through December 7, 2020, when beneficiaries can sign up.

For more information, please go online to CMS at https://innovation.cms.gov/innovation-models/part-d-savings-model.

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During these difficult times, we must forge ahead and adapt to this new way of living, with social distancing, behaving responsibly when we feel sick and taking every precautionary measure possible to guard ourselves from this deadly outbreak. The Centers for Medicare and Social Services is actively doing everything possible to make seniors aware of what they can do to keep themselves and their families stay healthy. If there is a COVID-19 outbreak in your community, depending on the severity of the outbreak, public health department officials are recommending certain community actions to combat it. These steps can contribute to slowing down the spread of COVID-19 and reduce the impact of disease.

The response by the Medicare in dealing with the coronavirus has been overwhelmingly positive. These are some of the steps that have been taken to help beneficiaries:

• Medicare covers the lab tests for COVID-19. There are no out-of-pocket costs.
• Medicare covers all medically necessary hospitalizations. This also applies if you are diagnosed with COVID-19, and instead of being discharged from the hospital after an inpatient stay, you must stay in the hospital under quarantine.
• Although there is not yet a vaccine for COVID-19, if one does become available, it will be covered by all Medicare Prescription Drug Plans (Part D).
• If you are enrolled in a Medicare Advantage Plan, you have access to these same benefits. Medicare is allowing these plans to waive all cost-sharing for COVID-19 lab tests.

Medicare is currently expanding telehealth services in response to the current Public Health crisis. These services are covered by Medicare, and give you far more access from locations (including your home), with a broader range of communication tools (including smartphones), to interact with a variety of providers (such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social worker). In addition, you will also be able to benefit from services through telehealth for evaluation and management visits (office visits), mental health counseling and preventive health screenings.

This will ensure your ability to have a “virtual check-in” (see below) with your doctor without leaving your home. Just this fact alone will put you at less risk of exposure to COVID-19.

• Medicare pays for “virtual check-ins”—brief, virtual services with your established physician or certain practitioners where the communication isn’t related to a medical visit within the previous 7 days and doesn’t lead to a medical visit within the next 24 hours (or soonest appointment available).
• Please be aware that you are required to give verbal consent if you want to use virtual check-ins and your provider must document that consent in your medical record prior to using this service. You would just pay your normal coinsurance and deductible for these services.
• Another way that Medicare will pay you to communicate with your doctors is by using online patient portals without going to the doctor’s office. Like virtual check-ins, you must request this type of communication.
• If you live in a rural area, you will be able to take advantage of this type of communication technology for full visits with your doctors. However, in order to comply with the law, all visits must be carried out at specified sites of service, known as telehealthoriginating sites. Services must be provided using a real-time audio and video communication set up at the site to communicate with a doctor or other type of practitioner who is remotely located.

Beware of scammers who may try to use the coronavirus emergency to take advantage of Medicare recipients via telemarketing calls, robocalls, social media posts, emails:

• selling fake coronavirus tests
• selling “Senior Care Packages” containing hand sanitizers
• falsely claiming that President Trump has ordered all seniors to get the coronavirus test

Once they have your attention, they will then try to get your Medicare number or your Social Security number on the premise of sending you a test kit or a sanitary kit sent to you. But what they really want it for is to bill for unwanted goods and services. To fight against this type of identity theft and Medicare fraud, Federal and state law enforcement officials have set up a task force so that they can share information to facilitate the investigation of these types of scams. The phone number for the HHS Inspector General’s hotline is 800-HHS-TIPS, and you can reach the National Center for Disaster Fraud hotline at 866-720-5721.

To get the latest up-to-date information on Covid-19, please see below:

• Coronavirus.govis the source for the latest information about COVID-19 prevention, symptoms, and answers to FAQs.

• CDC.gov/coronavirus has the latest public health and safety information from CDC and for the predominant medical and health provider community on COVID-19.
• USA.gov for the latest news about what the efforts of the U.S. Government in response to COVID-19.
• Visit Whitehouse.gov for the full set of guidelines for the coronavirus.

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65Medicare.org is a leading, independent Medicare insurance agency for people turning 65 and going on Medicare. If you have any questions about this information, you can contact us online or call us at 877.506.3378.

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As part of the government’s fight on opioid addiction, pain treatment has been expanded to other modalities of therapy, one of which is acupuncture. Statistics show that opioids have become a public health crisis. There were 47,600 overdose deaths in 2017 due to opioids, and CMS wants to support these alternative treatments that can replace these addictive drugs. Studies on adults 65 years of age or older show that patients with chronic low back pain in these studies demonstrated improvements in overall function and pain level. In addition, all the evidence reviewed for this decision supports various strategies for chronic low back pain including non-prescription drug therapies.

According to the CMS, while there is variation in covered indications and frequency of services, many private health plans provide at least some acupuncture coverage for their subscribers today. Furthermore, as a result of the CMS decision in covering acupuncture, more health plan administrators may consider adding or expanding their coverage to include acupuncture.

You’ve probably heard of the field of “naturopathy”, of which acupuncture is one facet – it is a form of alternative medicine. It is most commonly practiced by naturopathic doctors. Although acupuncture might be synonymous with naturopathy, it is a practice based in ancient oriental roots. It originated in China thousands of years ago. It is a form of therapy using needles which stimulate channels of energy or meridians of the body to improve energy flow (chi). This “chi” restores a sense of balance and health to the body. Over time, Western medicine has evolved to be more accepting of this ancient practice and is used by health practitioners in addition to traditional forms of treatment.

According to proponents, the benefits of acupuncture are many, including the following:

• Stress reduction
• Reduction in neck tension and joint pain in the hands and arms;
• Relief from headaches;
• Insomnia
• Sciatica
• Reduced eye strain
• Improved immune system
• Increased energy
• Relief from digestive ailments
• Allergy relief
• Reduced desire for nicotine
• Weight loss

The World Health Organization (WHO) also says that acupuncture may help the following conditions, although more evidence is needed to confirm efficacy:

• fibromyalgia
• neuralgia
• post-operative convalescence
• substance, tobacco and alcohol dependence
• vascular dementia
• whooping cough, or pertussis
• Tourette syndrome

The WHO also suggests that it may advantageous to treat a number of infections, including urinary tract infections and epidemic hemorrhagic fever.

The overall benefits of having acupuncture can be life-changing for some people, if it is performed correctly. Unlike many prescribed medications, there are very few side effects when performed correctly. It can be effectively integrated with other modalities of treatment. However, the number of treatments needed depend on the patient, and whether the condition(s) for which he/she is being treated is/are chronic or acute. A chronic problem may take longer to be eradicated than an acute one.

It is advised that acupuncture is not used as the sole means of treatment. It is advisable to use it in coordination with conventional treatments in cases of chronic or severe illness.

All therapies have risks as well as benefits. Some possible risks of acupuncture are:

• Excessive bleeding if a patient has a bleeding disorder or takes blood thinners
• Bleeding, bruising, and soreness may occur at the insertion sites
• Infection resulting from unsterilized needles
• In rare cases, a needle may break and damage an internal organ
• In rare cases, risk of collapsed lung when needle inserted deeply into chest or upper back

The United States (U.S.) Food and Drug Administration (FDA) regulate acupuncture needles as medical devices. Their manufacture and labeling must meet specific standards. The needles must be sterile, nontoxic, and labeled for one use only, by a licensed health care practitioner.

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65Medicare.org is a leading, independent Medicare insurance agency for people turning 65 and going on Medicare. If you have any questions about this information, you can contact us online or call us at 877.506.3378.

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CMS (Centers for Medicare & Medicaid Services) has surged ahead with a campaign to review their billing processes for fraud. Nonetheless, you should still take a proactive approach in helping to protect yourself, your family and Medicare itself against fraudulent practices involving seniors.

Here are the 4 R’s of helping you protect yourself:

1. RECORD: Keep a running list of all your appointments with your health care providers. This also includes laboratory tests, x-rays and any other diagnostic imaging or tests performed. Write down the exact admission and discharge dates, if you were in the hospital, as well as your diagnosis. Finally, remember to save any invoices and statements from all those providers.To help you with the recording tasks, if do not have a calendar, a local Senior Medicare Patrol program can assist you. They can provide you with a free Personal Health Care Journal. To find a local SMP, you can go online at smpresource.org. Alternatively, you can call them at 877-808-2468.
2. REVIEW: Review your Explanation of Benefits (EOBs) or Medicare Summary Notices (MSNs) for any entries you think are incorrect or should not be there in the first place. Be aware of any charges for services, medical equipment or other items that you did not receive. If you had any hospital admissions, read your statements very closely. There may be medications listed which you had not taken. It is within your patient rights to question anything on your bills/EOBs/MSNs that do not appear justified.Whenever you pick up medication from a pharmacy, make sure you have the exact number of pills you were supposed to get. In addition, pay attention to the label on the bottle to verify that your name and medication, along with dosage is correct. Take charge of your health care and educate yourself on knowing what a provider can and cannot bill to Medicare.
3. REPORT: How Do I report Medicare Fraud? If an error has been made on your bill or think that Medicare fraud has been committed, please see below for instructions on how to report it:
   • Call Medicare at 1-800-MEDICARE. Be sure to have your Medicare number available.
   • You may contact the Office of the Inspector General to report any fraud by calling 1-800-HHS-TIPS (1-800-447-8477). TTY users call 1-800-377-4950.
   • You can also contact your local Senior Medicare Patrol office, which will help you in reporting fraud.
4. REMEMBER: Be careful to protect your information against Medicare fraud by remembering these crucial tips.

• For your security protection, do not divulge your Medicare number to anyone, other than your physician or other health care provider. In addition, be vigilant regarding your Social Security number. Do not give it out to anyone asking for it except people you know and trust.
• Be careful not to be taken in by any media advertisements that offer special deals asking you to give out your Medicare number. Some unscrupulous Medigap companies may try to obtain your number for the purpose of signing you up for insurance you do not want.
• Medicare will never contact you, nor ask you for your personal information, and that also pertains to your bank information.
• Keep an eye on your bank accounts to make sure any premiums, such as your Medigap premiums, are not higher than they are supposed to be.

In addition to the 4Rs above, be on your guard and pay close attention to the following:

• Never give your Medicare card to anyone else to use. Vice-versa, you should never use anyone else’s card.
• Never let someone else urge you to see a healthcare provider, unless you absolutely need to see one.
• Never buy any medical supplies or equipment from any door-to-door salesperson, if you did not talk to them prior to showing up. Medicare and Medicaid will never send a representative in person to your home.

The bottom line is that you have to take an active role in controlling your health and your information! Watch out for your medical records, which contain your personal health information. Be on the lookout for any Medicare scams, including fraudulent billing claims, drug prescriptions or medical equipment or services given by health care providers. Lastly, if you have a suspicion that any type of fraudulent activity has been committed, immediately contact your health care provider. Alternatively, you can get in touch with the fraud hotline, provided by the Dept. of Health and Human Services Office of the Inspector General, contact Medicare, or your SMP.

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65Medicare.org is a leading, independent Medicare insurance agency for people turning 65 and going on Medicare. If you have any questions about this information, you can contact us online or call us at 877.506.3378.

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It is a common misconception that seniors have access to free healthcare. That may generally be true for Part A. However, that is not the case for Medicare Part B, Medicare Advantage, Medicare Part D, or Medicare Supplement (Medigap) plans. Below you will see pertinent information on 2019 Medicare costs, including those that are premium-free.

MEDICARE PART A – Premium

Medicare Part A covers inpatient hospital stays, skilled nursing, and rehabilitation up to certain limits, once a deductible is met. If you are hospitalized for longer than 60 days, you will need to pay a share of the expenses; after 90 days, if you’ve already used up your 60 lifetime reserve days, you will be responsible for 100% of your bill.

You Can Get Part A Premium-Free If:

• You already receive Social Security benefits or Railroad Retirement Board benefits.
• You’re eligible to collect Social Security or Railroad benefits but have not yet filed for them.
• You or your spouse had Medicare-covered government employment.

If you’re under 65, you can get premium-free Part A if:

• You have already collected Social Security or Railroad Retirement Board disability benefits for 24 months.
• You have End-Stage Renal Disease (ESRD)and meet certain requirements.

The Part A premium, for most people, is free. Hence, it is usually called “Premium-free” Part A – it is not one of the normal Medicare costs; however, it is not free for those who do not qualify. To qualify, you are required to have completed at least 40 quarters of employment (10 years) of paying Medicare and FICA taxes while working. If you paid Medicare taxes for 30 quarters or less, Part A premium is $437. If you paid Medicare taxes for 30-39 quarters, the Part A premium is $240.

Usually, if you decide to buy Part A, you are required to also have Medicare Part B (Medical Insurance) and pay monthly premiums for both Part A and Part B. For more information about Part A, contact the Social Security Administration.

MEDICARE PART A – Inpatient Hospital Deductible & Coinsurance:

Deductible: $1,364 (for each benefit period)

Coinsurance:

• Days 1-60 $0 (for each benefit period)
• Days 61-90 $341 (per day for each benefit period)
• Days 91+ $682 (per each “lifetime reserve day” after day 90 for each benefit period, up to 60 days over your lifetime)
• Beyond lifetime reserve days: You pay all costs

MEDICARE PART B – Premium

The 2019 monthly Part B premium is $135.50, or higher depending on your income (see IRMAA below). However, if you are already collecting Social Security benefits, the premium may be less, on average $134.

The standard premium amount of $135.50 pertains to you if:

• You are signing up for Part B for the first time
• You are not collecting Social Security benefits
• You are on direct bill for the premiums
• You are on Medicare and Medicaid, and your premium is paid by Medicaid (your state pays the standard $135.50 premium amount)

What is IRMAA?

IRMAA stands for “Income Related Monthly Adjusted Amount”. If your modified adjusted gross income on your IRS tax return 2 years prior is over a certain amount, you will have to pay the standard premium amount plus an IRMAA. In short, it is an additional charge on your premium. See table below.

If your yearly income in 2017 was:

Individual                  Joint                           Married/Separate Tax Return                 Monthly Premium

$85,000 or less            $170,000 or less                        $85,000 or less                                    $135.50

$85,000-170,000         $170,000-214,000                        Not Applicable                                   $187.50

$107,000-133,500       $214,000-$267,000                        Not Applicable                                   $267.90

$133,500-160,000       $267,000-$320,000                        Not Applicable                                   $348.30

$160,000 +                  $320,000 +                              Above $85.000                                   $428.60

Important Note: If you’ve had a life changing event, i.e. you just retired, you might be qualified for a reduction on any of the above amounts. Call Social Security at 800-772-1213, to find out more.

MEDICARE PART B – Annual Deductible

The annual deductible in 2019 for Part B is $185/year. Once you meet that deductible, then you pay 20% coinsurance (the Medicare-approved amount) for covered services, which includes:

• Most doctor services (including while you are in the hospital)
• Any outpatient therapy
• Durable medical equipment

Clinical laboratory services: Cost is $0 for Medicare-approved services

Home health services:

• $0 for home health care services
• 20% of the Medicare-approved amount for durable medical equipment

Outpatient mental health services:

• You are entitled to a free yearly depression screening, provided that your physician or health care provider accepts assignment.
• You pay 20% of the Medicare-approved amount for doctor or other health care provider visits, to diagnose or treat your condition. Part B deductible will apply.

Please note: you might be obligated to pay an additional copayment or coinsurance amount to the hospital, if you receive your services in a hospital outpatient clinic or outpatient department, i.e. if you have x-rays taken by a physician whose office is in a Medical Center or hospital,

Mental health services requiring partial hospitalization:

• You pay a percentage of the Medicare-approved amount for doctors’ services or other qualified mental health professionals, provided they accept assignment.
• You will also pay coinsurance for services in a hospital outpatient setting or community mental health center, while you are an inpatient, and the Part B deductible will apply.

Please be aware that in 2019, there may be limits on physical therapy, occupational therapy, and speech language pathology services. If there are, there may be exceptions to these limits.

Outpatient hospital services:

• Your share is 20% of the Medicare-approved amount for physician or other health care provider’s services. Part B deductible will apply.
• You will usually pay a copayment for all other services in a hospital outpatient setting. That copayment might be higher if in a hospital outpatient setting as opposed to a doctor’s office.
• Some screenings/preventive services might be at no cost, since your coinsurance, copayments and Part B deductible will not apply.

MEDICARE PART C – Medicare Advantage

• Deductibles, copayments, & coinsurance:

The cost for Part C (Medicare Advantage) deductibles, copayments, and/or coinsurance also varies according to which plan you have. To see a list of Medicare Advantage plans in your service area, you can go online at https://www.medicare.gov/find-a-plan. Once you find a plan, you can call that provider for further information and to enroll. Also, note that, on this type of plan, the deductibles, co-pays and overall out of pcoket costs change annually.

MEDICARE PART D – Prescription Drug Coverage

• Part D monthly premiums vary considerably by plan and where you live. Also, if you earn a higher income, you may pay more (IRMAA).

Medigap / Medicare Supplement Plans

• Medigap plans are plans that fill in the gaps in Medicare Part A and B. The premiums for this type of plan are based on several variables including: age, zip code, gender, tobacco use, health, and others in some cases.
• Costs vary tremendously in different parts of the country – in some states, Medigap premiums are as much as 3x other states
• Go here to get a list of current Medigap rates delivered via email

If you have any questions about what your Medicare costs will be in 2019, please visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227) for more information. TTY users call 1-877-486-2048.

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65Medicare.org is a leading, independent Medicare insurance agency for people turning 65 and going on Medicare. If you have any questions about this information, you can contact us online or call us at 877.506.3378.

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Each year, millions of Medicare beneficiaries and their families rely on the information in the “Medicare and You” publication to make healthcare and insurance decisions for the following calendar year. The draft of the 2019 “Medicare and You” book was published in May, and soon after, the three non-profit groups issued a joint letter to Seema Verma, Administrator of the Centers for Medicare & Medicaid Services (CMS). The letter urges CMS to rectify errors in the draft version prior to issuing the 2019 version of the booklet.

The three groups, which advocate for Medicare beneficiaries as opposed to one specific type of insurance plan, outline several significant inaccuracies/biases in the book, including:

• The book does not adequately inform Medicare beneficiaries about the network-based requirements that are inherent in Medicare Advantage programs
• It presents “prior authorization” that is required in Medicare Advantage plans as a “right” that is not available in “original” Medicare. In reality, this is an extra step required of Medicare Advantage members before they can access care, as opposed to Medicare itself, which does not have that requirement.
• Third, the draft version of 2019 “Medicare and You” implies that Medicare Advantage is the clear-cut less expensive option for all beneficiaries. This is a sweeping generalization that does not take into account the numerous variables that impact a Medicare beneficiary choosing the coverage options that are most suited to their individual needs.

This is not the first time there have been widespread objections to the information published in “Medicare and You”. Many stakeholders in the Medicare and Medicare insurance market have encountered Medicare beneficiaries that have been misinformed or confused by the information presented in the book in previous years.

As one example, the “Medicare and You” book always lists all available Medicare Advantage plans for a beneficiaries county, while not listing any Medigap providers or Medigap rates. While the reasons for this are obvious – CMS has oversight of Medicare Advantage and not Medigap – this does cause confusion and misunderstanding for many beneficiaries when selecting a plan.

Medicare Rights President Joe Baker issued a written statement:

“From the Medicare Rights Center’s experience assisting people with Medicare and their families, we know how challenging it can be for beneficiaries to make the best coverage decision for their unique circumstances. The Medicare & You Handbook must support this decision-making process by accurately describing the rules, restrictions, and benefits of both Original Medicare and Medicare Advantage. Regardless of the coverage they ultimately select, all people with Medicare deserve the opportunity to make an informed choice. We commend CMS for incorporating many of the language changes we suggested in prior years, and urge the agency to address our concerns with the draft 2019 Handbook prior to its publication.”

It remains to be seen what will be done in response to the groups’ letter to CMS, if anything. What is certain is that Medicare beneficiaries absolutely must take the time and due diligence to understand Medicare and their Medicare options for themselves. Just like you cannot take what a friend, insurance agent or neighbor says about Medicare as the absolute truth without examining for yourself, you likewise should take carefully consider anything you read from Medicare itself. This can be challenging, but it is essential to making an informed, prudent choice on these important matters.

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65Medicare.org is a leading, independent Medicare insurance agency for people turning 65 and going on Medicare. We have worked with 10,000+ Medicare-eligible individuals over the last 10+ years, assisting with understanding and comparing the plans. You can get a list of Medigap quotes in your area. Or, if you have any questions about this information, you can contact us online or call us at 877.506.3378.

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With the ever-increasing incidence of personal identity theft, Medicare is finally taking action to remove Social Security numbers from Medicare cards. They are doing this by issuing new Medicare cards with new Medicare numbers. This plan was put into place several years ago, but it has taken some time to implement the change. The new Medicare cards will finally begin going out by mail in April 2018.

We fully expect this change to result in much hassle for seniors, doctors, and us. However, it is certainly far overdue and is a change that had to be made. Here are the bottom-line FACTS that you need to know about the new Medicare cards changeover:

When Will the New Medicare Cards Be Sent Out?

The new Medicare cards be begin to be mailed out in April of 2018. They are being sent out in waves, a few states at a time. The first wave of cards will go out between April 2018 and June 2018. They will be sent to residents of the following states: Alaska, American Samoa, California, Delaware, District of Columbia, Guam, Hawaii, Maryland, Northern Mariana Islands, Oregon, Pennsylvania, Virginia and West Virginia.

Other states will fall into other groups (total of 7 groups), and their cards will be mailed out in subsequent months. Those have not been publicly announced yet, but it would be after June 2018. The mailings of the new Medicare cards will be complete by April 2019. If you want to know exactly when your Medicare card will be sent, you should periodically check the CMS website.

Do I Need to Do Anything Before the New Medicare Cards are Sent?

You should always make sure that your mailing address is correct with Social Security. If you currently receive mail from them, then it should be correct. But if your address needs to be corrected, contact Social Security at ssa.gov/myaccount or 800.772.1213.

Also, it is important to note that there will likely be many unscrupulous scam attempts as a result of this change. Do not give out personal or private information to anyone who contacts you about your new Medicare card. Social Security/Medicare will never ask for your personal information or require you to give anything in order to get your new Medicare card.

Again, and we cannot reiterate this enough, you should never give out your personal information by phone to anyone claiming to be from Social Security or Medicare. This includes your Social Security number, Medicare claim number and any other personal information. Medicare will not ever call you to obtain this information.

What Changes with the New Medicare Cards?

The new Medicare cards are part of a “fraud prevention project that removes Social Security numbers from Medicare cards to help combat identity theft and safeguard taxpayer dollars.” Your Medicare benefits will not change in any way as a part of this change.

What will change is the identification number that is listed on your Medicare card. It will no longer be tied to your, or a spouse’s, social security number. On the contrary, it will be a unique number that is 11 digits and is alpha-numeric. This number will be unique to you.

What Should You Do When You Get Your New Medicare Card?

When your new Medicare card arrives by mail (between April 2018 and April 2019), you should destroy your old card and start using your new card right away.

It is important to take care when destroying the old card. Remember, the reason for this change is to remove personal, sensitive information from the Medicare card, so take care in your final step of destroying the card to avoid your personal information is not still accessible (i.e. don’t just throw the whole/complete Medicare card in your household trash).

Does Anything Change As Far as How You Use Your Medicare Card?

No, the new Medicare cards will be tied to your personal Medicare account. You will just start using the new Medicare card right away and providers will be able to use the new identification number as a way to file claims and communicate with Medicare about your benefits.

It also does not affect anything about Medigap/Medicare Supplement insurance or Medicare Advantage insurance. You would keep using those cards as you do now, and no identification numbers on those cards are changing.
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If you have any questions about this change or if we can help you with anything related to this process or Medicare/Medigap itself, you can contact us here or by calling 877.506.3378.

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