Seniors can get help wth Medicare sign-ups

A only constant in life is change. Change is also an annual occurrence in Medicare drug coverage and Medicare Advantage plans.

That's why seniors should review their coverage during the annual open enrollment period that began Oct. 15 and runs through Dec. 7, said Mike Carsey, a volunteer with Volunteers Assisting Seniors.

During that window, seniors can join, switch or drop a Medicare plan or change Medicare Part D Drug coverage or Medicare Advantage plans for the coming year. If beneficiaries like their plans, they can keep them. If they don't change, their current plan automatically rolls over.

Volunteers Assisting Seniors serves as the east-central Nebraska office of the federally funded Nebraska State Health Insurance Assistance Program, which covers Douglas, Sarpy, Cass, Washington and Dodge Counties. The office, like others in the state, is staffed by trained and certified volunteers who provide free, unbiased consultations with Medicare-eligible clients comparing plans.

Some of the same dynamics that affected plans last year are in play again for next year, with some additional elements, Carsey said.

In 2025, the Inflation Reduction Act of 2022 ended the Medicare Part D coverage gap, sometimes referred to as the doughnut hole. This year, the law caps Medicare beneficiaries' yearly out-of-pocket expenses at $2,100.

In 2027, the cap will increase to $2,400, meaning beneficiaries won't pay more than that for medications, Carsey said.

Anything beyond the cap is known as the catastrophic coverage stage. However, medications subject to the cap must be on the formulary for the beneficiary's plan. If a beneficiary takes medications that aren't on their plan's formulary, the cap won't apply, and they will pay more.

"People should know that not every single medication that they could ever be prescribed is going to be covered by Medicare," he said.

That also makes it important for beneficiaries to make sure the drugs they take are covered as they compare plans. If they're not, Carsey said, beneficiaries would look at patient assistance programs or pursue a formulary exception, which is initiated by the prescribing physician.

The plans then determine whether they will make an exception and cover the medication. Patient assistance programs, on the other hand, are offered by drug manufacturers to help drive down the costs of expensive medications.

Volunteer counselors, Carsey said, outline how beneficiaries can access the programs. Eligibility for patient assistance programs is based on income and asset guidelines, which vary by manufacturer.

In another change, beneficiaries can expect fewer plans for next year.

Nebraska seniors will have nine Medicare Part D plans next year, down from 11 this year and from a recent high of 21 in 2024. Monthly premiums will range from $5.30 to $222.90, he said, higher than what the volunteers have seen. When comparing 2026 and 2027, seven plans will increase premiums, and two will lower them. But three plans offered last year are being discontinued. Beneficiaries enrolled in those plans should have received a letter from the plan notifying them of the change.

Beneficiaries enrolled in two of the discontinued plans, HealthSpring Assurance and HealthSpring Extra, both by Cigna, will be "cross-walked," or automatically enrolled in a new Cigna plan called HealthSpring Assurance Rx.

However, beneficiaries won't know whether that plan is the best for them until they compare the plans available in their market.

"They should not assume that the plan into which they have been cross-walked is the right plan for them," he said.

The number of Medicare Advantage plans available to Nebraskans in the five counties covered by the Omaha office also will decrease slightly, from 29 to 24. Lincoln-area seniors also have access to 24 Medicare Advantage plans.

While Medicare Advantage offerings remain more abundant in parts of eastern Nebraska service area, fewer such plans are available in other parts of the state. A list of plans available by county is posted on the Nebraska State Health Insurance Assistance Program page on the Nebraska Department of Insurance website.

Some hospitals and health care providers also have opted out of the plans. About 34% of Medicare-eligible residents in Nebraska have signed on to them.

Carsey said plans that offer drug coverage are responding to changes under the Inflation Reduction Act that require both plans and drug manufacturers to bear a greater share of the cost of medications. In 2025, plans paid 15% of the cost of drugs in the catastrophic coverage stage. In 2026, that share went to 60%.

To head off predicted increases in Part D premiums as a result of the cost shift to insurers, the Centers for Medicare & Medicaid Services adopted a $9.8 billion demonstration program aimed at stabilizing premiums, which affected Part D plans in 2025 and 2026.

The demonstration was slated to end at the end of 2027. But CMS determined that the demonstration was no longer necessary and ended the program a year early, meaning it ends this year. That's intended to allow the market to return to traditional pricing without stabilization.

Whether the end of the stabilization program will result in increased premiums next year remains to be seen, he said.

"It's still dependent on the medications a person takes," Carsey said. "So it's more important than ever for people to review their current plan and make sure it's the best plan for them next year."

Seniors, in fact, should review their plans each year even if their medications haven't changed, because contract costs for medications can change from year to year.

Everyone eligible for Medicare and enrolled in a Part D or Medicare Advantage plan should have received an annual notice of change from the federal government in September explaining expected changes in their plan.

A study by KFF in September 2024, however, indicated that seven of 10 Medicare beneficiaries do not review their Medicare Advantage or prescription drug coverage.

For next year, the highest deductible for a Medicare Part D prescription drug plan will be $700, up from $615 this year. While that's the maximum set by CMS, many plans will have lower deductibles based on the mix of medications a beneficiary uses and the pharmacy they choose.

Medicare Advantage participants, he said, also should check each year whether their providers still accept their plans.

Carsey also advises beneficiaries not to pick a plan based on premium alone. The volunteers will use the Medicare.gov website to help them identify the least-expensive option from a total cost standpoint, including premiums and medications.

Going through a review can pay off. Last year, the local group helped about 2,300 people review their coverage, which resulted in savings of about $3.5 million.

"There are dollars on the table," Carsey said. Volunteers Assisting Seniors will have 25 offsite, in-person events across the metro area during open enrollment, where beneficiaries can get help reviewing their plans. Telephone and in-person appointments also will be available at the group's office, 900 S. 74th Plaza, Suite 403.

To make an appointment or find a meeting, call 402444-6617 or check the 2026 event calendar at https:// www.vas-nebraska.org/ oe-2/ The Lincoln office can be reached at 402471-2841. To contact other groups around the state, call 800-234-7119.

Distributed by Newsbank, inc.