Michele’s Medicare Monthly Nov2025

Medicare Matters — November 2025 Newsletter

Stay ahead of changes & protect your health coverage

1. 📅 Important Dates & Reminders

Open Enrollment (Annual Enrollment Period) for Medicare Advantage and Part D runs October 15 – December 7, 2025. This is your window to join, switch, or drop plans.

Changes you make during this period typically take effect January 1, 2026.

It’s a good time now (in November) to review your current plan’s Annual Notice of Change (ANOC), check provider networks, drug formularies, and new costs for next year.

If you haven’t already, mark your calendar for Jan 1, 2026—the day many of the upcoming benefit changes take effect.

2. 🔍 Key Medicare Changes Beneficiaries Should Know (Effective or Preparing for 2026)

Prescription Drug (Part D) & Cost-Caps

Beginning in 2026, your out-of-pocket costs for prescription drugs under Part D are capped at $2,100.

Also in 2026, the law allows the first round of negotiated drug prices for some high-cost medications under Medicare. AARP+1

These changes mean you may still pay premiums and deductibles, but your risk of extremely high drug bills is reduced.

• Medicare Advantage & Original Medicare

For the 2026 contract year, the Centers for Medicare & Medicaid Services (CMS) finalized updates to the Physician Fee Schedule, which may impact provider reimbursement and possibly provider participation in your area.

There are also policy & technical changes for Medicare Advantage and Part D plans (CY 2026) that affect plan operations, benefit design and marketing.

Premiums, Cost-Sharing & IRMAA

Premiums for Part B and Part A, and cost-sharing amounts are expected to increase in the near future.

If your income is above certain thresholds, you may face higher premiums via IRMAA for both Part B and Part D in 2026.

✅ What You Should Do This Month

Read your ANOC and Evidence of Coverage when it arrives. Pay particular attention to:

• Changes in provider networks and whether your doctor or facility remains in-network.
• Changes in drug formularies (lists of covered medications) and whether any of your medications will move tiers or go off the list.
• Any premium, deductible or copayment changes for 2026.
• Use the Medicare Plan Finder or a trusted advisor to compare your current plan versus alternatives. The goal: make sure your 2026 plan meets your needs and budget.

If you anticipate major changes in your health care needs (e.g., new prescriptions, upcoming procedures, new specialists), consider switching plans during open enrollment to get better coverage for those needs.

• Keep your income and life-situation documentation up to date in case you are subject to IRMAA and may qualify to request a reconsideration if your income drops due to retirement or other changes.
• Ask your health providers: “Will my telehealth services / other benefits stay covered under my plan in 2026?” As benefit rules and networks evolve, some services may change.
• Stay aware of deadlines: Changes you make before Dec 7 must be submitted by then to take effect Jan 1, 2026.
• 4. 💡 Tips & Reminders

The $2,100 cap for 2026 on prescription drug out-of-pocket costs applies to covered Part D drugs — it does not replace your plan premium or network/coverage rules.

Even if you like your current plan, do not assume it remains the best fit — next year could bring new costs, new benefits, new networks.

For beneficiaries with limited income/resources: Explore programs such as Extra Help and Medicare Savings Programs (MSPs), which can reduce your premiums, deductibles, and copays.

If you’re helping a caregiver or family member: November is a good time to discuss “What if” scenarios (chronic illness change, new medications, provider changes) so you’re not caught off-guard.

• Contact a certified Medicare counselor (like your SHIP program) or your insurance agent well before the December deadline to give yourself time to ask questions, compare plans, and avoid last-minute pressure.

Take time this month to compare your options, ask questions, and make an informed decision. If you’d like assistance or have any questions about your coverage, I’m here to help.

2026 Make sure you do NOT use for Flex card for Utilities or Rent/Mortgage. Medicaid will now be using that amount and counting it as INCOME!!! You could LOSE your medicaid by using the flex card for rent or utilities! Spread the Word.

Warmly,
Michele Wagoner

Your Little Insurance Lady!
Your Medicare Broker