Transcription
If you have a Medicare Part D prescription drug plan, I have some news that could cost you an extra $600 a year starting in 2026. Also, more than a million seniors on Medicare Advantage will soon be finding out that their plans are being completely eliminated next year. But don't panic. I'm going to show you exactly what's happening and how to protect yourself. Keep watching this video because at the end I'll give you a resource on how to find the best, the most appropriate Part D drug plan just for you and a step-by-step guide on how to read your annual notice of change when it arrives in September. That guide alone could save you hundreds of dollars.
I'm Christopher Westfall of the Senior Savings Network. I've been helping seniors with insurance since 1995. That's 30 years of experience helping seniors and now we're in all 50 states and Washington DC. But what I'm about to share with you affects millions of people with standalone Part D plans. And if you don't take action during the annual election period, you could be looking at a premium increase of up to $50 per month. That's $600 a year.
So here's your timeline. In September, you'll get your annual notice of change, showing you exactly how your plan would be changing if you did nothing. Then from October 15th through December 7th, that's your annual election period when you can switch plans. This year, that window is more critical than ever. In the next few minutes, I'll explain three main reasons why your premiums are going up and why Medicare Advantage members are getting a different deal and most importantly, what you can do about it. So stick around because this could be important information that will help you for the next year.
The first reason premiums are going up might surprise you. It's not just that drugs are getting more expensive. They are. It's that people are using a lot more of the really expensive medications. So, here's what the data shows. In 2024, the use of specialty drugs, those drugs that cost more than $950 for a 30-day supply, jumped by nearly 10%. But here's the kicker. For people who aren't low income, that number shot up by 24%. We're talking about drug conditions like rheumatoid arthritis, multiple sclerosis, and yes, even those new weight loss medications that everyone's talking about. When your neighbors are start using a thousand a month drug medication, guess who helps to pay for it? Everyone in the risk pool. This trend is accelerating. The Trump administration is even considering a pilot program to expand access to weight loss drugs through Medicare, which could start in 2027. More on how this affects you in just a minute.
So now the second reason is actually a good thing that's causing a problem. So starting this year, Medicare has the $2,000 cap for 2025, $2,100 cap for 2026. And that's huge for people that are taking very expensive medication. Before this, people could be paying $10,000 to $15,000 a year for a single drug. So here's what's happening behind the scenes. That $2,100 cap for next year has shifted the cost away from patients and onto the insurance companies. And guess what insurance companies do when their costs go up? They raise costs for everyone. So, it's like this. Imagine you're at a restaurant and the owner decides to cap the maximum meal price at $20. So, it's great for people ordering the lobster, but to make up the difference, everyone else's meal gets more expensive. That's exactly what's happening with Part D. The good news is if you've ever needed expensive medications, now you're protected. The challenge is that you're paying for that protection in your monthly premiums. So whether you use it or not, it's going to go up.
The third reason for all these changes is a policy change that most people are unaware of. Remember, these premium increases were expected when they first had the $2,000 cap for 2025. The government created under the last part of the Biden administration a temporary program to help keep premiums stable while the insurance companies start absorbing these. So that year the program spent about $15 per month per person to keep your premiums down. But the Trump administration just announced that they're cutting that support by 40%. So it's going to be $10 per month subsidy per person. And under the new administrator Dr. Oz at CMS, the Trump administration is taking a different approach. They want to reduce the government bailout and let market forces work, even if that means higher premiums for seniors. Why? Well, one government official said that keeping the full funding would mainly benefit the insurance companies and cost all taxpayers an enormous excess amount. He said they want to keep the market returning to normal conditions. And here's proof how bad that situation would really be. So in July, for the first time in Medicare history, CMS actually rejected some insurance companies bids for the premium increases that were so outrageous, they said. They forced insurance companies to go back to the negotiating table. And that's how you know it just wasn't normal market conditions. This was a crisis.
What this means for you? Insurance companies can now raise premiums by up to $50 per person per month for 2026 compared to the $35 limit that they were imposed with in 2025. And it's not just Part D premiums. Medicare Part B, that's just to be on Medicare premiums, are expected to jump by 11.6% next year to over $26. The final number will be out in November. That's the biggest increase since 2022. This will eat up 40% of the Social Security cost of living increase, leaving seniors with almost nothing extra despite the inflation that's happening.
Now, if you're on Medicare Advantage, you might be wondering if this affects you. The short answer is yes, but not in the way that you would probably think. We'll talk about that shortly. So, if you're watching this video because you're worried about your mom or your dad and they're on Medicare, please listen carefully. This might be the year that you actually as a son or daughter or even nephew, you have to actually get involved. For decades, parents may have handled their Medicare just fine on their own. But this year is different with Part D premiums potentially jumping $50 a month, Medicare Advantage PPO plans disappearing by the thousands, and Metagap Medicare supplement premiums having their worst rate increases in history. Your parents might need your help navigating these changes.
Here's what's at stake. If they have a Medicare supplement plan plus Part D, they still have the freedom to go to any doctor in the country that accepts original Medicare. No networks, no prior authorizations to speak of and no hassles. That's worth protecting and worth keeping if at all possible. So, if they're getting overwhelmed by all these changes and they're just going to default into whatever Medicare Advantage plan is available, thinking that they can go to a zero or near zero monthly premium, they could lose that freedom that they've enjoyed forever. Most states now allow the Medigap insurance companies to medically underwrite anybody that's giving up their Medicare Advantage plan and coming back to original Medicare, wanting that freedom of a Medicare supplement plan. And that could make the supplement itself either unavailable because of the underwriting or completely unaffordable depending on their health issues. So, if your parents are in their 70s or 80s or 90s, they're probably going to be feeling overwhelmed by all this. And that's your cue if you're the son or daughter or nephew to possibly step in and help them preserve their freedom, which might involve helping to pay for part or all of those premiums on their behalf.
So, here's what every Medicare beneficiary needs to understand. If you have a standalone Part D drug plan, you cannot this year just set it and forget it. First, watch your mailbox in September for your annual notice of change. This document will show you exactly how your plan is changing for next year with the premiums, the formulary changes, and there will be a lot, and other changes, too. Don't just glance at it and throw it away like most people always have. This year it's more critical than ever. Second, you must absolutely shop during the annual election period. You can't put this off and I encourage you to do it sooner rather than later. That period again is October 15th through December 7th. That's when you can switch your Part D drug plan or onto or a different or off of a Medicare Advantage plan. So even if your current plan is raising premiums by the full $50 a month, there might be a better plan. The plan that works better for your particular situation and for your drugs because those formularies do change every year.
So for Part D drug plans, I recommend going to startpartd.com. Just plug in your medications, your pharmacy preferences. It'll show you the most available plans for you side by side and you can compare which one might be best. You can also use medicare.gov for the same comparison, but startpartd.com is often easier to navigate. Our office cannot help manually with the Part D drug plan appointments anymore. They're far too many of them and too many of them changing and we have this small finite window upon which to affect help for those people losing their Medicare Advantage plans. So that's why it's important that we've created startpartd.com, the tool that makes it so easy to look at the plans available tailored to you and you can sign up for that plan in just a few minutes.
So millions of seniors are also going to lose their Medicare Advantage plans as I mentioned this year, especially the PPO plans. United Health alone announced that they're dropping 600,000 members from their PPO plans. Etna just announced similar measures for next year. If you're one of those affected, and you'll find out in September, you need to find new coverage for next year. This isn't just about a few companies. The entire industry is shifting away from PPO plans. And many of the Medicare Advantage HMO plans that had the free rides to doctors and free gift cards and they would let you go to the pharmacy with a debit card and they'd give you all these different freebies. Many of those are now being taken away because they say they can't control their costs. And so for the first time in years, HMOs will now outnumber the PPOs in Medicare Advantage and the era of broad networks and low premium plans is over. If you want to look at Medicare Advantage plans that we work with, you can do that on your own. You don't even have to talk to an agent or fill out any paper forms at all. You can go to medicareadvancenearme.com. medicareadvancenearme.com. You can even enroll right there during the annual election period without talking to an agent.
And here's another big change. Medicare supplement premium increases, we've talked about that, are having massive impact across the country. Many people who've had Medigap plans now for years and years are for the first time considering Medicare Advantage just to escape the rising cost. But remember, if you want to shop Medicare supplement plans, you can do that any time of the year. And you should. If you haven't shopped your rate since your last rate increase, you should do that now. Don't wait for the annual election period because Medicare supplements have nothing to do with the annual election period. If you want to look for a Medicare Advantage plan, that's the time to do it. But don't just take these rate increases without looking for a possible alternative.
Here's my advice. The last worst thing you can do if you're going to shop your Medicare supplement plan just to get a better rate, even the same plan. The worst thing you can do is wait till October when everyone out there is scrambling. That's the worst time to shop for a Medigap plan because there's chaos everywhere. This year is going to be unlike any other. And we're already booking appointments now for this annual election period. And I guarantee like past years, we will run out of space on the calendar. If you need personal help navigating these changes for your Medicare Advantage or your Medicare supplement, you have to book an appointment as soon as possible. You can do that at seniorsavingsnetwork.org.
So, look, I know this is overwhelming between Part D premium increases, Medicare Advantage cancellations, Medigap rate increases. This is the most disruptive year Medicare has seen in decades. That's why I put together a complete resource package for you. First, it's the Part D shopping checklist. It walks you through exactly what to compare when you're looking at plans. Second, my step-by-step guide on how to read your annual notice of change. This shows you exactly what to look for when that big envelope does arrive in September, maybe early October, so you won't miss anything. I've also included a complete resource guide with all the websites that I mentioned here today. startpartd.com for comparing drug plans, medicareadvancenearme.com for comparing Medicare Advantage plans that we work with or to book a personal consultation at seniorsavingsnetwork.org.
Remember, and it's worth repeating, the annual election period is October 15th through December 7th, but don't wait until October to try to make an appointment. Your annual notice of change arrives in September and that's your signal to start shopping even when signing up for your Part D drug plan or Medicare Advantage plan. If you opted to get an online notice of your annual enrollment or your annual notice of change, you don't want to wait and look for an email that may or may not get to you. Many of these people are reporting to us. Those went to spam. They never got their booklet because they signed up for online notifications only. And if that was you, you need to reach out to your insurance company and tell them that you want the paper version of your annual notice of change.
This is going to be the most challenging annual election period ever. And you have to start thinking about what you're going to do for next year. Are you one of the millions losing your plan for Medicare Advantage? If so, let me know in the comments what you're finding and what you expect for the next year. And if you have questions about these changes, we'll try to get to those in the comments. But if you need personalized help on your Medicare supplement or your Medicare Advantage plan, that's what we're here for. If this video helped you at all understand what's possibly coming, please give this video a thumbs up. Share it with anybody that you know that's on Medicare so that they're prepared.
If you wait around like so many millions of people did until November or the first week of December and say, "Okay, now it's my time." And every year thousands of people reach out to me at the beginning of December. I kid you not, and say, "Okay, it's time to look at my plans for next year." Well, guess what? We are booked up for that last week of December, probably in November already. So, please hit that notification bell on your subscription so you are staying in touch with what's happening with Medicare. We'll have more details as we get closer to the season. Remember, preparation is your best protection. And don't wait until October when everybody already is scrambling. You can make your appointment now. Start planning now. I'll see you in the next video. God bless you. Thank you for watching.