We welcome back Josh Kinzel from Seniority Benefit Group for his sixth visit to the podcast. The focus of this conversation is on the upcoming changes to Medicare enrollment and coverage for 2026, as well as practical advice for those approaching or currently navigating Medicare options. Breaking Down the Medicare Alphabet Soup Josh walks us through the parts of Medicare and why understanding them is so important: Original Medicare includes Part A (hospitalization, generally free) and Part B (outpatient coverage, with a monthly premium). Original Medicare typically covers 80% of approved costs, but there’s no out-of-pocket cap for the leftover 20%. That’s where the choice between a Medicare Supplement (Medigap) plan and a Medicare Advantage (Part C) plan comes in. Medigap fills in gaps left by Original Medicare—giving simplicity and freedom to see almost any provider accepting Medicare. You add on a Part D drug plan for prescriptions. Medicare Advantage plans are administered by private insurance companies. The government pays these companies on your behalf, so the advertised zero-premium plans are real—but always remember, your Part B premium still applies. With Advantage, you’re often in an HMO or PPO network, may have to seek pre-approval for some services, and pay more out of pocket if major health issues arise. What’s New for Medicare in 2026? As usual, we’re recording before all federal rules are final, but here’s what we know: Part B premiums are expected to rise by about 11%, reaching an estimated $206.50 monthly. Part D drug plan costs may inch up, mainly as insurers adjust to the new $2,000 annual out-of-pocket limit (from the Inflation Reduction Act). While deductibles and catastrophic thresholds rise, costs for many drugs, especially for diabetes, are actually dropping. The infamous “donut hole” coverage gap is now virtually gone, making prescription coverage simpler. Talk continues about longer-term Part D and Advantage contracts (potentially covering more than one year) and the introduction of more pre-authorization (prior approval) steps, including the use of AI to address fraud and control costs. Medicare Advantage and the “Free” Plan Question A recurring theme is whether Medicare Advantage’s free or low-cost plans are really “free.” Josh explains that these plans are genuinely $0 premium because the government subsidizes them, but you’ll still pay the Part B premium, plus out-of-pocket costs when you use services. The trade-off is less predictability, more restrictions on doctor/hospital networks, and a risk of higher costs if you need significant care. If you like this episode, please let us know. We appreciate the feed back, and your support of offset costs of producing the podcast! MyCare Ohio: A New Managed Care Option for Dual Eligibles We explore MyCare Ohio, a managed care model that combines Medicaid and Medicare benefits for those who qualify for both. Expanding to all 88 counties in Ohio, this program promises consolidation, fewer cards to carry, and—potentially—lower out-of-pocket costs for those with low income and assets. Eligibility, plan availability, and making sure your doctors are in-network are important considerations. How Employers and Retirees Fit In For people who are still working at 65 or have retiree health coverage, we emphasize comparing employer plans with Medicare options—never simply assuming your current coverage is best. Employers can use experts like Josh’s group to help employees or retirees make smart,...
