As of this time of post, we’re a little over a few weeks into the start of Medicare’s Annual Enrollment season for 2026 plans.
Have you notice less advertising for Medicare Advantage this year compared to previous years?
Sure, you still get a ton of telemarketer calls. That’s not going to stop anytime soon. But overall Medicare marketing spending is down.
Why is this? Well, it’s the usual suspects: Healthcare utilization and the costs that come with it are rising much faster than the government’s reimbursement rates paid to insurers.
And on top of that, there’s the impact of the Inflation Reduction Act which shifted the burden of paying the majority of the costs (60%) of covered prescription drugs above the $2000 out of pocket cap onto the insurance companies.
Prior to this change, the Government picked up most of the tab when you reached the Catastrophic stage of your prescription drug plan.
This is why you’re seeing less advertising. Insurers are cutting back. The extra benefits that Joe Namath, and Jimmy Walker used to tout will be skimpier next year on some plans,
And while $0 premium plans are still being offered the cost sharing on some of those plans have increased.
I’ve also noticed prescriptions like Ozempic and Trulicity will have Prior Authorization requirements with several plans next year.
That means if your current plan is covering these drugs and you switch plans; you’ll need to get a new prior authorization in a hurry in January. And hope and pray the plan accepts it. Otherwise, you’re going to have to find an alternative prescription that the plan will cover.
You might just be better off staying with the plan that’s already covering your prescriptions, if the costs aren’t changing significantly in 2026.
This fall is probably the most important time than ever before to study your Advantage or stand-alone Part D plan’s Annual Notice of Change booklet to learn what’s changing next year
You don’t want to wait until January to find out your most expensive prescription is no longer covered, or your doctor is no longer in network,
Take the time now to review what’s changing. If you don’t understand what’s changing, get with someone who can help explain it to you,
And if you don’t like what’s changing, now is the time to review your options.
If you’re healthy enough to qualify for a supplemental Medigap plan, one of your options is returning to Original Medicare, where things don’t change every year all that much, other than your annual Medigap plan premium increases.
And you won’t have to worry about whether your doctor, or hospital is in network, because there is no network. On Original Medicare you have the freedom to see any doctor or hospital anywhere in the U.S. that accepts Medicare.
Now you will still have to deal with the drama of standalone drug plans changing every year. There’s no escaping that. But there are tools online that make it very easy to compare and enroll in plans if you do need to make a change.
Bottom line, the way Medicare Advantage and Part D drug plans are currently designed are unsustainable under the Inflation Reduction Act.
Insurers may have to go back to the drawing board. $0 or very low premiums plans may have to go bye bye. They may have to introduce medical deductibles. Some plans are already doing that now.
And if you want a lower Maximum out of Pocket, you just might have to start paying a higher premium for it. It just makes sense.
But if you do have to pay a higher premium and you still have significant cost sharing, you might want to compare that to Original Medicare supplemented with a Medigap plan.
First, you’ll want to determine if the monthly premium for a Medigap plan is affordable for your budget.
And if it is, you’ll want to find out if you will medically qualify for underwriting, it only takes a few minutes to find out. Talk to a qualified agent who is proficient in underwriting. Not all are. Especially if they mainly sell Advantage plans where there is no underwriting involved.
Once you’re fairly confident you’ll qualify, here’s how the application process works:
You submit an application to the carrier, for a future effective date that you want the policy to begin, During the Annual Election Period, when you’re wanting to return to Original Medicare, that would be January 1st.
If approved, you can begin the process of returning to Original Medicare effective January 1st by selecting and enrolling in a Standalone Part D plan during the Annual Enrollment period between October 15th and December 7th.
It’s important to NOT do this prior to receiving an approval from the Medigap plan, because enrolling in a Standalone Part D drug plan is the trigger that notifies Medicare that you are returning to Original Medicare on the effective date.
If you do this prior to being approved for a Medigap plan, you’ll be returned to Original Medicare come January 1st without any supplemental coverage that picks up most of Medicare’s out of pocket cost sharing.
If you just have Part A and B only, you’re responsible for 20% of the Part B medical expenses with no maximum out of pocket limit. And a $1676 deductible for 2025 on Part A Hospitalization for the first 60 days. And beyond 60 days you have a significant daily copay to meet.
You don’t want to be on Original Medicare only unless you’re wealthy and can afford to self-insure the potential unlimited cost-sharing.
So, make sure you’re approved by underwriting with the Medigap plan before you enroll in a standalone Part D plan, if you are returning to Original Medicare next year.
I hope this helps someone. Let me know in the comments if you have any questions.