By Christian Regalado
Now that we’ve finished the first quarter of 2026, I’ve seen some changes and trends that affect those on or going on Medicare. If that’s you, perk up. I’m here to help you get sorted.
In the past, most seniors aging into Medicare chose to enroll in an Advantage plan. The premiums were usually $0, and the extra benefits commonly offered for vision, dental, and hearing that aren’t provided by original Medicare were attractive to many enrollees.
Today, those perks aren’t so perky. Some plans that once offered generous dental benefits have been reduced to as few as a couple of checkups a year. At one time, Over-the-Counter benefits were $75 per quarter or higher on some plans. Some carriers cut their OTC benefits completely, while all others reduced them.
Why all the reduction in benefits? Federal funding cuts, along with rising medical costs and lower than expected reimbursement rates have cut into carriers’ profit margins. Carriers choose to lighten extra benefits in order to help their profitability. After the out-of-pocket max for prescription drugs went down in 2025, beneficiaries’ costs went from $8000 to $2100 in 2026, and carriers replaced that lost revenue by cutting other benefits.
Most Advantage carriers have eliminated or reduced their offering of PPO plans that don’t require referrals and allow out-of-network benefits. I expect next year that there will be even fewer PPO plans offered. You may have noticed talk in the media about HMO Advantage plans denying pre-authorizations. When this happens, it can be anywhere from a hassle to a nightmare for some folks. In our area, it does happen, but it appears that incidents are low.
In the past, most of the clients that I enrolled in a Medicare plan chose an Advantage plan; they were primarily motivated by the $0 premiums and the extra benefits not offered by original Medicare. This has changed. These days, more folks are choosing to enroll in Medicare Supplement plans.
The mean income for someone over 65 in Walton County is around $70k. This allows many seniors to afford the monthly Supplement premium costs which can start around $100/month. However, most plans people want are closer to $200/month, but there are many options. PDP premium costs run from $0 to over $100/month, depending on their formularies. Which plan suits you best will depend on the prescriptions you take. If you do not take any prescriptions, remember to still at least enroll in a $0 premium PDP to save yourself costly penalties for a future PDP plan. Too many Medicare beneficiaries make this mistake because they simply did not know about this penalty.
Many of our area’s seniors have above average incomes and are subject to IRMAA (Income Related Monthly Adjustable Amounts). If your adjusted gross income two years ago was over $109,000 for a single, or $218,000 for those filing a joint return, you are subject to an additional tax on your Medicare. This surprises most folks when they get a bill from Social Security. It is a tax and not a payment to an Advantage plan. This is one of many things to discuss with your broker.
The job of a broker is to help you sift through the many options available to you and help you decide which available plans and carriers will work best for your situation. Whether you are looking for a low-cost Advantage plan or your best option for a Supplement plan, I am here to help. Everyone’s needs really are different! Call me for a free consultation at my office in Santa Rosa Beach at (850) 687 7606 or reach me by email Christian@evergreenhealthins.com. It doesn’t cost you anything but a moment of your time. However, it can save you a lot of money and unwanted frustrations. I look forward to visiting with you!
