Medicare Open Enrollment 2026

SPEAKER_00 0:00

The following is for informational purposes only. For medical advice, please see a medical professional.

SPEAKER_01 0:17

Welcome to Staying Alive with Margaret and Susie. Hi, Susie.

SPEAKER_02 0:20

Yes, hello. Here we are.

SPEAKER_01 0:22

So as we record this, it is mid-October, and uh we decided for the next episode we want to cover open enrollment, Medicare open enrollment, which begins on October 15th, and it will have just begun when you hear this episode. Um and we've we've covered Medicare once before, and what we did a year ago, I guess it was, right, Susie. Um we we covered traditional Medicare versus Medicare Advantage, which is basically private insurance, but more affordable. Um and and we covered that so for people who are basically first timers or may maybe people who were switching to try and figure out which plan worked best for them. And we're covering this again because there are things going on in the United States right now where a lot less things are going to be covered in the coming year. And we don't know yet what all those things are, unfortunately. We just know that there will be major cuts to Medicaid, which is our um and uh uh plans for for poor people in this country and or for people who yeah, people who qualify based on income, yeah. Yeah, low income. Yeah, and so um twenty-one percent of people on Medicare we all have supplemental insurance if we're on traditional Medicare, and 21% of those uh use Medicaid as their supplement. And then there's Medicare Advantage, which is private insurance, and they are very much cutting back what what they're going to cover in the coming year. And Susie, you were mentioning that there are doctors not covering our in your area. Yeah, you have to do that. Right.

SPEAKER_02 2:21

Well, I know of I've known of a few people who've told me that their uh physician is no longer accepting Medicare Advantage. And I heard of a big hospital in Portland, Oregon that is no longer accepting Medicare Advantage. A big hospital. So yeah, it's it's a concern because you know they can do whatever they want, just like they can raise prices after the first of the year. You buy a supplement, these years think, oh, it's a hundred and something or two hundred or whatever a month, and then boom, comes March, April, oh now it's more.

SPEAKER_01 2:54

You know, they can so it's an important thing to cover. Um I mean, there are 64 million seniors in the United States, and about 35 million of us are on traditional Medicare with the supplement. Uh no, thirty thirty-five million are on Medicare Advantage, the private insurance, 29 million on traditional Medicare with the supplement. I looked, I looked that up, I didn't have it memorized. And so um we we know at this point that one million seniors on Medicare Advantage have been told that that their plan is no longer covered in their area at all.

SPEAKER_02 3:36

Yeah, and you should have gotten notification, right?

SPEAKER_01 3:39

Yes.

SPEAKER_02 3:40

Yeah if you had if you're not going to be covered.

SPEAKER_01 3:43

Yes. A letter would have been sent to you. Keep that letter because you want to use it to f find your new plan. And uh the the good news about that termination is that you have done something that's a one-time golden ticket called guaranteed issue. And that means you can go back and sign up for any plan you want from traditional Medicare to an advantage plan, and they do not have the right to refuse you based on any type of medical conditions.

SPEAKER_02 4:20

Right. So pre-existing conditions are not a factor, yeah.

SPEAKER_01 4:23

Right. So that's important. I mean, younger people know they can be turned down for pre-existing conditions. Unfortunately, seniors can too, and we're much more likely to have pre-existing conditions by a certain age. So uh once we're locked into a plan, it's not easy to change with the exception of this guaranteed issue. If your plan has been completely terminated. So, because there are over a million people experiencing that right now, and we know there are cuts and benefits, we want to talk about it. Yeah. Um, my sister called me, she's in an area of the country. Like, we're we're not gonna talk about specific plans or bad badmouth certain states or anything. Um, but um, my sister's in an area of the country where her plan wasn't terminated, so she didn't have guaranteed issue, but her needs had gone up so much, it was no longer cost effective for her to stay on Medicare Advantage. She was playing, paying like hundreds of dollars out of pocket for MRI and such. I on traditional Medicare, I don't pay anything for an MRI. That's completely covered by my supplement because I got the Cadillac supplement, right? But so anyway, she she kind of did the math and figured, I want to switch over to the plan that Margaret has. And she called her broker and she said, he said, Well, you don't have guaranteed issue because that they're not canceling your plan and you do have pre-existing conditions now. He said, All we can do is put the application in and see, see if they take you.

SPEAKER_02 6:10

And um some plans are better than others. I had to switch five years ago. I had to switch from a Medicare Advantage plan to a supplement. And I called my broker because I got diagnosed with cancer, and I was worried that I would have too much cost. So I called him and he said, You've got about three days. And uh, because you can switch until March 31st. So you got in just in fact the only company that would accept me, and I'm you know, it's okay if I say what kind of company it is. There are some there are some companies that will accept pre-existing conditions.

SPEAKER_01 6:47

Well, if you can just say generically in a way, I mean I I think that's enough said. Like there are some companies, there are some companies.

SPEAKER_02 6:54

So so it isn't and that's some companies too.

SPEAKER_01 6:57

Maybe it was then, but it's not now.

SPEAKER_02 6:59

Yeah, that's right. And so really be careful and don't be afraid to talk to a broker, although they have changed the rules about brokers. I read the other day, brokers are no longer uh uh required to divulge up front that they don't work with all plans. And they're also not required to kind of guide you away from a Medicare Advantage plan. So it the rules have changed, and the rules have changed. I got a letter about my drug plan, and it said, we no longer have the right to research the drugs that you're taking and find out if they're covered by your plan. You have to do that yourself. Because it used to be that they would be able, when you went to a broker, you'd say, Oh, I'm taking a cholesterol medication or whatever. And they would look it up to find out how much you would be paying for which plant. They don't, they don't can't do that anymore. So you really have to be careful.

SPEAKER_01 7:58

Yeah, and to take it one step further, in this particular year, we are having major like billions of dollars of cuts in medicade on January 1st. And the particular administration at this time has said, and don't we're not revealing any of it till the first of the year. We've got to get through the midterms. And so and so even the brokers, they don't know, like even the insurance companies, they don't know. They they don't know yet how it's gonna impact them, so they can't even right now tell us how it's gonna impact us. Yeah, and and so we have to just do the best that we can based on what we know with our medical conditions and what we need. Uh, and um, we might not be able to be totally savvy consumers about it. We just can't be because we can't get all the data.

SPEAKER_02 8:58

Yeah, there's you know, you can go to a broker that brokers certain insurance plans, but there's also some government agencies, right?

SPEAKER_01 9:06

Yeah, I wanted to mention the the three that I'm aware of. So um each state has something called state health insurance assistance or ship. And you said it there was a different name in your state.

SPEAKER_02 9:19

My state in Washington, it's called Sheba, S-H-I-B-A.

SPEAKER_01 9:23

Okay, and it's called something else in the state where my my cousin lives. But but you can go to www.shiphelp.org and it will give the information for your state. So Susie's in Washington, Shiba would be in there under the Washington. Yeah, you can you can call Medicare, 1-800-Medicare. Or you can go to their website. Yeah. Yep. And there's also a Medicare helpline, uh 1-800-333-4114. And uh, and so those are three sources for you just to talk to people and start deciding now what, if anything, you want to do. Well, obviously, if you're one of the million who has gotten a guaranteed issue, you want to do something before the first of the year. Otherwise, even though you have till March, like Susie mentioned, you'd have to do that.

SPEAKER_02 10:21

We have till March to change.

SPEAKER_01 10:22

You don't have March to sign till March to sign up. Yeah, whatever you're on now.

SPEAKER_02 10:26

You only had till December 7th to sign up. Yeah.

SPEAKER_01 10:29

You what and whatever you have now ends December 31st. So you want you want to get signed up so that you have continuous coverage in the first year.

SPEAKER_02 10:39

Yeah, I have a new doctor, and she said, you know, she's actually um got her education in China, and she said there is no perfect medical system anywhere in the world, but the United States is the most chaotic. Yeah, which is you know, it's sad. Yeah. You know, people people get so confused about all this stuff, it's really not good.

SPEAKER_01 11:02

Yeah. I I always like to believe, well, we can learn lessons from this. And um, because of the chaos in our medical system now more than ever, I'm hoping that it's gonna bring pro positive changes in the in the future. I hope so too. I I really do. Um, you you may not think that if you're on the Medicare Advantage Plan or the private insurance, you may not think that your costs are going up because what the Medicare Advantage plans will do is they will keep the monthly premium the same, or in some cases they even lower it to entice you in, just the monthly premium.

SPEAKER_02 11:44

Right.

SPEAKER_01 11:44

And and and then you don't know that the way that they're gonna get their costs met is on the back end for your services and deductibles. And yeah, if you're gonna get an MRI, that's gonna cost you $200, you know, or and and you know, different things like that. And so um don't think just because your premium isn't going up, that means your costs aren't going up because they they want to get their costs met. And since the government's not reimbursing them like they had been, they're gonna have have it come out of us. They just are. That's they're they're a business.

SPEAKER_02 12:26

It's really unfortunate.

SPEAKER_01 12:28

Yeah, yeah. And and also contact your doctor's office. Sometimes um the the staff, you know, particularly the the back office staff, the the people in the um in the office who who does billing and such, that they have some good tips. And that they'll they'll give you a couple ideas.

SPEAKER_02 12:51

Right.

SPEAKER_01 12:51

Yeah and um with these changes that are coming, um, they predict that medical debt is gonna go up hugely in the coming year. And and they're gonna be using AI to collect the debt. Like that article just came out today.

SPEAKER_02 13:09

I just I feel so bad because then my fear is that people won't get the care they need. You know, that they'll just they'll just you know, go, oh, I'm not gonna go to the doctor. And then serious things can happen and yeah, you know, people even die. I mean, you know, it's not good. Yeah. So, but I think that's that's uh a good message, yeah.

SPEAKER_01 13:30

To to get yourself signed up and and take care of yourself, and and maybe maybe you'll decide as my sister did, because she was rejected, and only she be she had too many pre-existing conditions to to be able to find a supplement in her area. So she's staying on her Medicare Advantage plan. And what I told her, which uh is a message I want everyone to hear, is um that can change. Like that, that's what you have to that's what you have to put up with for the coming year. But we're into an election cycle now. And remember that laws change and we can envision a future and and vote what we believe in so that no one, especially seniors, is denied the health care that they need. And um and laws can be changed so that insurers can no longer reject one for having a pre-existing condition, um, exorbitant price hikes can be capped. Um this is the time to get your voice heard in the voting booth. And that's right. Remember that seniors are a powerful constituency. Like maybe we make up 19% of the adult population, but we're over 30% of the electorate. And politicians know that. So let's so let's speak up.

SPEAKER_02 14:54

Everybody's talking about the price of gas and the price of food, but and you know, the price of health care. But you know, look at people's um politicians' record about how they are about health care. You know, that's all there's to it.

SPEAKER_01 15:09

Yeah.

SPEAKER_02 15:09

Anyway, that's good. I think I think that pretty much does it for today.

SPEAKER_01 15:13

It does. It is and um take good care of yourself. We're gonna be here rooting for you. And until next time, we are we are staying alive alive.

SPEAKER_00 15:26

You've been listening to Staying Alive with Margaret and Susie. This show is hosted by Margaret Cooley and Susie Hymas. To subscribe to our show, leave a comment or ask a question, please visit staying alive with margaretandsuzy.com. Our podcast is available on all major podcast platforms. If you've enjoyed our program, please feel free to leave us a five star review. Thanks for listening.