Dealing with Medicare? Rule 1: RELAX
This fall, it may feel like someone pressed the “spin cycle” button on Medicare. Youtube videos, online influencers, and even neighborly chats are laced with stress, fear of increased costs, and/or lost benefits — or losing Medicare coverage entirely.
“It’s not happening,” reassures longtime Medicare broker, George Dunford. “We still have Medicare, we still have coverage, and there are still options — whether you have a traditional (basic) Medicare (with or without Medigap) or Medicare Advantage plan.”
“We’ve been here before,” George adds, explaining that in years past we’ve seen plans
pull out of certain communities, and premium and drug plan costs change.
As for prescription medication coverage for 2026, George says, indeed, deductibles and drug formularies have pretty much changed across the board. But, he assures, “not nearly as dramatically as people may think.”
Likewise, premium costs have increased. What about people with zero-premium plans? George says those are still available, but that some may now have a higher co-insurance or co-pay.
Out of pocket (OOP) maximums have also increased. “But out of pocket maximums are just a protection mechanism,” George explains, “so you can budget for next year.”
George highlights these four things to keep in mind this year:
- If your Advantage plan is cancelledthere is time to make a change — including after Dec 7 when the Annual Enrollment Period ends. “We can meet up until Dec 31st and get you covered effective January 1, 2026.”
- “It’s time to bring the temperature down a bit.” George says people getting information from Youtube, friends, or online influencers can be setting themselves up for inaccurate information that might be frightening or upsetting. Which brings us to number 3:
- Find a broker you trust.
George recommends working with a local broker. These folks know the plans and choices available in your area and options for navigating the current tumultuous climate, so they’re equipped to ensure that in 2026 you have a plan that meets your needs. “Phone solicitors are fine,” George notes, but just as when you’re seeking professional help of any kind, do your research, seek referrals/reviews, and interview candidates to ensure they will meet your needs.
- Medicare is still going, and hospitals are still operating.
While the number of carriers has decreased in some areas (some more than others), George reminds us to resist reacting out of fear. A better approach is to connect with someone you feel you can trust, knowing that you do have options.
What if you’re running late? “If a Medicare beneficiary misses the Dec 7 AEP close, as long as they have had Medicare Advantage, there is a second period — Open Enrollment or OEP — during which changes can be made Jan 01 through Mar 31.”
The OEP affords those with Medicare Advantage a one-time opportunity to change their plan to address drug coverage or participating doctors or services. “Maybe they didn’t realize their drug coverage was wrong,” George notes, “or that their doctor will no longer accept their plan.” During OEP, they can change to another plan to better fit their needs.
Oregonians also have another important option. “Oregon has the birthday rule,” George says, which allows those with a Medicare Supplement or Medigap Plan to move to an equal or lesser benefits Supplement Plan offered by a different carrier with a lower premium. The time to change is within 30 days of your birthday. The best part: during this period coverage is “guarantee issue,” meaning coverage is granted without medical questions or exams.
According to the birthday rule, enrollees who have had a Medicare supplement since their Medicare eligibility date can move to an Advantage plan and have a one-year period, or Trial Right, to disenroll from the Advantage plan and return to their Guaranteed-Issue Medicare Supplement.
Above all, says George, “Relax. Don’t be swept up in fear-mongering by online information, influencers, or Youtube.” “We still have coverage, there are still options, and we still have Advantage, Medigap, and Basic Medicare available. No need to stress.”
George Dunford is the Principal Broker with Proulx-Dunford, LLC.