According to a recent article on Marca.com, Medicare Advantage users have good news: payments to these plans are jumping 5.06% in 2026, more than double the originally proposed 2.23% increase announced in January.

Why the Big Increase?
The Centers for Medicare & Medicaid Services (CMS) cited updated data as the primary driver. Fresh fee-for-service payment data through Q4 2024 pushed the effective growth rate from 5.93% to 9.04%, reflecting rising healthcare expenses.
This $25+ billion windfall for insurers represents the largest benchmark increase in a decade and marks the first major Medicare move under the Trump administration, contrasting with the Biden era's tighter 0.2% decrease for 2025.

Industry Impact
Major insurers like UnitedHealth and Humana will decide how these funds affect premiums and benefits for beneficiaries. Humana's stock soared 11.5% after the announcement, showing Wall Street's confidence. The Better Medicare Alliance praised the decision, calling it protection for seniors and full funding for Medicare Advantage.
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What It Means
With $9.2 trillion projected for Medicare Advantage over the next decade and over 32 million of the 65 million Medicare beneficiaries enrolled in MA plans, this increase could significantly impact plan options and out-of-pocket costs in 2026. CMS also finalized a three-year risk adjustment phase-in to improve payment accuracy and prevent over-coding.

Are you feeling stuck with a Medicare Advantage plan that isn't meeting your needs? Many seniors don't realize they have another opportunity to make changes after the Annual Enrollment Period ends. This little-known second chance period could be your pathway to better coverage.

Understanding the Medicare Advantage Open Enrollment Period
While the Annual Enrollment Period (October 15 - December 7) gets most of the attention, the Medicare Advantage Open Enrollment Period runs from January 1 through March 31 each year. This special enrollment window provides flexibility for those who missed the earlier deadline or discovered their current Medicare Advantage plan isn't working as expected.

During this period, you have options. If you're currently enrolled in a Medicare Advantage plan, you can:

• Switch to a different Medicare Advantage plan
• Return to Original Medicare (and potentially enroll in a Part D prescription drug plan)
  
  

Why Consider Making a Change?
There are numerous reasons why your current Medicare Advantage plan might not be meeting your expectations:

Your doctors or preferred healthcare facilities may no longer be in-network, requiring you to find new providers or pay higher out-of-pocket costs. Perhaps your prescription medications have changed, but your current plan's formulary doesn't cover your new medications adequately. Many beneficiaries also discover unexpected coverage gaps for specific treatments or services they need.

Some find that their plan's premiums, deductibles, or copayments increased more than anticipated. Others may have experienced service issues, such as difficulty getting claims approved or reaching customer service representatives.

Taking Action During the Open Enrollment Period
If any of these scenarios sound familiar, don't continue struggling with inadequate coverage. This special enrollment period exists specifically to help beneficiaries find better solutions for their healthcare needs.

The process for changing plans is straightforward, but navigating the options requires careful consideration of your specific health needs, preferred providers, and budget constraints. Working with an experienced Medicare advisor can help ensure you select the most appropriate plan.

Next Steps to Better Coverage
Begin by reviewing your current healthcare needs, including regular doctors, specialists, facilities, and prescriptions. Compare these against the networks and formularies of available Medicare Advantage plans in your area.

Consider coverage for any planned procedures or ongoing treatments you may need this year. Evaluate the total cost picture, including premiums, deductibles, and expected out-of-pocket expenses based on your typical healthcare usage.
Don't miss this valuable opportunity to improve your healthcare coverage. The Medicare Advantage Open Enrollment Period only runs through March 31, giving you limited time to make this important decision.

Reach out today to explore your options and find a Medicare Advantage plan that truly serves your health needs and financial situation. A simple phone call could be the first step toward better, more affordable healthcare coverage for the rest of the year. 

The Centers for Medicare & Medicaid Services has released the 2025 cost structure for Medicare Parts A and B, including key changes to premiums, deductibles, and coinsurance amounts. Here is a summary from the CMS website:

Part B Changes
- Standard monthly premium increases to $185 (up $10.30 from 2024)
- Annual deductible rises to $257 (up $17 from 2024)
- Higher premiums apply for approximately 8% of beneficiaries through income-related monthly adjustment amounts (IRMAA) for both Parts B and D

Part A Updates
- Most beneficiaries maintain $0 premium
- Full premium of $518/month applies to those with less than 30 quarters of qualifying work history
- Reduced premium of $285/month for those with 30-39 quarters
- Hospital deductible increases to $1,676 (up $44)
- Inpatient coinsurance for days 61-90 rises to $419 per day
- Skilled nursing facility coinsurance for days 21-100 increases to $209.50 per day

2025 Medicare Parts A & B Premiums and Deductibles - Detailed Summary

The 2025 Medicare cost adjustments reflect CMS's response to projected price changes and historical utilization patterns. For Part B, beneficiaries face moderate increases in both monthly premiums and deductibles, with the standard premium rising by $10.30 to $185 and the annual deductible increasing by $17 to $257.

Part A costs show similar upward trends, particularly affecting those who must pay premiums due to limited work history. While most beneficiaries continue to receive premium-free Part A coverage, those required to pay face monthly premiums of either $518 (full) or $285 (reduced), depending on their work credits. Hospital-related costs are also increasing, with the inpatient deductible rising to $1,676 and higher daily coinsurance rates for extended stays in both hospitals ($419) and skilled nursing facilities ($209.50).

Income-related monthly adjustment amounts continue to affect approximately 8% of Medicare beneficiaries, requiring them to pay higher premiums for both Part B and Part D coverage based on their income levels. These adjustments ensure that higher-income beneficiaries contribute proportionally more to the program's funding.

These changes reflect CMS's ongoing efforts to maintain program sustainability while balancing beneficiary costs with healthcare service delivery. The adjustments account for both anticipated price changes and expected utilization patterns based on historical data.

If you have questions about your Medicare coverage, connect with Ted for a complimentary consultation.

This recent Newsweek.com article:
https://www.newsweek.com/new-medicare-rule-could-force-seniors-switch-health-insurance-1928581 carefully examines a new Medicare rule under the Inflation Reduction Act could require seniors to switch health insurance plans or face penalties. This change particularly affects those who continue working past 65 and remain on their employer's health plan instead of Medicare.

Currently, seniors can avoid late penalties for Medicare Part D if their company's plan pays, on average, as much as the traditional Medicare prescription drug plan. However, starting January 1, employer plans may no longer be accepted to avoid these penalties due to changes in Part D coverage.

The key change is the introduction of a $2,000 out-of-pocket maximum for Part D coverage. Many employer plans have combined health and prescription maximums exceeding $2,000, potentially disqualifying them as creditable coverage. This could subject Medicare-eligible employees to late enrollment penalties.

The late enrollment penalty applies if, after the initial enrollment period, a person goes 63 or more days without Medicare drug coverage or a creditable employer-provided plan. The penalty is calculated as 1% of the national base beneficiary premium ($34.70 for 2024) multiplied by the number of months without coverage. This amount is permanently added to the monthly Part D premium.

To avoid confusion and potential penalties, seniors should take proactive steps:

1. Call ahead to ensure their Part D insurance replacement remains creditable.
2. Pay close attention to notifications from insurers about the creditable status of their prescription drug coverage.
3. Be mindful of these changes, especially if continuing to work past retirement age with employer-provided health insurance.

A financial literacy instructor at the University of Tennessee at Martin, Alex Beene, emphasizes the importance of this issue, noting that seniors are already facing high healthcare costs. He advises seniors to be vigilant about these changes to avoid missing out on significant savings.

The new rule presents a challenge for seniors who must now carefully evaluate their current coverage against the new Medicare standards. Those with employer plans that don't meet the $2,000 out-of-pocket maximum may need to consider switching to Medicare Part D to avoid penalties. This change underscores the complexity of healthcare decisions for older Americans and the need for clear communication and guidance from both employers and Medicare to help seniors navigate these important choices.

Contact Ted Czabanowski if you have any questions about .your current Medicare plan.

In the recent Forbes Magazine article titled: Biden's In Inflation Reduction Act Unravels Medicare Part D, the point is made that while the act may reduce inflation in parts of the US economy, it appears that it will also raise costs for seniors in the Part D program.
 
​The Inflation Reduction Act (IRA) of 2022, touted by Democrats as a means to lower Medicare costs for seniors, is having unintended consequences on Medicare Part D coverage. The Act authorized drug pricing "negotiations" and introduced measures like a $2,000 cap on annual out-of-pocket prescription costs and a 6% limit on yearly Part D premium increases.

However, the reality is that seniors themselves are bearing the cost of these supposed savings through hidden premium increases. The IRA's interventions are making the Part D drug benefit less attractive for insurers, leading to a significant reduction in plan options. Since 2006, the number of available plans has dropped by over 50%, with an 11% decrease in the past year alone.

Moreover, the remaining plans have become considerably more expensive. The average standalone Part D plan now costs $48 per month, a 21% increase from the previous year, with steeper increases projected for 2025. The new guidance is expected to exacerbate these trends, potentially leading to more restrictive measures like prior authorization or step therapy requirements.

The core issue lies in the IRA's focus on saving government money rather than benefiting seniors directly. While some provisions do save money for certain seniors, they shift costs onto insurers. The Medicare premium increase cap, advertised as 6%, applies only to one calculation used in setting monthly premiums, allowing actual costs to rise by 20-40% while still complying with the cap.

Furthermore, the price controls implemented by the IRA may deter generic competitors from entering the market when drugs go off-patent. The new guidance also indicates that Medicare officials will continue setting drug prices with minimal input from physicians and without a process to monitor the impact on medicine availability for seniors.

In essence, the Inflation Reduction Act, contrary to its promises, is leading to higher premiums, fewer choices, increased government control, and a situation where patients and doctors are left to navigate the consequences. While officials may overlook these issues, the Act appears to be undermining the Medicare drug benefit it was meant to improve.

Contact Ted Czabanowski if you have any questions about .your current Medicare plan.

A recent article in Forbes Magazine discusses whether it’s possible to use a Health Savings Account (HSA) to pay for Medicare premiums. While HSAs are typically used for medical expenses, including qualified health insurance premiums, Medicare premiums are an exception. You cannot directly pay Medicare premiums from your HSA. However, you can use other funds to cover these costs. It’s essential to understand the rules and limitations to make informed decisions about managing your healthcare expenses. Keep in mind that this information is accurate as of the article’s publication date in February 2024.

​Can You Pay Medicare Premiums From Your HSA?
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There's often confusion surrounding whether you can directly pay your Medicare premiums from your HSA. Let's clarify:

1. Technically, No Direct Payment: You cannot directly pay your Medicare premiums from your HSA. However, you can still use your HSA funds to cover these costs.

2. Reimbursement: Most people have their Medicare premiums deducted from their Social Security checks. Even if this is the case, you can reimburse yourself for premiums paid from your HSA.

3. Eligible Premiums: Once you turn 65 and enroll in Medicare:
   - You can use HSA money tax-free to pay premiums for Medicare Part B and D.
   - Medicare Advantage plans are also eligible for reimbursement.
   - However, premiums for Medicare supplement policies are not eligible for tax-free reimbursement from an HSA.

4. Contributions After Medicare Enrollment: While you can no longer contribute to your HSA once you're on Medicare, you can still keep your existing HSA account active. It can continue earning interest or be invested.

5. No HSA Withdrawal Deadline: Unlike other accounts, there's no deadline for HSA withdrawals. You can let your money grow and reimburse yourself for medical expenses well into the future.

6. Tax Advantages:
   - HSA funds offer triple tax advantages:
     - Contributions via payroll are not subject to Social Security, Medicare, or income taxes.
     - Investment growth within the HSA is tax-free.
     - Funds can be withdrawn tax-free for medical expenses (including Medicare premiums).

7. 2024 HSA Contribution Limits:
   - Single individuals can contribute up to $4,150 (a 7.8% increase from 2023).
   - Families can contribute up to $8,300 (a 7.1% increase from 2023).
   - HSA users aged 55 and older can contribute an additional $1,000.

8. HSA Eligible Expenses:
   - Qualifying expenses include medical copays, dental cleanings, prescriptions, and even colonoscopies.
   - Surprisingly, you can't pay health insurance premiums with HSA funds—except for Medicare premiums, which are eligible for reimbursement.

9. Consider HSA as a Retirement Account:
   - Given rising healthcare costs for retirees, consider using your HSA as a de facto retirement account.
   - Consult a tax-focused financial planner to maximize your HSA benefits.

Remember that this information is accurate as of now, and it's essential to stay informed about any changes or updates related to HSAs and Medicare.

Contact Ted Czabanowski if you have any questions about .your current Medicare plan.

According to this recent article on cbs42.com, Medicare is expand drug coverage to cover drugs that treat conditions related to obesity, but not drugs used for weight loss purposes: 

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​The Centers for Medicare and Medicaid (CMS) has issued new guidance regarding the coverage of anti-obesity medications. However, there’s a catch: these medications will be covered only when they are indicated for treating conditions other than obesity itself. Specifically, the recent expanded indication of the anti-obesity medication Wegovy (semaglutide) informed CMS’s decision.
Wegovy recently received FDA approval for reducing the risk of cardiovascular death, heart attack, and stroke in patients with both cardiovascular disease and obesity. As a result, Medicare Part D and Medicaid coverage rules now apply to Wegovy based on its updated use. 
It’s important to note that Medicare has historically been prohibited from covering weight loss treatments due to the Medicare Modernization Act of 2003. Back then, concerns about dangerous side effects associated with weight loss drugs, such as fenfluramine/phentermine, led to this restriction.
The Treat and Reduce Obesity Act, currently introduced in Congress, aims to expand coverage under Medicare for health care providers, services, and drugs related to obesity treatment. Advocates, including obesity medicine groups and drugmakers like Novo Nordisk, have been lobbying for the bill’s passage.
Wegovy belongs to a newer class of drugs known as GLP-1 agonists, which mimic a gut hormone to stimulate insulin production and suppress appetite. In a multi-national study, Wegovy was found to statistically reduce the risk of major adverse cardiovascular events by 20 percent. 

If you have any questions about what your Medicare plan will or will not cover, contact Ted Czabanowski for assistance.

Per this article from CNN.com, the Centers for Medicare and Medicaid Services announced that the standard monthly premium for Medicare Part B will increase by $9.80 to $174.70 in 2024, up from $164.90 in 2023. The annual deductible for all Medicare Part B beneficiaries will be $240 in 2024, an increase of $14 from the annual deductible of $226 in 2023. The increase is mainly due to projected increases in health care spending and payments that the agency has proposed making to hospitals that typically serve larger shares of disadvantaged patients. 

Medicare Part B covers physician services, outpatient hospital services, certain home health services, durable medical equipment, and certain other medical and health services not covered by Medicare Part A.

​The good news is that In October 2023, the Social Security Administration announced that Social Security recipients will receive a 3.2% cost-of-living adjustment  (COLA) for 2024. While this is significantly lower than the inflation-fueled boosts of the past two years, this monthly increase of $59 on average, will increase estimated monthly benefits to $1,907, to help retirees offset the aforementioned Medicare premium increase. NOTE: These Social Security monthly benefit amounts are before Medicare premiums are automatically deducted.

Medicare premiums have fluctuated in recent years. In 2022, the standard monthly premium spiked by 14.5% to $170.10 due to a projected jump in spending caused by a costly new drug for Alzheimer’s disease named Aduhelm. However, the manufacturer then cut the price, and CMS limited coverage of the drug. As a result, the standard monthly premiums decreased by $5.20 to $164.90 for this year, marking the first year-over-year drop in more than a decade.

One more positive note, the Medicare Extra Help Program is expanding in 2024. where some Medicare recipients will be moved from partial to full coverage for certain prescription costs.

Need help navigating the complexities of elder care insurance in 2024? Connect with Ted Czabanowksi for a complimentary consultation.

In this detailed and most informative article:
www.myfederalretirement.com/hsa-medicare by Edward A. Zurndorfer, a Certified Financial Planner, Zurndorfer discusses the pitfalls of Health Savings Accounts (HSAs) and Medicare for federal employees over 60 years old who own HSAs. Zurndorfer explains how HSAs work and how they can be used to pay for qualified medical expenses in a tax-beneficial way. HSAs offer triple tax savings, including contributions made with before-taxed dollars, earnings that accrue over time and are tax-free when used to pay for qualified medical expenses, and tax-free withdrawals that can be made before and throughout retirement to pay for qualified medical expenses. Qualified medical expenses during retirement include medical and dental care expenses not paid by insurance, long-term care insurance premiums, hearing aids, custodial care nursing services not covered by insurance, and the reimbursement for Medicare Part B and Part D monthly premiums. However, there are important rules that an HSA owner in their early 60s needs to heed in order to avoid being subject to an IRS penalty when the HSA owner enrolls in Medicare. The article discusses when an HSA owner must stop contributing to an HSA and how an HSA owner can continue to use HSA dollars to pay qualified medical expenses after the HSA owner enrolls in Medicare. Upon reaching age 65, an HSA owner can also make penalty-free withdrawals to pay for any nonqualified medical expense such as home repairs or personal expenses.
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HSAs and Medicare have eligibility rules that prohibit HSA owners from contributing to their HSA or receiving contributions from their employer when enrolled in any part of Medicare. If contributions are made to the HSA after enrollment in Medicare, the HSA owner will be subject to an IRS excise tax penalty. For instance, if an individual is currently contributing to an HSA and plans to enroll in Medicare the month before they become 65, they must ensure all HSA contributions cease before the month they become 65. An HSA owner whose 65th birthday is on the first day of any month should stop their HSA contributions by the beginning of the month before they become 65. Federal retirees enrolled in an HDHP associated with an HSA should change their FEHB program enrollment to a non-HDHP plan if they know they will become 65 in the coming year.

If you are enrolled in any part of Medicare, you cannot contribute to your HSA or receive contributions from your employer. If you make contributions to your HSA after enrolling in Medicare, you will be subject to an IRS excise tax penalty. To avoid the penalty, you should stop contributing to your HSA at least six months before applying for Medicare Part A or both Medicare Part A and Medicare Part B or starting your Social Security retirement benefits. The “6-month lookback” rule starts when an HSA owner over age 65 enrolls in Medicare or starts to receive their Social Security retirement benefits. However, to avoid the IRS excise tax penalty, the HSA owner should withdraw those HSA contributions by the end of the tax year. This HSA restriction leads some HSA owners working past age 65 to defer enrolling in Medicare and maintaining their current employer-based health insurance coverage so that they can continue contributing to their HSA until they retire.