Medicare Changes for 2026

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Today, we're gonna be talking about Medicare changes for 2026. Hi, and welcome to our show, Money Talks. My name's Ken Wink from Summit Financial Consulting. If you'd like to hear more after you listen to our show, be sure to go to our website, check out the podcast page. You can subscribe, listen to past shows, also check us out on YouTube. If you'd like to meet face-to-face or have extra questions, give us a call at 586-226-2100. or you can go to our website summitfc.net. So if you're on Medicare, you know that the program can definitely change from year to year, the cost can change from year to year. Today we're just gonna talk about what's changing coming up in 2026. We'll see how much me and Tony chit chat here, whether this is a short show or a long show, a short power packed show. But, you know, I want to introduce my co-host, Tony Shore and just say, Tony, I'm so excited. We have been getting phone calls from listeners all over the country. Just in the last week, we've heard from people in Georgia, Oklahoma, Arizona. So, you know, our podcast is becoming a national powerhouse here. So awesome. Why do you think people are calling in? Is it your great voice? Is it your great looks? What's going on here?

The golden pipes. You're the brains. You know, I'm just eye candy, I guess. No. And I love how listeners and viewers, if you note, Ken dropped a hint there to me. That was directed right at me, hoping to keep this short and to the point. Oh, no. That was directed right at me, where... No chit-chat today, Tony.

No, I can go off on a tangent.

Here's why you've been getting so many calls, and we went over the stats for the show. They've been great. I mean, thousands of views on YouTube, and it's you, Ken, and here's what people are saying about you out there. You know what they call you. Financial Panther, eh? The Financial Panther, Ken Wink, ladies and gentlemen.

I can't wait to tell my wife that my nickname is the Financial Panther.

And Homer Simpson. Financial Panther, eh? So that's about it for the chit chat. I want to get right into the topic today, Ken, because as I mentioned before the show, and I'll let our listeners and viewers know, I'm an only child. Yes, I know. Spoiled rot, everything. I get it. But my parents, unfortunately, both have Parkinson's. They're not doing well. They're both in full-time nursing care, right? Right. They're in full-time, long-term care. My dad, we're just transitioning him now. They moved him over there last week. It's not been easy. He wants to get up and go, and it's hard. So that's tough. But Medicare is a big issue that I have to help with because they can't handle it themselves. Right. They can't operate computers anymore or anything and don't understand all the forms. My dad's having some cognitive issues. So. I've got to figure out this Medicare Advantage and all the Medicare options for them. And I explained to you that the provider they use there in Minnesota, Minnesota, as I call it, where I'm from, the big one of the biggest providers there and really the best has been you care a company called you care. But they're getting out of the Medicare Advantage business because it wasn't profitable for them. And so they're getting out. And so they have until the end of the year to figure it out because they're in long term care. Those that aren't only have an annual enrollment period to figure it out. Right. So we're going to talk about that some today. And so I have questions for you, Ken. What do you think? What are you going to talk about today then?

Well, we could just start off with the first big change that's coming for 2026. Okay. So everybody knows that prescription drug costs are getting crazy, right? Again, yeah. Yeah, the cost of everything is going up. And that's especially true when it comes to health insurance premiums and prescription drug costs. So in 2025, Medicare rolled out, you and I love our acronyms, the MPPP. So that is the Medicare... prescription payment plan. And basically what that lets people do is spread out their drug costs over the year, instead of just getting slammed when you go to the pharmacy counter the first time in the year, when you go to get a refill. So it just is a process to make that payment situation a little bit smoother rather than a bunch all up at the front, sort of spread it out over the year. So in 2026, they're just trying to make it a little bit smoother. They've gotten good feedback about the program. So if you're already enrolled in it, you don't actually have to re-enroll on your own. So less paperwork, less hassle, less red tape. You'll just automatically be enrolled. So that's that's nice. Less steps, especially for for kids that are trying to take care of it for their parents. If for whatever reason someone wanted to get out of the plan, they're trying to make that a little bit simpler. Also, you'll supposedly within three days get a notice saying that you've been disenrolled in it. So not a big paperwork follow up nightmare there. So I think that's a smart move from Medicare. You know, let's try and help people's budgeting, increase the flexibility a little bit. Anytime we can get rid of red tape, that's a good thing. So if you're retired and you've got a monthly budget, this will just make it a little bit easier if you're on prescription drugs.

Yeah, reduce that sticker shock, too. If you reduce red tape and sticker shock, that's going to go a long way. I'm glad you pointed out that change. Now, before we continue with this talk and talk about the next big Medicare change that's coming for next year, I think we should remind our listeners that we're currently in or entering into the annual enrollment period. And that's important for people to know. So the Medicare annual enrollment period begins here in October and goes through December 7th. So they need to meet with a Medicare specialist. You work with a Medicare specialist there, right?

Yeah. So I think it's really important to point out that. All these Medicare plans, whether it's Medicare supplemental or Medicare Advantage or prescription drug plan, they cost the exact same amount, whether you get help or do it on your own. So why not work with an agent and get help from someone that literally does this all day and has the understanding of all the nuances? And in my opinion, most importantly, can help you budget and say, OK, this is what I normally spend. on doctor's visits, prescription drugs, and put a custom plan together. So the goal is for you to have as little out of pocket as possible when the dust settles on the premiums and then prescription drugs and everything else. So yes, we have a full team here. Summit Health Services is located directly in our office. They are licensed in over 30 states. and have 1,300 customers, both businesses and individuals that they take care of. So we've got a deep bench here, Tony. We'd love to help people out. Give us a call at 586-226-2100. We'd be happy to schedule an appointment either face-to-face or over Zoom or even over the phone to figure out what makes the most sense for your specific situation.

Yeah, I'm glad you pointed this out, because whether it's with you or another Medicare specialist, especially there for you, if people come in to meet with Summit Health to talk to a Medicare specialist about, hey, should I stick with just Medicare Part B? What drug plan do I need? Am I going to need to switch my, uh, I'm, I have an advantage plan. Am I in the best plan? You need to talk to a specialist and it's not going to cost you more to do that than it would to try to figure it out on your own. In fact, doing it on your own may end up costing you more because you might not know all of the options or understand what you need. And if some people say, well, I've already enrolled in Medicare, it's been fine. Uh, Costs are going up. And so if you want to make adjustments and like my parents plan, different plans go away. They come, they drop features, they add features. So you need to review it every single year, don't you?

Yes, absolutely. Annual reviews are absolutely essential. There are changes literally every year to what drugs are covered, what drugs aren't covered by certain plans. The costs change, the deductibles change, the copays change. You know, should you switch from a Medicare Advantage to a medical supplemental with a prescription drug? Like there's just so many different options. You know, it's like playing chess with the government trying to figure out.

It's gotten so complicated. It's not just enrolling in Medicare and paying the monthly Medicare premium. It's gone way. It used to be that. It's gone way beyond that now. And it's gotten so complicated in the health care industry. Things have gotten so expensive. You need to really look at this. People think, oh, I'm on Medicare. I'm going to have a flat fee. It's not going to cost me much. I'm not worried about health care costs. Well, you know, things have changed over the years and you really need a plan, don't you?

Yeah. I mean, I think that you have to as as a business, we try to be licensed with every company that we can. You know, everyone that's out there that that seems to possibly make sense.

So you're looking at all the options. You're not beholding. The great thing about Summit is you're independent and independent. And for our listeners and viewers out there, you want to work with a company that's independent and is looking at all the providers. Hey, this supplemental plan is best to get you what you need. You know, if you need a better prescription drug plan, this certain advantage plans have little or no fees or premium. So you need to know what's available and what's changed. And, you know, you're talking about changes, Ken. What's the what's the next big Medicare change for next year?

So if you do take regular prescriptions, this is one you'll definitely want to keep an eye on. So starting in 2026, the out-of-pocket cost for Part D prescription drugs is now going to be indexed to inflation. So you hear that phrase indexed to inflation from time to time. So Social Security is indexed to inflation. Yeah. They call that the COLA, cost of living adjustment. And then nice things like IRA contributions, those are oftentimes indexed to inflation. 401(k) contribution limits are indexed to inflation. So all indexed to inflation means is that it's going up a bit to sort of keep up with the cost of things. But unfortunately, in this case, the amount of money that someone has to pay for their prescription drugs is going up. So in 2025, the cap was set at $2,000. In 2026, it's going to be moved up to twenty one hundred. So it's an extra hundred bucks that people are potentially on the hook for this year. I know one hundred dollars a year doesn't seem like a major game changer, but especially if things keep indexing, you know, it adds up year over year. And, you know, one hundred bucks is one hundred bucks with everything else going on in the world and inflation the way that it is.

Well, yeah. And in retirement, I don't care how much money you have or how little, everyone's on a fixed income. Every dollar needs to have a job. And that's really tough because it's yet another rise in health care costs. I don't care if it's 50 bucks or 100 bucks or 1,000 bucks. Any increase to health care costs for seniors is a negative. And that's an unfortunate change.

Yep, I agree. Next one on my list to cover is maybe a little bit more nuanced. So this is for anyone that is managing chronic conditions. So got another acronym to throw at you, the SSBCI. That is the special supplemental benefit for the chronically ill. Wow. Yeah, it's just some extra money to help pay for stuff for people that are chronically ill. But they've cut this list down, Tony, and they're taking away a lot of fun here. So no longer can you spend this extra money on alcohol or cannabis or tobacco or non-healthy food, funeral planning and expenses, cosmetic expenses. anything that's cosmetic related and not for actual health. So basically they're just, they're trying to make things, make sure that the money is going towards benefits that are actually healthy and support your function and not just sort of fluff stuff. That sounds nice, but doesn't really, you can,

argue some of those things, move your... Well, I'll have to talk to my parents because they qualify for the SSBCI now. And sorry, dad, no cannabis. I'm kidding. I just, yeah, I don't think my parents have access to any of this or need any of it. I mean, although the funeral planning and expenses, that's a tough one. Everybody needs to do that. That's probably the only non-frivolous thing on here. So... I agree with that list and precluding you from spending that money on everything on there except for that. They should have left that one eligible, but I guess they actually want the benefits to support your health and function.

Yeah, not just the raging parties going on at the nursing homes.

Yeah. What? I've never seen that. I mean, assisted living and senior living communities, maybe, but not, not long-term care nursing homes.

No, I know I'm making light of it. There are people that have really bad chronic pain and cannabis products do. Oh, that's true.

I guess that's true. Yeah. Yeah.

Yeah. The parents are going to have to, or their kids are going to have to sneak in the, the cannabis products, I guess. I don't know. Sure.

Well, and, and again, this is one more reason to review that Medicare advantage plan and review it annually. Right.

Yeah, absolutely. Yeah. So much can change from year to year. So yeah, you don't want to get into trouble because you're spending money on things that you can't. Right. So next thing on my list here is actually a little bit of good news. So if you or somebody you know is dependent upon insulin, you know, taking insulin, starting in 2023, the cost for insulin was capped at $35 a month. So that was a huge, huge, huge win for affordability. But starting in 2026, they're actually making it a little bit better. So one bonus is that deductibles no longer apply to insulin. So, you know, it's going to really help with budgeting. And, you know, for people that don't hit their deductible every year, this is, you know, if all they need is the insulin, this is absolutely fantastic. And then they also help to reduce the cost a little bit. So they basically said moving forward every single year. Um, the, uh, the person who's receiving the benefit, their cost will be the lowest of three things. So it'll be the lower of $35 or 25% of the fair price under Medicare's price negotiation program or 25% of your plans negotiated price. So ultimately we're just protecting people here from runaway insulin costs. And that's, that's fantastic.

See, that's good news. We reached a crisis point a few years back. People might remember. I think the one pharmacy guy actually got arrested for gouging for the EpiPens, you know? Yes. And insulin prices went up. And there were a couple of news stories. A young man in his 20s didn't have any family support, was a diabetic, needed insulin. Um, couldn't afford a pen, uh, lost his job, um, thought he'd skip it, but he died and, and he couldn't afford it because it was like a thought he didn't have. Hey, he lost his job, didn't have healthcare, um, and couldn't afford the new healthcare plan yet. And so he skipped a couple of insulin, couldn't buy a new EpiPen and passed away. And there were a few cases like that. People actually died because insulin costs so much at one point. I mean, it was insane, too. I mean, it was like I forget what those pens were like or the insulin shots were at one time. If you didn't have you know, if you didn't have a plan through your company, they were outrageous. Right. To just go in and buy them on your own. So the cost of I mean, just everything they got, they have so much money.

potential profit for so many companies and middlemen and things like that. That, so like these insulin pens are, you know, thank God their, their cost is getting more reasonable. Uh, for me and my family, my son Jack has, uh, all sorts of allergies. So he's allergic to peanuts and tree nuts and eggs. Wow. And, uh, eggs. Yeah, the eggs we've been working on. That's a tough one. It's in everything, man. So, yeah, we're doing like giving him a little bit of egg for over a year now. So now he can safely eat one tenth of an egg without any problems. So that at least, you know, if he wants to have some French fries at a restaurant, he can. But talking about EpiPens, you know, so for him, for pistachios, they rank it on zero to one hundred. And he was like ninety seven allergic to pistachios. So they were saying, like, there's a really good chance he's going to pass away. They get exposed to these things. So we have to have EpiPens. And when he was first born 10 years ago, I mean, it was, we were budgeting like $1,600 a year for EpiPens at the time. And that's with insurance. That's with insurance.

Imagine if you didn't have insurance and you just walked into a pharmacy and tried to get one or a doctor's offices.

We, we live close to the Canadian border and I was calling pharmacies in Canada and I was just going to go over to Windsor and in Canada, they were much, lots of people do it. It was like a hundred bucks instead of 1600, you know, it's crazy what, what they were sort of getting away with. But now it's now it's much more reasonable. Yeah.

I mean, yeah, that was a crisis for a bit. And luckily they, fortunately they capped that problem. Well, I think that's huge. So how about one more piece of insight?

So in 2026, Medicare Part D will permanently cover all adult vaccines at no cost. with no deductible and no copay. So if you're trying to take advantage of this, you always want to look at the updated list every single year and make sure that everything's covered that you want to take. But it's, you know, some people really feel strongly about flu shots and certainly other vaccines. So that's something that you're interested in. Good news. No cost, no deductible, no copay. You can go right in and get those vaccines.

That's awesome. That's another bit of good news. So, Ken, a lot of great information. There are a lot of changes happening. And it seems like every year, but it seems like the changes that are going to start January 1st, there's even more and more impactful. And there's a lot more than that within each individual plan. There are changes that we're not getting into because there are hundreds of them. So for our listeners and viewers out there, If they really they should not make a decision during the annual enrollment period without getting some talking to a Medicare specialist. I know you have a team there. Summit has a separate Medicare team. They're licensed. They're Medicare specialists. How can our listeners and viewers get a hold of them or set up a consultation?

Yeah, give us a call at 586-226-2100 or just go to our website, summitfc.net. Just go to the Contact Us page and we'll be happy to get one of our Medicare licensed agents in touch with you and come up with a game plan that works for you and your budget and everything you have going on health-wise.

That sounds great. And while you're doing that, you can set up a consultation. I know, Ken, you and your team would be happy to look at their finances and make recommendations. Again, there's no charge or obligation. If they want to work with your team, you can talk about that moving forward. But everybody's situation is different with Medicare, with finances, with retirement income planning, Social Security. everybody's situation is different. That's why you want to work with a fiduciary like Ken and his team who are going to look out for your best interests and are going to only recommend what's in your best interest to meet your individual goals. That's why they need to meet with you. That's why they offer the initial no charge, no obligation consultations, whether that's with someone on their Medicare team or their financial and retirement planning team. I think you offer it all there under one roof. It's very good to Summit Financial. You've been helping people in the community and beyond for so long now. Ken, great job. Great show. Listeners and viewers, thanks for tuning in. That does it for today's episode of Money Talks with Summit Financial and our host, Ken Wink. Thank you for joining us for Money Talks. Don't head into retirement without a strategy that addresses both income and taxes. For more information, please contact Ken Wink at Summit Financial, working with people you trust. Call 586-226-2100 or visit summitfc.net. Join us again soon for another episode of Money Talks.