Significant Upcoming Changes to Medicare Transcript

Speaker  00:00

No need to lose sleep over planning your Medicare coverage. Lisa Lauro and the team at Secure Money Health want you to get the best, most customized service when planning your Medicare coverage. In fact, Lisa wants to share her new book with you, the ultimate Medicare book. It’ll help you choose the right plan, understand your benefits and avoid common pitfalls. Go to mymedicarebook.com. That’s mymedicarebook.com. It’s time to secure all your healthcare needs.

Lisa Lauro  00:34

And we will really simplify the process.

Steve Sedahl  00:37

Welcome to Secure Health with Lisa, welcome in everybody to Secure Money Health radio where Medicare matters. Lisa Lauro is here. Lisa, how are you? Good to see you.

Lisa Lauro  00:52

Good to see you as well. Steve, I’m doing great. How are you?

Steve Sedahl  00:56

Oh, very well, thanks. I mean, now you- Again, I’m just gonna remind everybody you’re president of Secure Money Health you work with, you know, Brian and the gang over at Secure Money Advisors. And all I know is you have put out such great information over the past. Well, since we’ve been doing this show you are the source, I think.

Lisa Lauro  01:17

Well, thank you. I like to think that each week, we are helping folks, you know, clarify their Medicare choices and keep up to date with the changes and things that are happening. So, I think it’s going to be a good one today well.

Steve Sedahl  01:34

And I think I want to remind everybody too that Lisa has written a book, and you can find it at medicaresimpleguide.com and you wrote the book because you just want people to know the basics, and it really does help Medicare make sense. And the book is free. All you have to do is go to medicaresimpleguide.com, and Lisa’s gonna send you the book.

Lisa Lauro  01:57

Yep, we’ll send it right to your mailbox. It’s called The Ultimate Medicare book. It’s about 50 pages. So great resources for those that are getting started, and even a resource for those that already have Medicare. But you know, there are some unique chapters in there for travel and how you’re covered there, and for veterans and things of that sort. So, it’s a good resource for all absolutely.

Steve Sedahl  02:22

And let’s jump into this. A lot of changes coming next year. Of course, there always are changes and again, I didn’t realize this, that the Inflation Reduction Act is still having an impact on things. Premiums are going up. But let’s, let’s start at the top and talk about premiums and Part B, deductibles climbing. This is not what we want to hear, but it’s a true- but it’s just happening.

Lisa Lauro  02:45

It is happening. Definitely not something that people are going to be excited about, but so, yeah, so you know, there is a premium for Part B. That’s the medical piece of Original Medicare and that’s because Part B covers 80% of your medical so that’s why you have a premium for that. And this year, in 2025 the premium the standard rate. Of course, you know premiums do vary according to your modified adjusted gross income, but we’re going to talk today about all the standard rates. And the standard rate this year is $185 and it’s projected to rise 11 and a half percent, reaching up to roughly $206.50 a month per person for next year for 2026.

Steve Sedahl  03:41

So, that’s a pretty significant jump, going over $200. That’s going to be a- that’s going to be an eye opener for some.

Lisa Lauro  03:47

I think so. I’m sad to see it go up. It does typically go up. Last year it went up roughly 10 bucks, you know. So, it is a significant jump. I think it’s one of the highest, steepest jumps that we’ve had in the last, say, four years. But, you know, unfortunately, things are changing, so…

Steve Sedahl  04:13

Sure they are well, and so let’s talk COLA, the Cost of Living Adjustment. What can we expect? Anything?

Lisa Lauro  04:19

Sure. Yeah. So, the cost-of-living adjustment is expected to be just 2.6 to 2.7% so that means that nearly 40% of that increase could be eaten up by your Medicare premium alone.

Steve Sedahl  04:38

Okay, all right, on that note, what are we- what do we need to do today to prepare for this?

Lisa Lauro  04:44

Yeah, you know what? There’s one more factor. I think it’s, it’s notable to mention, and that would be the Part B deductible, because that too is increasing. So, we have the Part B premium, which is the cost to have the Part B monthly, and then you do have a deductible for your Part B and that is set to climb up to about $31, landing at $288 a year. So, for 2025 the deductible for the Part B is $257 and they are projecting that it’s going to be roughly $288 for next year. So, I think there needs to be some planning about how people are going to deal with these adjustments.

Steve Sedahl  05:34

And in doing so, we need to be able to is that a time to sit down with you and to sort of evaluate where things are and where it’s coming from.

Lisa Lauro  05:44

I think, you know, you know, there are some things we can talk about, and we’ll talk about a couple today. You know, some things that people can naturally do to accommodate for this adjustment, right? But I also think these are some things that are, you know, when you’re talking about budgets and things of that nature, you need to sit with your financial advisor and kind of say, hey, you know what? You know, we’ve got this adjustment here and, you know what? What should I do about that as well? So hopefully your advisor has you set up where, you know, $30 here and $50 there isn’t going to be too much of a risk for you in terms of your budget. But, you know, there are some things. So today we can talk about, you know, revisiting your monthly budget. So don’t wait until January to do this. Don’t procrastinate. Okay, you want to be able to factor in $20, $30 monthly, of an increase to avoid a surprise, you know, hit to your bank account later. Okay, so that’s something to think about. You know, maybe there’s some things, if money is tight, where you can cut out to accommodate for that. The other thing is, you want to review your Medicare plan if, especially if you’re on a Medicare Advantage plan or a supplement plan. You know the annual enrollment period is this fall. It’s a great time to explore whether your current coverage is still cost effective for you, especially if you’re also trying to manage the drug costs and co-pays for those as well. So, you know, you don’t want to procrastinate. You want to get on this so that you are fully prepared when you have new options coming up this fall, which starts October 15. Another one that you can do is prepare for higher out-of-pocket costs, an increase in the deductible. May not seem huge, but combined with premiums and other costs, it does add up, you know, so maybe just start now by setting aside some extra funds, maybe in a health budget, a little bucket or a little account that you have that you can start budgeting now, so that, if You start early, you’ve got, you know, five, maybe five months before the end of the year to start preparing a little extra here, a little extra there, to offset that cost increase. And then finally, your annual Medicare review. You know, each year, I help clients review their Medicare and prescription drug coverage and to ensure that it still meets their needs. So, it’s very important that if you’re not working with someone like myself, give us a call. We’re happy to help you what you were happy to sit down with you or any of your friends that might need some help with their Medicare planning. You know, don’t assume that your doctor’s in the network or that your prescription drugs are still being covered. The same way you want to sit with someone and be sure that going forward, you are covered correctly.

Steve Sedahl  08:55

724-242-6828, is the number you can call right now and connect with Lisa, set up a time to come on and sit down and review things. Because, I mean, you know, with the administration change and all of the changes that are coming there, plus the ones from the inflation Reduction Act, boy, there’s a collision of a lot of things that are happening. So, it’s important to be aware and to sit down with you and understand how our health care is going to be impacted, because it will be.

Lisa Lauro  09:22

Right, that’s exactly right. Yeah.

Steve Sedahl  09:28

724-242-6828. So out of pocket drug cap. So, the out of pocket goes to like $2,100 is what we’re saying.

Lisa Lauro  09:35

For prescription drugs. Yeah, yeah, yeah. So, so this year, there’s a few things that that that are happening with the prescription drugs. The good news is that, you know, as of January of ‘25 they put a cap, a $2,000 cap, on your prescription drug costs, and it is going to increase to 2100 for the year of 2026 or so. So, you have to meet that $2,100 cap, and then the prescription drug plan will cover your drugs for the remainder of the year. So, it’ll slight increase there, but it’s still a good thing. It’s a great thing to have this way. It’s not just this runaway train of prescription drug costs throughout the year. For some folks- are really on some very expensive medications, and I’m hoping that that they felt a little bit of a breather this year with that cap in place, you know?

Steve Sedahl  10:30

Well, just from my own experience, that cap came in, came into play for me in the middle of July, and again, I reached, I reached the max, so I’m good the rest of the year.

Lisa Lauro  10:40

That’s wonderful, yeah.

Steve Sedahl  10:43

But I guess, and again, I’m thinking that a lot of people are discovering that, because it was kind of a surprise for me. I mean, I knew it was coming, but kind of nice,

Lisa Lauro  10:49

Right, right, yeah. And the other one is there. You know, this year, the deductible for standard Part D prescription drug plans is roughly around $590 some a little less, but, but it that also is rising, and that’s going up to $615. So, for those, you know, there’s different prescription drug plans. Some have a deductible. Some, actually, have a higher premium so that it offsets the cost of the deductible. So, there’s no deductible, but you’re paying, you know, a lot more for- to have the plan. So, each of those are kind of unique in their own way, but for those that do have a deductible, you can plan on roughly about $615 for your prescription drugs. Now most of the plans, which is nice, is that they don’t charge you that deductible, at least the way it is this year on your tier one and two medications, but tiers three, four and five are usually subject to that deductible.

Steve Sedahl  12:01

Fair enough. 724-242-6828, we’ve got a lot more to talk about. We’re going to take a break here, and when we come back, I want to dig into the Medicare Advantage plans. I know there’s a lot of talk about that and changes, and I want to explore that and so much more right here on Secure Money Health radio, where Medicare matters. With Lisa Lauro, we are going to take a break and we’ll be right back after this.

We are back on Secure Money Health radio, where Medicare matters. Lisa Lauro’s here. She is the one who makes Medicare matter. Actually, what Lisa, what you do for me is you just make it all make sense, because, because it can get complicated.

Lisa Lauro  13:10

Yes, maybe that’s what we should have named the show where, where Medicare makes sense.

Steve Sedahl  13:19

Yes, I like that. So, we’ve been talking about, you know, changes coming up in the next year, and you were talking about the Part D coverage, and what’s happening with that. So, let’s review that and then and see, because we were talking about, we haven’t talked about drug prices, specifically insulin.

Lisa Lauro  13:36

Yes, yes, yeah. So just to recap, you know, part D, deductible increase. We’re seeing a slight increase from $590 this year to $615 in 2026. The cap, the out-of-pocket cap, still remains on the prescription drugs. However, it is increasing 100 bucks. So, it’s- that’s going from $2,000 to $2,100 and then lastly, what we what I’d like to talk about just for a second, is just a lot of diabetics will be happy to know that the insulin cap still applies. So that’s good news for them. Right now, the insulin costs remain capped at $35 a month for covered products. So as long as it’s covered and on the formulary, the insulin would be capped at $35 a month. And that has helped a tremendous amount of diabetics I know. Years ago, before they had this cap, people were really struggling with the cost of their insulin. And you know, as you know Steve and I know people that are diabetic cannot just skimp on their insulin. That does not work for them. They have to take it correctly to monitor their sugar. Could be life threatening, right? So, We want to i It’s one of, one of my favorite things, especially it’s near and dear to me. My brother-in-law is a severe diabetic, and so when that all came into play, I was pleased that the insulin is now kept at that $35 and will remain that way for 2026.

Steve Sedahl  15:18

Nice. That’s, I mean, that’s a good thing, folks. 724-242-6828, if you’re looking for clarity there. And so that’s, that’s a good thing. That whole insulin, that was quite the controversy for a while, wasn’t it?

Lisa Lauro  15:31

It really was. Yeah, it was. And they really did right by the diabetic folks by capping it. And you know, it’s definitely way more affordable. Now, you know, there are some of these combo diabetic prescription, you know, insulins that it’s, you know, they have different drugs, you know, combination drugs. Those, you know, may not be on the formulary, but your basic insulin. You know, if it’s on the formula is going to be capped at that 35 so good news.

Steve Sedahl  16:08

It is. Good news. And so, let’s talk about Medicare Advantage. Can we?

Lisa Lauro  16:13

Yeah, there’s a few things I’d like to talk about just, just to finalize this last piece of the prescription drugs, which is, you know, what should folks do? And then this way we can just kind of finish that topic up. But so, there’s a few things that you can do. And the one is, you know, it the way it is, is, if you are happy with your prescription drug plan, you know it will just auto renew, but I honestly don’t recommend just letting it auto renew without having someone check your prescriptions, because you shouldn’t assume that they are covered the same way, year over year. So usually what I do is I touch base with my clients, and I just have them update their prescription drug lists with me. You know, if they’ve gotten any new ones over the year, that that I need to be aware of, if they stop taking some that are no longer, you know, on their list, we’ll, we’ll update that list in our program. And then I usually run, you run it to see, you know, if their current plan is still going to be the best plan for them. I hate to assume those things. It’s just not the right thing to do. So always have somebody check on that for you, so that you know, and you could do that over the phone. That’s not something you have to come in the office for, you know, just touch base and we have a conversation, if you know, there, like last year, there were several that I knew I had to make a change for folks, because there was, you know, a plan that that made significant changes, that that, you know, took some things off the formulary, and I had to work around that. And so, you know, if that’s the case, then you know, you may have to come to the office. But it is- it definitely is something it would behoove you to go ahead and have somebody check that for you. So that’s really important. You also want to, you know, they do have new plans each year. So, you want to make sure that, you know, even if you like your plan, is it still the best? Maybe there’s one that’s, you know, a little bit better or a little more cost effective for you. So, you want to watch for that. You want to watch for Tier changes. What I mean by that is that prescription drugs are tiered one to five. Sometimes they will re-tier them. So, you know, if it’s a- it could be a three, tier three that goes to a tier four, which would cost you more money. Sometimes they go down in Tier as well. But just to be aware of that and I would start doing this, you know, sometime, getting your list together in September, we can start checking as early as October 1.

Steve Sedahl  18:51

Okay, good to know, 724-242-6828, that’s the number to call and sit down with Lisa once again, you can visit the website, securemoneyhealth.com, and get a pretty good idea of what Lisa does and certainly what she can help you with. That’s right. So, are we talking Medicare Advantage?

Lisa Lauro  19:10

Yeah, that’d be great.

Steve Sedahl  19:11

Okay, because that’s- I mean that I think I’m- I’ve read a couple different stories. I’m hearing grumblings. Is it ever going to be massive changes, do you think? In the Advantage Market?

Lisa Lauro  19:20

market, I know, you know, there will be some changes. I don’t know if they’re going to be massive, but that, you know, there will definitely be changes. There’s- there are a few things that are kind of on the docket, that that are being discussed. And so for one is, it sounds to me like the Advantage plans are getting, you know, some type of a funding boost for 2026 and I think I’m not sure if it’s been approved yet, but CMS is thinking about approving an average of 5% payment increase totaling over 25 billion in funding across the board. And. So, you know, if they are giving these ADVANTAGE plans 5% payment increase, I would think that would be a good thing, right? Like they’re going to fund more, seems like it, you know, but not all of that is going to be trickled down to beneficiaries. So, there’s a few things that come into play here with that. So, one is risk adjustment and star rating. So, they do rate these plans from one to five. And so, you know, if usually you know, the higher the star rating, the better the plan. That’s the way it works. So, five being the best, right? So one of the things is, I think those that have lower star ratings may not see the full increase trickle down to that plan and its member so I think the way it sounds to me, and this is also like sort of speculation, because it’s not all written in stone yet, but it sounds to me as though, you know, the plans with the higher ratings are going to benefit, obviously, more than ones with, you know, a two or three rating, perhaps.

Steve Sedahl  21:14

With Medicare Advantage. I mean, we’re thinking about the extras, right? We talk about the dental we talk about the eyes, you know, the eye care. Do you see any changes in those as a result of this?

Lisa Lauro  21:27

Yes, potentially, so it could affect some of the extra supplemental benefits where some of those might be taken away, not completely, but maybe the- might shrink down to a little bit less than what they’re offering. So, like, maybe on the dent, like what we saw this past year is some of the plans, how they compensated this year for some loss in revenue was, was with the dental so you know, where they might have given 3,000 on the max, and now it’s down to $2,500 or $2,000 so I don’t think, I think, you know, it would be a big mistake to discontinue those types of benefits. People love them. That’s why they choose those plans. So, I feel like they’re kind of walking on a narrow path with this where they have to be careful, because that’s what people love about these programs. But I do think that overall, we may see a little bit of a slash in the total amount of benefits that they give, you know, maybe a little less on eyeglass wear, you know? Oh, sure, I don’t think they would discontinue gym memberships, but I think-

Steve Sedahl  22:49

Yeah, that would be a bad thing. I would think.

Lisa Lauro  22:50

That would be a bad thing because just, you know, they’re very big on preventative screenings and things and go having that gym membership is very important, right, with keeping your overall health in check, for those folks that are actually using it, but with the gym memberships, I think there might be some restrictions in play, like maybe you have to just pick one gym. You can’t go to a number of gyms. I know they frown upon that, but I don’t think that there’s anything that they’ve put in that says you can’t have multiple gyms. And I think maybe that’s an area where they may say, hey, we need to, you need to pick a gym. We’re not going to pay for multiple memberships for you. The over-the-counter allowances, again, is another thing that people love that might, that might maybe, that maybe they’ll slash a little bit at that of those benefits. So, we’ll see. It’ll be interesting to really see. I’m really looking forward to October 1, when I can see all the plans and really take a hard look at what changed for good or for bad, right?

Steve Sedahl  23:52

Sure, sure. Because there’s going to be some of each, correct?

Lisa Lauro  23:55

Usually there are sure.

Steve Sedahl  23:57

And again, as we get towards that we’re here. Here we are in August. I mean, October is around the corner, and so it is important to, you know, sit down with you and review what your plan is, make sure that it’s what you need and what you want.

Lisa Lauro  24:12

That’s right. That’s exactly right.

Steve Sedahl  24:15

Well, again, on that note, 724-242-6828, is the number to call 724-242-6828, 724-242-6828, and again. Lisa, this is the show. Holy cow. Went by quickly, folks, if you want to know some more, please give us a call. 724-242-6828, or visit securemoneyhealth.com. Lisa, next week, we’ll do it again.

Lisa Lauro  24:35

That sounds great. Steve, take care.

Speaker 2  25:03

The investment advisory services are offered through Foundations Investment Advisors, LLC, an SEC, registered investment advisor. The content provided is intended for informational and educational purposes only. The views, statements, and opinions expressed herein are those of the individual speakers and are not necessarily those of foundations and its affiliates. The information contained herein does not constitute an offer to sell any securities or represent an express or implied opinion or endorsement of any specific investment opportunity offering or issuer. Any discussion of performance or returns is not indicative of future results. Any discussions of specific strategies are for informational purposes only, and have been provided to help determine whether they may be appropriate for your specific situation. If applicable. The primary goal in converting retirement assets into a Roth IRA is to reduce the future tax liability on the distributions you take in retirement or on the distributions of your beneficiaries. Each individual investor situation is different, and any ideas provided may not be appropriate for your particular circumstances. Comments regarding a particular client’s experience may or may not be the same as another client’s experience, and is not an indication that any client or prospective client will experience the same or a higher level of future success or performance. Foundations only transacts business and states where it is properly registered or is excluded or exempted from registration requirements. Registration as an investment advisor is not an endorsement of the firm by securities regulators, and does not mean the advisor has achieved a specific level of skill or ability. Nothing herein constitutes a recommendation that any security portfolio of securities or investment strategy is suitable for any specific person. No legal or tax advice is provided. Please review your retirement tax and legacy planning strategies with a legal or tax professional before transacting or implementing any strategy discussed here in any comments regarding safe and secure investments and guaranteed income streams, refer only to fixed insurance products. They do not refer in any way to investment advisory products. Rates and guarantees provided by insurance products and annuities are subject to the financial strength of the issuing company, not guaranteed by any bank or the FDIC. This is not endorsed or affiliated with the Social Security Administration, any federal Medicare program, nor any US government agency, if applicable. We do not offer every plan in your area, and contacting us at the phone numbers provided herein will direct you to a licensed insurance agent. Any information we provide is limited to those plans we do offer in your area, please contact medicare.gov, or one 800 Medicare to get information on all of your options. All Rights Reserved.

Outro  25:03

Coach, P Radio.