It’s Medicare season, when the millions of Americans enrolled in Medicare plans are allowed to make changes to their plans. These opportunities are limited and this year presents some new challenges. Big Medicare insurance companies are dropping plans, trimming benefits and increasing deductibles. You’ll want to do the homework to make sure you’re getting the coverage you need and the coverage you can afford.
Medicare insurance has become less profitable for big insurance companies and they’re trying to limit costs. It’s that simple. Enrollment in Medicare Advantage plans is expected to shrink in 2026, for the first time in 15 years. The companies are focused on profits, not growth.
If your medications have changed since last year or if your prescription coverage isn’t paying enough, it’s time to review your plan. Most of us have seen our premiums go up—they never go down—so a plan that worked with your retirement budget last year might not work in 2026.
You’ll need to review the Annual Notice of Change, Summary of Benefits and Evidence of Coverage. No, it’s not enjoyable reading but it’s necessary to know the changes coming to your current plan.
New York residents can go to HIICAP – Health Insurance Information, Counseling and Assistance Program at the Office for the Aging or call 1800-701-0501 to speak with a counselor in your county. HIICAP can help with comparing different plans, including Medicare Advantage, Original Medicare + Part D, Medigap and understanding the benefits and costs of these plans. Help is also available for enrollment, appeals and the general paperwork that goes with Medicare enrollment.
What to Look Out For When Deciding on a Plan
There is admittedly a lot that can go wrong when picking a plan. What looks great on paper may not work in practice. Hospital systems, specialists, and networks vary significantly by insurer, so you’ll want to ask your providers to make sure your main doctors, specialists and local hospitals are included.
Medicare Advantage plans penalize claimants for going out of network. Be careful with plans that severely restrict the providers you can use. Many hospitals and doctors are leaving Medicare Advantage networks. Contact your providers directly, as the insurance company directories are typically not updated.
Plans also change from year to year. Some insurers leave markets or change counties based on their profitability. Even if your plan continues in your area, benefit changes may impact drug coverage, tier lists or prior authorizations may change.
What about Traditional Medicare?
Many people skip the Advantage plans altogether. Traditional Medicare includes most doctors and most hospitals. You’ll need a Medicare Supplement (also known as Medigap) policy, which can be expensive but covers what Medicare won’t.
Drug Plans are More Expensive
The number of stand-alone Medicare drug benefit plans (Part D) are decreasing sharply and their costs are escalating. Drug deductibles are up, and many co-pay prescriptions will require higher patient payments next year. Insurance companies are using the term “coinsurance” which is corporate-speak for you’ll have to pay for this.
Medicare.gov has a tool to review prescriptions and help identify what you’ll pay for medication under each plan.
Cost-Assistance Plans in New York
New York offers the Medicare Savings Program, which helps pay Medicare Part premiums and, in income is low enough, may pay deductibles and copays. There’s also “Extra Help” /Low Income Subsidy for Part D to help with drug costs, premiums, and deductibles. If you’re a resident, look into EPIC – New York’s Elderly Pharmaceutical Insurance Coverage program, which might help with drug costs for NY residents. All of these programs are available through the New York State Office for the Aging.
On Long Island, there are a few nonprofit advocacy groups who can help. Family & Children’s Association (FCA) in Garden City, Nassau County, provides free, unbiased guidance to local seniors through its HIIPCAP Medicare counseling efforts. AARP also offers a variety of resources for 2025 Medicare enrollment, including online guides, webinars, and tools.
How We Can Help
We recognize the process of figuring out what plan to use can be confusing. We are able to find options for specific zip codes on Long Island and identify the ones that look strongest for our clients. We do not sell insurance and are not insurance experts, but we have certain research tools that may be helpful. You are invited to contact the office if you’d like input on their plans.
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