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Glaucoma and Medicare

Tue, 31 Mar 2026 06:00:10 GMT

What You Need to Know About Protecting Your Vision

Did you know that about half of people with glaucoma don’t even know they have it?

Glaucoma is often called the “silent thief of sight” because it develops slowly and often with no noticeable symptoms in the early stages. By the time vision changes become obvious, it usually means permanent damage has already occurred.

What is glaucoma? It’s actually a group of eye diseases, not just one single disease. What they all have in common is that they damage the optic nerve, which is the vital connection between your eye and your brain. It’s often associated with increased pressure inside the eye, but it can occur even when eye pressure is normal. Left untreated, glaucoma can lead to permanent vision loss and even blindness.

Early detection and treatment are crucial to slow or prevent further vision damage. That’s why regular screenings are essential if you are at a higher risk for glaucoma based on your genetics or family history.

Why Early Detection Matters

In its early stages, glaucoma typically has no warning signs. There’s no pain or sudden changes in vision. The most common form, called open-angle glaucoma, gradually reduces peripheral (side) vision first. Because central vision remains clear for a long time, it can take quite a while to realize anything is wrong.

Other, less common types, such as angle-closure glaucoma, can develop more suddenly and may cause more obvious and acute symptoms like severe eye pain, headache, nausea, blurred vision, or seeing halos around lights. These symptoms require immediate medical attention.

The only way to know if you have glaucoma is through a comprehensive, painless eye exam that includes specific tests to check:

Eye pressure
Optic nerve health
Peripheral vision
Drainage angle of the eye

According to the National Eye Institute , regular eye exams are critical, especially as we age, because early treatment with prescription eye drops, laser therapy, or surgery can help prevent further vision loss.

Vision lost from glaucoma cannot be restored, which makes early detection essential.

Medicare Coverage for Glaucoma Screenings

Medicare Part B covers glaucoma screenings once every 12 months for people who are considered high risk (see the list below).

The screening must be performed (or supervised) by an eye doctor who is legally allowed to provide the service in your state, such as an ophthalmologist or optometrist.

If you qualify as high risk and receive your screening from a provider who accepts Medicare assignment, Medicare Part B will cover 80% of the approved amount (once your Part B deductible has been met). You would be responsible for the remaining 20% as coinsurance.

It’s important to confirm that your provider accepts Medicare assignment to help minimize out-of-pocket costs. If you have a Medicare Advantage plan, coverage rules may vary slightly, so review your plan details, or ask us to help determine what your coverage is.

Who Is at Higher Risk for Glaucoma?

While anyone can develop glaucoma, certain groups have a higher risk. Medicare considers you at high risk if at least one of the following applies:

You have diabetes
You have a family history of glaucoma
You are African American and age 50 or older
You are Hispanic and age 65 or older

Because risk increases with age, glaucoma screening becomes even more important for Medicare beneficiaries.

Protecting Your Vision Starts with a Conversation

If you fall into a high-risk category, talk with your primary care provider or eye doctor about scheduling a glaucoma screening. Your vision plays a major role in your independence, safety, and overall quality of life. When it comes to your eyesight, waiting for symptoms isn’t a safe strategy. A simple, painless screening once a year could help preserve it for years to come.

If you have questions about how your Medicare coverage works, including preventive screenings like glaucoma testing, reach out to review your benefits and make sure you’re taking full advantage of what’s available to you.

Delicious Foods That Fight Diseases

Tue, 24 Mar 2026 06:00:00 GMT

Eat for Your Health

Eating well is one of the simplest ways to support long-term health. While no food can cure or prevent disease on its own, many everyday foods contain nutrients that help strengthen the immune system, reduce inflammation, and support overall wellness. The good news? Many of these foods are both familiar and delicious.

Colorful Fruits and Vegetables

Fruits and vegetables are packed with vitamins, minerals, and antioxidants that help protect the body from cell damage. Berries like blueberries, strawberries, and raspberries are especially rich in antioxidants that support brain and heart health. Leafy greens such as spinach and kale provide essential nutrients like vitamins A, C, and K, along with fiber that supports digestion and cardiovascular health. A simple rule of thumb is to add more color to your plate—each color offers different health benefits.

Healthy Fats That Support the Heart

Not all fats are created equal, and healthy fats play an important role in fighting disease. Fatty fish such as salmon and sardines contain omega-3 fatty acids, which are known to support heart health and help manage inflammation. Plant-based options like walnuts, chia seeds, flaxseeds, and avocados provide similar benefits and are easy to add to meals or snacks.

Whole Grains and Plant Proteins

Whole grains and legumes help fuel the body while supporting stable blood sugar and digestive health. Foods like oats, quinoa, brown rice, beans, and lentils are high in fiber and nutrients that may reduce the risk of heart disease and support weight management. These foods also help you feel full longer, making them a smart choice for everyday meals.

Herbs, Spices, and Gut-Friendly Foods

Small additions can make a big impact. Garlic has long been associated with immune support, while turmeric contains curcumin, a compound known for its anti-inflammatory properties. Fermented foods such as yogurt, kefir, sauerkraut, and kimchi contain probiotics that support gut health—which plays an important role in immunity and overall wellness.

Small Changes, Big Benefits

Healthy eating doesn’t require drastic changes. Simple steps like adding an extra serving of vegetables, choosing whole grains more often, or enjoying fish once or twice a week can support better health over time. When paired with preventive care, good nutrition becomes another powerful way to invest in your well-being.

Eating well should be enjoyable, not stressful. With so many tasty foods that also support your health, fighting disease can begin with something as simple as your next meal.

ACA Marketplace Plans and Tax Season

Tue, 17 Mar 2026 06:00:00 GMT

What ACA Participants Need to Know Before They File

When tax season rolls around, many people enrolled in an Affordable Care Act (ACA) Marketplace plan are surprised to learn that their health coverage and their tax return are closely connected.

If you purchased coverage through the Marketplace, here’s what you need to remember when filing taxes — and how to avoid costly mistakes.

1. You Should Receive Form 1095-A

If you had Marketplace coverage for any part of the year, you’ll receive Form 1095-A: Health Insurance Marketplace Statement .

This form includes:

The months you had coverage
The total premium for your plan
The amount of Advance Premium Tax Credit (APTC) paid on your behalf
The “benchmark” premium used to calculate your subsidy

Do not file your tax return without it. The information on this form is required to complete IRS Form 8962.

2. You Must Reconcile Your Premium Tax Credit

If you received Advance Premium Tax Credits (APTC) to lower your monthly premium, you are required to reconcile that amount when you file your federal tax return. When you received Advance Premium Tax Credits , the government estimated your subsidy based on:

Your projected annual income
Household size
Tax filing status

Because that was just an estimate, the IRS requires you to compare (reconcile) the estimated credit to what you actually qualified for based on your final income.

If your actual income was lower than estimated , you may qualify for additional premium tax credit , increasing your refund.
If your actual income was higher than estimated , you may have to repay some or all of the advance credits you received.

How Does This Reconciliation Happen?

Reconciliation happens when you file your federal tax return. If you received APTC, you will file your taxes using Form 1095-A and Form 8962 . Form 8962 is attached to your Form 1040.

Most tax software completes this automatically once you enter your 1095-A information.

3. Changes in Income Matter

Common life events that affect your subsidy and your taxes include: raises or bonuses, job loss, starting self-employment, marriage or divorce, birth or adoption of a child, and a dependent no longer qualifying.

If these changes weren’t reported to the Marketplace during the year, it can result in a tax surprise.

4. Filing Status Is Critical

Premium tax credits are generally only available if you file Married Filing Jointly (if married). Married individuals who file Married Filing Separately are typically not eligible for premium tax credits, with limited exceptions for domestic abuse or abandonment situations.

This is an important planning conversation before tax filing.

5. Self-Employed Individuals Have Special Considerations

For self-employed clients:

Marketplace premiums may be deductible as a self-employed health insurance deduction.
However, the premium deduction interacts with the premium tax credit calculation.

This can create a circular calculation that tax software usually handles — but it’s important to understand the interplay to avoid errors.

6. If You Don’t File, Future Subsidies May Be At Risk

Even individuals who are not otherwise required to file taxes must file if they received advance credits. Failure to file and reconcile premium tax credits can result in:

Loss of eligibility for advance premium tax credits in future years
Delays in coverage renewals

Final Thoughts

ACA Marketplace coverage provides valuable financial assistance, but that assistance is tied directly to your tax return.

The key takeaway: Your health insurance and your taxes are connected — and accuracy matters.

If you have questions about how income changes may affect your Marketplace subsidy, or if you anticipate life changes this year, it’s wise to review your coverage proactively rather than waiting for tax season surprises.

This article is for informational purposes only and does not constitute tax advice. Consult a qualified tax professional regarding your specific situation.

IRMAA and Your Taxes in 2026

Thu, 12 Mar 2026 18:54:51 GMT

What You Need to Know Before Filing

If you're on Medicare—or about to enroll—there’s a little acronym that can have a big impact on your wallet: IRMAA. Short for Income-Related Monthly Adjustment Amount, IRMAA is an additional charge added to your Medicare Part B and Part D premiums if your income exceeds certain thresholds. As tax season approaches, it’s a good time to understand how IRMAA works, how it’s calculated, and what you can do to plan ahead.

What Is IRMAA?

IRMAA is not a penalty or a late fee. It’s an income-based surcharge that applies to Medicare beneficiaries who earn above a certain level. The idea is that individuals with higher incomes can afford to contribute more to the cost of their Medicare coverage.

If IRMAA applies to you, it will be added to your Part B premium (which covers doctor visits and outpatient services) and, if you have it, your Part D premium (for prescription drug coverage).

2026 IRMAA Thresholds

Your IRMAA amount is based on your modified adjusted gross income (MAGI) from two years prior—which means in 2026, the Social Security Administration (SSA) will look at your 2024 tax return. MAGI includes your adjusted gross income (AGI) plus tax-exempt interest income.

Here are the 2026 IRMAA thresholds (based on 2024 income):

For individuals, IRMAA does not apply if your 2024 modified adjusted gross income (MAGI) is $109,000 or less. IRMAA does apply if your income is above $109,000.
For married couples filing jointly, IRMAA does not apply if your 2024 MAGI is $218,000 or less. IRMAA does apply if your income is above $218,000.

The amount of IRMAA increases in tiers. The higher your MAGI, the more you may pay in additional premiums. These charges are automatically calculated and communicated by the SSA each year.

Why IRMAA Matters at Tax Time

Since IRMAA is based on your income from two years ago, your tax planning should include a forward-looking strategy—especially if you're approaching retirement or expect significant income changes.

For example, if you’re planning to retire in 2026, your 2025 income could trigger IRMAA surcharges in 2027. Even if your income drops after retirement, your Medicare premiums could remain high temporarily unless you take action. That’s why it pays to start thinking about IRMAA before you leave the workforce.

Tax Strategies to Reduce Future IRMAA Charges

Here are a few ways to plan ahead and potentially reduce your future IRMAA costs:

Time capital gains and Roth conversions wisely: Large one-time income events—like selling a property or converting a traditional IRA to a Roth—can increase your MAGI. If possible, spread these over multiple years to stay under IRMAA thresholds.
Delay Social Security: If you don’t need the income right away, delaying your Social Security benefits could reduce your MAGI during key years and help you avoid IRMAA.
Coordinate with retirement withdrawals: Work with a financial advisor to plan your distributions from tax-deferred accounts in a way that manages your taxable income.

What If You’ve Already Retired or Your Income Has Dropped?

Let’s say your income has decreased since 2024 due to retirement, the loss of a spouse, or another life event. You may request a reduction in your IRMAA amount through the SSA's reconsideration process.

This is particularly useful if your current income is much lower than what’s shown on your 2024 tax return.

How the Reconsideration Process Works

If you think your IRMAA determination is based on outdated or incorrect income information, or if you've experienced a life-changing event, you can file Form SSA-44: Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event.

Qualifying life events include:

Retirement or reduction in work hours
Marriage or divorce
Death of a spouse
Loss of income-producing property
Loss of pension income
Settlement from an employer

You’ll need to provide documentation of the event and your reduced income. If approved, SSA may lower your IRMAA or remove it entirely for the current year.

To learn more or access the form, visit ssa.gov/medicare/lower-irmaa .

A Final Word on IRMAA and Planning Ahead

IRMAA is a tax-related surprise that many Medicare beneficiaries don’t expect, especially those transitioning into retirement, but it doesn’t have to catch you off guard. By understanding how IRMAA is calculated, staying below the income thresholds where possible, and knowing your appeal rights, you can keep your Medicare premiums manageable—and avoid paying more than necessary.

If you’re unsure whether IRMAA might apply to you, a retirement planner or financial advisor can help you develop a strategy to reduce future exposure. Planning ahead now can lead to meaningful savings later.

Made Changes to Your Medicare Plan? Here’s How to Get Ready for January 1

Mon, 05 Jan 2026 15:02:35 GMT

If you made changes to your Medicare coverage during the Annual Enrollment Period (AEP) your new plan will go into effect January 1, so this is the time to get organized so your new benefits start smoothly.

Even if you didn’t make any changes, your current plan may have—and those updates also begin January 1. It’s important to review your documents carefully to avoid surprises at the pharmacy or doctor’s office.

Here are the key steps everyone should take now to be ready.

1. Watch for New ID Cards and Welcome Packets

If you enrolled in a new plan, your new insurance card and welcome packet should arrive before the end of December. These materials typically include:

Your ID card
A Summary of Benefits
Provider directories
Drug formulary (for prescription plans)

Tip : Make sure your mailing address is current with your plan so your card and documents don’t get lost.

2. Read Through Your Plan Details (Yes, Really!)

Even if you've had Medicare for years, it's worth taking time to review the details of your new or updated plan. Look closely at:

Which doctors, hospitals, and specialists are in-network
Your costs for office visits, urgent care, and hospital stays
How your copays, coinsurance, and deductibles work
Your pharmacy network and prescription drug coverage

Didn’t change plans? Still review your materials— existing plans can change their benefits, premiums, or drug coverage each year.

3. Double-Check Prescription Drug Coverage

Formularies (the list of covered drugs) can change annually. Make sure:

Your medications are still covered
The tier or cost hasn’t increased
Your pharmacy is still in-network

If something changed, talk to your doctor —there may be an alternative medication covered under your new plan or a way to file for an exception.

4. Confirm Your Providers Are In-Network

Before scheduling appointments in January, verify that your primary care doctor and any specialists accept your new plan. This is especially important if:

You enrolled in a new Medicare Advantage plan
Your insurer changed networks or provider contracts

5. Hold Onto Your Current ID Card Through December

Even though your new coverage starts January 1, keep your 2025 ID card on hand until the year ends. If you need care in December, providers will need your current insurance information.

6. Review Premium Payments and Billing

If your premium or plan changed, be sure you understand:

Whether your premium is deducted from Social Security or paid directly
When your first payment is due
How to set up automatic payments if you haven’t already

Missing your first payment could delay access to your benefits in January, so double-check early.

7. Keep Key Contact Info Handy

Have questions or run into issues? Be prepared by keeping these numbers easily accessible:

Your plan’s customer service number
1-800-MEDICARE (1-800-633-4227)
Your agent —we’re just a phone call away and happy to help you understand your plan.

Final Thoughts

Whether you made changes to your Medicare coverage or your existing plan simply updated its benefits, January 1 is an important date for your health care coverage. Preparing now ensures you don’t run into coverage issues, prescription problems, or billing surprises.

If you have any questions about your plan—or you’re unsure what changed—reach out to us. We’re here to make Medicare simple, and your transition into the new year as smooth as possible.

What Is Medicare Extra Help and How Can It Lower Your Prescription Drug Costs in 2025?

Mon, 24 Nov 2025 14:00:06 GMT

If you’re struggling to keep up with the cost of your prescription medications, the Medicare Extra Help program could be the financial relief you’ve been looking for.

Also known as the Low-Income Subsidy (LIS) , Extra Help is a federal program that assists eligible Medicare beneficiaries in paying for Medicare Part D prescription drug costs . This includes help with monthly premiums, annual deductibles, and co-payments for medications.

Why It Matters in 2025

In 2025, changes to Medicare are making Extra Help more valuable than ever. One major update: annual out-of-pocket costs for prescription drugs will be capped at $2,000 for everyone with Medicare drug coverage. If you qualify for Extra Help, your costs could be even lower—or nothing at all.

Who Can Get Extra Help?

Eligibility for Extra Help is based on your income and assets. In general, you may qualify if:

Your income is below a certain level (specific thresholds vary slightly by year).
Your resources (like savings and investments, not counting your home or car) fall under the program’s limits.

Some people automatically qualify, such as those who:

Receive full Medicaid benefits
Are enrolled in a Medicare Savings Program (MSP) that pays your Medicare Part B premium
Receive Supplemental Security Income (SSI)

Even if you don’t automatically qualify, you can apply separately through the Social Security Administration .

What Does Extra Help Cover?

If approved, Extra Help may reduce or eliminate:

Part D monthly premiums
Annual Part D deductibles .
Co-pays for covered prescription drugs.

Many beneficiaries with Extra Help pay no more than a few dollars per prescription . Plus, you won’t pay the Part D late enrollment penalty if you qualify.

How to Apply

You can apply for Extra Help in one of several ways:

Online at www.ssa.gov/extrahelp
By phone at 1-800-772-1213 (TTY: 1-800-325-0778)
In person at your local Social Security office

If you’re unsure whether you qualify, it’s still worth applying. Many people are surprised to find they’re eligible, especially those with limited savings or fixed incomes.

Need Help Navigating the Process?

You don’t have to figure it out alone. Your local State Health Insurance Assistance Program (SHIP) offers free, unbiased support. You can also reach out to us... we are happy to help!

The Bottom Line

Prescription drug costs shouldn’t be a barrier to getting the care you need. If you’re on Medicare and need help with drug costs, Extra Help can make a real difference. It’s easy to apply, and you could save hundreds—or even thousands—of dollars a year.

Want to see if you’re eligible or learn more about your Medicare options? Contact us today for guidance.

Navigating Medicare: Why Partnering with a Trusted Agent Matters More Than Ever

Tue, 18 Nov 2025 02:00:00 GMT

As you approach Medicare eligibility, you're likely encountering a whirlwind of information, choices, and deadlines. The complexity of Medicare—encompassing Parts A, B, C, and D, along with various supplemental plans—can be overwhelming. Making uninformed decisions or missing critical enrollment periods can lead to costly mistakes, such as unnecessary expenses or gaps in coverage.

Dr. Katy Votava, a health economist and Medicare expert, emphasizes that "the big mistakes that people make in their Medicare decisions and choices can be very costly." She notes that many individuals end up with duplicative coverage or overspend on health insurance when they can least afford it. The anxiety surrounding Medicare's complexity often hinders decision-making, increasing the risk of errors.

While it's tempting to navigate Medicare on your own, the intricacies of the system—such as understanding the interplay between different parts, evaluating Medicare Advantage versus Original Medicare, and considering supplemental coverage—make it a challenging endeavor. Moreover, the lack of comprehensive guidance from employers during the transition from workplace plans to Medicare leaves many unprepared.

Working with a knowledgeable and trustworthy Medicare agent can alleviate this burden. An experienced agent can help you:

Understand the differences between Medicare parts and what each covers.
Evaluate the pros and cons of Medicare Advantage plans versus Original Medicare with supplemental coverage.
Identify the most cost-effective prescription drug plans tailored to your needs.
Ensure timely enrollment to avoid penalties and coverage gaps.

Dr. Votava advises initiating Medicare planning by age 64 to ensure a smooth transition. Early planning allows ample time to assess options, gather necessary information, and make informed decisions without the pressure of impending deadlines.

In conclusion, while Medicare offers essential health coverage for seniors, its complexity necessitates careful navigation. Partnering with a trusted Medicare agent can provide clarity, prevent costly mistakes, and offer peace of mind as you embark on this new chapter of healthcare coverage.

If you need assistance finding a reputable Medicare agent or have further questions about Medicare options, feel free to ask!

What You Should Know About Possible Changes to the Affordable Care Act in 2025

Mon, 10 Nov 2025 14:00:13 GMT

Lawmakers in Washington have passed the One Big Beautiful Bill Act (OBBBA) that includes significant changes to the Affordable Care Act (ACA). While the legislation is now official, many of its details are still being shaped through rulemaking, guidance, and state-level decisions. That means the real-world impact could shift as the law is rolled out. Here's a look at what the law includes so far and how it may affect individuals and families in the months ahead.

1. Changes to ACA Subsidies

One of the most notable proposals involves the expiration of enhanced premium subsidies —financial assistance that lowers the monthly cost of health insurance for many individuals and families.

These subsidies were originally expanded under pandemic-era legislation and later extended through the Inflation Reduction Act. If not renewed, they are set to end in late 2025.

According to the Congressional Budget Office (CBO), premiums could increase significantly—by up to 75% in some states .
Roughly 4.2 million people could lose their current coverage due to rising costs.

2. Adjustments to Enrollment Policies

The bill also suggests several updates to how people enroll in ACA health plans:

A shorter annual enrollment period , reducing the time available to sign up for coverage
The end of automatic re-enrollment , which currently helps about 11 million people maintain continuous coverage
Annual eligibility checks to verify income and qualification status
Revised access rules for certain lawfully present immigrants

The CBO projects these changes could result in 3.1 million more individuals becoming uninsured.

3. Proposed Medicaid Reforms

The legislation includes potential reforms to Medicaid, a key health program for low-income individuals and families.

Proposed updates include:

Work requirements for some adults without disabilities
Increased cost-sharing (e.g., co-pays) for people with income above the poverty line
Stricter eligibility verification processes
A reduction in federal funding for state Medicaid programs that cover undocumented immigrants
Funding limitations on certain services, including gender-affirming care

According to CBO estimates, these Medicaid-related changes could lead to 7.8 million fewer people being enrolled in the program.

What Happens Next?

These proposals are still being debated and may change before any final legislation is enacted. While some changes are designed to reduce government spending, they could also increase the number of people without health insurance or lead to higher out-of-pocket costs for some Americans.

Timeline for Changes

The One Big Beautiful Bill Act brings a phased rollout of ACA and Medicaid changes beginning in late 2025. By the end of 2025 , enhanced premium subsidies are set to expire, potentially raising costs for millions starting January 2026. In 2026 , key ACA enrollment changes take effect—including a shorter sign-up window, elimination of automatic re-enrollment, and stricter income verification. Starting in 2027 , Medicaid work requirements for able-bodied adults begin, alongside increased cost-sharing and tighter eligibility checks. Additional reforms will continue rolling out through the late 2020s, with the full impact—an estimated 15+ million additional uninsured—projected by 2034 .

Bottom line: If you or your family rely on ACA coverage or Medicaid, it’s a good idea to stay informed and watch for updates. Policy shifts like these can impact eligibility, premiums, and benefits—so being proactive can help you plan ahead.

Stay tuned as more details unfold—and consider checking with an independent insurance agent ahead of the next open enrollment period.

How to Prepare for ACA Open Enrollment

Mon, 03 Nov 2025 14:00:01 GMT

The Open Enrollment Period for ACA (Affordable Care Act) health insurance runs from November 1 to January 15. This is your window to enroll in a new plan, renew your current one, or make changes to better fit your needs for 2026.

Here’s how to get ready:

1. Review Your Current Coverage

Take a moment to think about how your plan worked for you this year. Were your doctors in-network? Did your prescriptions cost more than expected? Make a list of what worked — and what didn’t.

2. Have Your Information Ready

It is useful to have the following information:

A list of your current prescriptions (with dosage)
Names of your doctors and specialists
Preferred pharmacies

This helps us match you with the best plans available.

3. Watch for Your ANOC

If you’re currently enrolled in a plan, your carrier will send you an Annual Notice of Changes (ANOC) in late September. It outlines any changes in your coverage or costs. Don’t ignore it — these changes could affect your care in 2026.

4. Stay Alert for Scam Communications

OEP is a popular time for scammers to target consumers with misleading calls, emails, and ads. If something seems off, check with your trusted agent before responding.

5. Be Ready to Schedule Your Appointment

We’ll begin sending notices soon to schedule an appointment to review your coverage. Appointments can start after October 1. Keep an eye out for communications from us so we can help you review your options and find the best fit.

Need help or have questions?

We’re here to guide you through the process and make sure you’re confident in your 2026 coverage. Give us a call!

The ANOC for Medicare Advantage Enrollees: Why It’s Important

Fri, 31 Oct 2025 13:00:02 GMT

The Annual Notice of Change (ANOC) is a letter your Medicare Advantage or Part D plan sends each year to explain what’s changing in your plan for the next calendar year — usually things like:

Monthly premiums
Deductibles and copays
Prescription drug coverage
Network providers
New extra benefits (vision, dental, hearing, etc.)
Reduced or eliminated benefits

Even if you’re happy with your current plan, these changes can impact your care or costs — so it’s worth the few minutes to take a look.

When should I expect it?

Your Medicare Advantage or Part D plan must send your ANOC by September 30 each year. This gives you time to review changes before the Medicare Annual Enrollment Period starts on October 15.

How do I read it?

Most ANOCs include a side-by-side comparison showing “This Year” vs. “Next Year.” Use it to quickly spot increases in your:

Monthly premium
Annual deductible
Copay or coinsurance amounts
Drug coverage tiers

Also, check to see if your doctors and pharmacies are still in-network , and whether any extra benefits have been added or removed.

We also suggest reviewing the plan’s formulary (list of covered drugs) for next year to see if your drugs will continue to be covered, and in which tier they are covered. You can see a copy of the 2026 formulary on the Medicare Plan Finder at www.medicare.gov , or the plan’s website.

What should I look for?

Ask yourself:

Are your prescriptions still covered and affordable?
Are your doctors still in the network ?
Are your benefits changing , like dental, vision, or fitness perks?
Are your out-of-pocket costs going up ?

If the answer to any of those is “yes,” you may want to compare plans during the Annual Enrollment Period: October 15 – December 7 (in most states).

Final Tip

Even if you don’t plan to change plans, the ANOC is your early warning system. It tells you if your coverage is still a good fit before the new year begins.

You don’t have to re-enroll in your current plan— but this is your chance to shop for a different plan if your needs (or your plan) have changed.

If you would like help understanding your options, we are always here to help!

ACA Marketplace Premiums Projected to Jump in 2026

Sat, 25 Oct 2025 13:00:13 GMT

If you buy health insurance through the Affordable Care Act (ACA) marketplace, you will want to pay attention to this information. Premiums could rise sharply in 2026, according to a new analysis by the Peterson Center on Healthcare and the Kaiser Family Foundation. Based on preliminary filings from more than 300 insurers across the U.S., the average proposed increase is about 18%, with some states seeing even higher hikes.

If those projections hold, it would be the largest increase since 2018, when policy uncertainty also sent rates soaring. So what’s behind these changes—and what can you do about it?

Let’s break it down.

What’s Driving the Premium Increases?

There’s no single reason for the higher costs—multiple forces are converging. Here are the key factors insurers are citing:

Expiration of Enhanced Subsidies

One of the biggest drivers is the scheduled end of expanded premium tax credits (first introduced in 2021 during the pandemic).
These enhanced subsidies have helped millions of lower-income Americans pay little or nothing for their monthly premiums.
Without congressional action to extend them, premiums could rise more than 75% for subsidized enrollees in 2026.
In at least 12 states, out-of-pocket premiums may double for some enrollees.

When subsidies shrink, many healthier individuals may opt out of coverage—leaving a pool of higher-risk, higher-cost enrollees. That shift could trigger even more premium hikes in future years.

Other Cost Pressures

Insurers also point to rising healthcare costs and systemic issues:

Medical cost inflation: Hospital stays, doctor visits, and outpatient services are rising 8–10% per year in many areas.
Expensive new drugs: Use of GLP-1 medications like Ozempic and Wegovy—and high-tech treatments like gene therapies—has driven up pharmacy costs.
Labor shortages: Healthcare facilities continue to pay more for staff, and those costs are reflected in insurance premiums.
General inflation: Broader economic inflation affects everything from administrative expenses to medical supply prices.
Trade uncertainty: Some insurers are preparing for potential tariffs on medications and medical products, which could push costs even higher.

What This Could Mean for You

If you get your health insurance through the ACA marketplace, 2026 will likely bring higher premiums, especially if the enhanced subsidies expire. Here’s how you can prepare:

Be proactive during open enrollment

Compare plans carefully. Shopping around is more important than ever—premiums can vary widely between insurers and plan types.
Switching metal tiers (for example, from Gold to Silver or Bronze) may help reduce your premium, depending on your healthcare needs.

Make sure your income estimate is accurate

Your premium tax credit is based on your reported income. An accurate estimate ensures you get the right subsidy—and avoids surprises when you file your taxes.
If your income changes during the year, update it in your marketplace profile as soon as possible.

Plan for different subsidy scenarios

It's still uncertain whether premium subsidies will be extended beyond 2025.
We can help you model your 2026 premium under both scenarios—with and without the enhanced credits—so you’ll know what to expect and can plan ahead.

The Bottom Line

Health insurance affordability is likely to become a bigger concern in 2026, especially for those who rely on ACA marketplace plans. With premiums projected to rise significantly, now’s the time to take a closer look at your coverage and budget.

You don’t have to navigate this alone. We’re here to help you review your options and make informed choices—so your health coverage fits your needs and your finances.

Will Insurers Cover Wegovy and other GLP-1 drugs if Medicare Expands Access?

Mon, 20 Oct 2025 13:00:14 GMT

There is a general truth in the health insurance sector: If Medicare and Medicaid are given the green light to cover a certain drug, insurers in the group health and individual health insurance market usually follow suit.

The Centers for Medicare and Medicaid Services (CMS) typically allows Medicare drug plans and Medicaid to cover a drug once the Food and Drug Administration approves it for specific conditions. However, despite the FDA's approval of popular-yet-pricey GLP-1 drugs like Wegovy, Ozempic, and Zepbound for weight loss, these programs do not cover them due to a long-standing rule not to cover anti-obesity medications (AOMs)

In 2024, CMS issued a proposed rule that would cover AOMs used solely for weight loss. However, in April 2025, CMS finalized the proposed rule but did not include coverage for AOMs solely for weight loss in the final rule. CMS stated it would continue to review AOMs and may revisit coverage in the future.

If CMS finalizes the rule, will group health and individual health insurers follow suit?

Current Medicare GLP-1 coverage

Medicare, through Part D drug plans, and Medicaid already cover GLP-1s for certain conditions, including:

Type 2 diabetes, and
Cardiovascular disease.
Currently, some states cover GLP-1 drugs and AOMs under Medicaid.

After the government programs began covering the medications for the above conditions, private insurers have largely done the same.

The drugs approved for these conditions include:

Ozempic,
Mounjaro,
Rybelsus, and
Wegovy.

The fine print

Experts say that if CMS approves GLP-1s and other AOMs for weight loss, private health insurers would likely do the same. However, this does not mean they would cover them outright. Each plan's copays, deductibles, and coinsurance would still apply, as they do for all other drugs.

The list price of these drugs is around $1,000 a month or more, though some manufacturers offer savings programs that significantly reduce the cost to patients.. Since GLP-1s and AOMs are expensive specialty drugs, insurers would likely put them in their pharmaceutical fee schedule's most expensive tier, meaning that enrollees would pay higher copays and/or coinsurance than for lower-tier drugs.

Additionally, health plans that decide to cover these drugs may require plan enrollees to first try less expensive treatments and/or lifestyle changes before approving a GLP-1 prescription.

Effect on costs

The rising cost of specialty drugs are contributing to overall premium inflation.

In 2023, health insurance outlays for prescription drugs increased by 10.8%, compared to 2.6% for all medical expenses, according to the U.S. Department of Health and Human Services . This increase was driven by brand-name and specialty drugs, particularly those used to treat diabetes and weight loss, such as GLP-1 drugs. If more insurers start covering these popular drugs, it would likely affect premiums.

However, there could be offsetting cost benefits. Consider that:

These drugs often result in a significant drop in blood-sugar levels, reducing the risk of diabetes-related complications.
GLP-1s yield an average weight loss of 15 to 20%, and about one-third of users lose approximately 10% of their body weight, according to a study .
Multiple studies have shown that they can reduce the risk of cardiovascular events, including heart attack and stroke.
There is growing research to determine if GLP-1s address other health conditions besides diabetes and heart disease.
The drugs may help people cut back on drinking, according to a study published in JAMA.

Conclusion

The future of Wegovy and other GLP-1 weight-loss drugs in Medicare coverage remains uncertain—but if CMS eventually expands access, private insurers will likely follow. Still, high costs, strict utilization rules, and placement in expensive drug tiers could shape how coverage is offered. For patients, this means progress toward broader access is possible, but planning ahead for out-of-pocket costs will remain essential. Staying informed—and working with a trusted advisor—can help you navigate these changes as the coverage landscape continues to evolve.

What Medicare Part D Users Can Expect in 2026

Wed, 15 Oct 2025 18:45:58 GMT

In 2026, Medicare beneficiaries with Part D prescription drug coverage will see major changes—thanks to the continued rollout of the Inflation Reduction Act (IRA). These changes are designed to lower out-of-pocket drug costs, improve predictability, and increase access to lifesaving medications.

Here’s what Part D users can expect in 2026:

1. Out-of-Pocket Costs Capped at $2,100 (Adjusted for Inflation)

In 2025, the annual cap on out-of-pocket drug costs is set at $2,000. In 2026, that cap will increase slightly to $2,100 , as indexed for inflation.

Once you reach this threshold, you will pay $0 for covered Part D prescription drugs for the rest of the year—no coinsurance or copays.

What this means for you:

Predictable yearly drug costs
No more catastrophic phase or the so-called “donut hole”
Major savings for those with expensive medications

2. Medicare Will Start Negotiating Drug Prices

Starting in 2026, Medicare will implement its first negotiated drug prices for certain high-cost medications covered under Part D.

These will initially include 10 brand-name drugs with the highest total spending in the Medicare program.

The first 10 drugs selected for Medicare negotiation are: Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, Fiasp / NovoLog.

These drugs were selected because they account for billions in Medicare spending each year, and do not yet have generic alternatives.

What this means for you:

Lower out-of-pocket costs if you take one of these drugs
Improved transparency around drug pricing

The negotiated prices will take effect January 1, 2026 . Additional drugs will be added to this list in the years to follow.

3. Monthly Payment Option for Out-of-Pocket Costs

If paying up to $2,100 all at once sounds daunting, you’ll have another option.

In 2025, Medicare introduced the Prescription Payment Plan (PPP) , which allows you to spread out your Part D out-of-pocket costs across the calendar year .

What this means for you:

You can choose to make monthly payments instead of large up-front costs
Easier to budget and manage finances throughout the year
Enrollment is optional—you can opt in or out as needed
Starting in 2026, if you are enrolled in the PPP, you will automatically be enrolled in the PPP the following year.

4. Insulin and Vaccine Cost Caps Continue

Even as the broader cap changes with inflation, these key protections remain in place:

The insulin cap in 2026 will be the lowest of $35, 25% of negotiated price, or 25% of maximum fair price
CDC-recommended adult vaccines (like shingles and Tdap) stay free with no copay or deductible.

5. Stricter Limits on Price Increases

Drug manufacturers will now face penalties if they raise prices faster than the rate of inflation for Medicare-covered drugs. This rule began in 2023, but will have stronger visibility and impact by 2026.

Coming Down the Road After 2026:

More drugs will be added to Medicare’s negotiation list annually.
By 2029 , up to 60 Part D and Part B drugs may have negotiated prices.

ACA Marketplace Renewal Notice: What It Is and Why You Should Read It

Fri, 26 Sep 2025 13:00:04 GMT

If you enrolled in health insurance through the ACA Marketplace (Healthcare.gov or your state exchange), there's a key document heading your way in the fall: your Renewal Notice .

It may not look like much — but it could affect your coverage, costs, and even your tax refund next year.

What is a Marketplace Renewal Notice?

Your Marketplace Renewal Notice outlines:

Changes in your monthly premium
Updates to your deductible or copays
Whether you’ll be automatically renewed in your current plan
Estimated subsidy amounts based on your latest income information

It's your preview of what’s ahead for the next plan year — and it gives you time to shop before the Open Enrollment Period begins on November 1.

When will I get it?

Most insurers send renewal notices in October or early November .

If you used the federal Marketplace (HealthCare.gov), the Open Enrollment Period runs November 1 through January 15 in most states.

If your state runs its own exchange (like Covered California or NY State of Health), dates may vary slightly.

How do I read it?

Your notice will explain:

Whether your current plan is being offered again
What your new premium and out-of-pocket costs will be
Whether your premium tax credits are changing (based on income)
Whether you’ll be automatically re-enrolled — or if you need to take action to retain insurance coverage

What should I look for?

Check the following:

Will your monthly premium change significantly?
Are your doctors and prescriptions still covered ?
Are your income and household details up to date ?
Are you in the right metal tier (Bronze, Silver, Gold, Platinum)?

Even if your plan will auto-renew, it’s important to update your income . Outdated income information could lead to incorrect subsidy amounts , which could affect your tax refund or tax bill .

Final Tip

Your Marketplace renewal notice is your heads-up to make sure your plan still fits your life and your budget. Use it as your cue to compare options and update your information — especially if your income, household size, or health needs have changed.

If you do nothing, you may be re-enrolled automatically — but that doesn’t mean it’s still your best option.

If you need help understanding your options, we are always here to help!

How to Prepare for ACA Open Enrollment (OEP)

Mon, 22 Sep 2025 14:00:00 GMT

The Open Enrollment Period (OEP) for ACA (Affordable Care Act) health insurance runs from November 1 to January 15. This is your window to enroll in a new plan, renew your current one, or make changes to better fit your needs for 2026.

Here’s how to get ready:

1. Review Your Current Coverage

Take a moment to think about how your plan worked for you this year. Were your doctors in-network? Did your prescriptions cost more than expected? Make a list of what worked — and what didn’t.

2. Update Your Information

We will need the following:

A list of your current prescriptions (with dosage)
Names of your doctors and specialists
Preferred pharmacies

This helps us match you with the best plans available.

3. Watch for Your ANOC

4. Stay Alert for Scam Communications

OEP is a popular time for scammers to target consumers with misleading calls, emails, and ads. If something seems off, check with your trusted agent before responding.

5. Be Ready to Schedule Your Appointment

Need help or have questions?

We’re here to guide you through the process and make sure you’re confident in your 2026 coverage. Give us a call!

Get Ready for Medicare AEP: What You Need to Know

Tue, 16 Sep 2025 15:24:30 GMT

It’s Time to Start Thinking About Medicare AEP for 2026

As summer rolls on, now is the perfect time to start preparing for one of the most important Medicare milestones of the year: the Annual Enrollment Period (AEP) . If you're enrolled in Medicare, this is your chance to review your current coverage, make changes, and ensure your 2026 plan still fits your health and financial needs.

Here’s a quick guide to what AEP is, when it happens, and how you can get ready.

Key Medicare AEP Dates for 2025–2026

October 1, 2025:
You can begin reviewing your 2026 Medicare Advantage (Part C) and prescription drug (Part D) plan options. While you can't make changes just yet, this is when insurers release their new plan details — including costs, coverage, and provider networks.

October 15 – December 7, 2025:
The Annual Enrollment Period is officially open . During this window, you can:
Join a Medicare Advantage or Part D plan
Switch plans
Drop coverage or return to Original Medicare

January 1, 2026:
Any changes you made during AEP take effect. Be sure to review your new plan information so you understand your coverage and any out-of-pocket costs.

Don’t Forget About Medigap (Medicare Supplement Plans)

If you have a Medicare Supplement (Medigap) plan, it’s important to know that AEP doesn’t apply to these policies. You can review or apply for a Medigap plan at any time during the year — though underwriting may be required outside of your initial enrollment window.

Still, this is a great time to check in on your Medigap coverage if your health or finances have changed.

How to Start Preparing Now

While you won’t be able to make plan changes until October 15, there’s plenty you can do now to make the process smoother:

Gather recent medical bills and expenses.

List your current prescriptions and dosages.

Note your preferred doctors, hospitals, and pharmacies.

Review last year’s coverage summary or annual notice of changes.

Watch for your Annual Notice of Changes (ANOC) from your health insurance carrier in late September. It outlines any changes in your coverage or costs.

Set a reminder to check back in early October for 2026 plan details.

The better prepared you are, the easier it will be to compare options and make confident, informed decisions once AEP opens.

You Don’t Have to Navigate Medicare Alone

Choosing the right Medicare coverage can feel overwhelming — but you don’t have to go it alone. Whether you're happy with your current plan or want to explore new options, a licensed Medicare agent can help you:

Understand your current plan’s changes

Compare available options in your area

Ensure your doctors and prescriptions are covered

Avoid late penalties or coverage gaps

Ready to Get Started?

While plan specifics can’t be discussed until October 1 , now’s the perfect time to start gathering information and thinking about your needs. If you have questions about Medicare AEP or want help getting organized, don’t hesitate to reach out.

Let’s make your 2026 coverage the right fit — together.

Preparing for Medicare AEP: Avoid These Common Mistakes

Fri, 12 Sep 2025 20:54:26 GMT

Make the most of Medicare's Annual Enrollment Period. This guide covers 6 mistakes to avoid—from ignoring your ANOC to forgetting your drug coverage.