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Author: Andy

Inspector General’s Report Sounds the Alarm on a Huge Medicare Advantage Plan Problem

Andy |

Christy Bieber

Retirees on Medicare Advantage are missing out on crucial coverage, and their health could suffer because of it.

Many seniors choose a Medicare Advantage plan over traditional Medicare because they hope the plan will provide broader coverage. In fact, an estimated 32.8 million people — more than half of all Medicare recipients — were enrolled in an Advantage plan as of 2024.

Unfortunately, these Medicare Advantage plan enrollees are at risk because of a serious gap in coverage. This troubling news comes from a report released by the Office of the Inspector General.

Here are some details on the coverage gap, along with some insight into what this could mean for retirees.

Inspector General reveals that Medicare Advantage has a serious gap in coverage

According to a report prepared by the IG for the Department of Health and Human Services, behavioral healthcare is covered by managed care plans for the majority of Medicare enrollees.

Behavioral healthcare is care for mental health conditions and substance abuse disorders. When this care is available as part of a managed care plan, it is typically covered only if plan enrollees can find an in-network doctor.

Advantage plans must provide a list of in-network providers. This helps seniors enrolled in these plans understand their care options and find a provider who will take their insurance.

Unfortunately, the Inspector General’s report revealed that the majority of Medicare Advantage plans had “limited networks of behavioral health providers.”

Even worse, many of the providers listed as participating in the plan were “ghost providers.” Their showing up on the list makes the network look larger, but they don’t actually provide any services to enrollees.

This is a huge issue, as the networks look comprehensive, but seniors who are signed up for Medicare Advantage plans end up with few to no options for behavioral healthcare.

Missing out on behavioral healthcare can be a huge problem

Previous IG reports have shown that there were fewer than five active behavioral healthcare providers per 1,000 enrollees in Medicare Advantage plans.

Since the Centers for Disease Control and Prevention has warned that around 4% of adults 70 and over suffer from depression, and roughly 17% of the elderly have health problems resulting from drug and alcohol abuse, a lack of access to behavioral healthcare providers could be a huge problem.

Unfortunately, covering this treatment out-of-pocket could put a significant strain on retirees, many of whom struggle to cover their expenses on Social Security and retirement plan distributions.

Retirees who are exploring their Medicare Advantage options should be alert to these issues and should compare plans carefully.

How can Medicare Advantage plan enrollees protect themselves?

If an Advantage plan lists a provider as being in-network, retirees may wish to call and verify this so they ensure they aren’t tricked by a ghost provider. Otherwise, they may not get the care they need, or may have to pay for it out of retirement savings from a 401(k) plan or other sources.

This is just one of many access-to-care issues retirees may face.

While Medicare and Medicare Advantage help provide coverage, there are gaps. Retirees should ensure they invest wisely, so they have the funds they need to cover any medical services that may be required.

Don’t put yourself at risk.   We can help with a true Medigap plan that will protect you against these pitfalls.

Andy Orlikoff

www.AZhealth.us

623-742-3878

#surprise,AZ #SunCity,AZ #medicare

The Great Medicare U-Turn: How to Switch Back to Original Medicare

Andy |

The Great Medicare U-Turn: How to Switch Back to Original Medicare

If you’ve spent the last year realizing that “Advantage” doesn’t always feel like an advantage, you aren’t alone. Maybe your favorite specialist left the network, or you’re tired of asking for “prior authorization” just to get an MRI.

The good news? If you’re reading this in January, the door is wide open for a change. But before you jump ship, there’s a specific sequence you need to follow to avoid getting stranded without coverage.

1. The “Right Now” Window: The 2026 MA OEP

Since today is January 26, 2026, you are currently in the Medicare Advantage Open Enrollment Period (MA OEP). This runs from January 1 to March 31. The Fall Window: Annual Enrollment Period (AEP) Dates: October 15 – December 7.

During this time, you can:

Note: If you make the switch this month, your new coverage will typically begin on the 1st of the following month.

2. The Medigap “Trap”: Don’t Drop Your Plan Yet!

This is the most critical part of the U-turn. Unlike Medicare Advantage, which must take you regardless of health, Medigap (Medicare Supplement) providers in most states can use medical underwriting.

The Risk: If you have a pre-existing condition, a Medigap insurer can charge you more or deny you a policy entirely unless you have a “Guaranteed Issue Right.”

Do you have a “Guaranteed Issue Right”?

You generally don’t need a health screening if:

The Golden Rule: Secure your Medigap policy and get an acceptance letter before you officially disenroll from your Medicare Advantage plan.

3. Your 2026 Transition Checklist

Switching back involves a three-step dance. If you miss a step, you could face lifetime penalties or massive bills.

Step Action Why it matters
Step 1 Apply for Medigap Ensures your “gap” coverage is locked in before you leave your current plan.
Step 2 Join a Part D Plan Medicare Advantage usually includes drugs; Original Medicare does not. Missing this causes a late-enrollment penalty.
Step 3 Confirm Disenrollment Joining a standalone Part D plan usually automatically triggers your exit from Medicare Advantage, but always call your plan to confirm.

4. What Original Medicare Costs in 2026

Since you’re moving back to the “Original” way of doing things, here is a quick look at the 2026 rates:

Why People are Making the Switch

In 2026, the maximum out-of-pocket (MOOP) for Medicare Advantage plans can be as high as $9,250. For someone facing a major surgery or chronic illness, that “low premium” plan can suddenly become very expensive. Medigap Plan G, by contrast, covers nearly everything after you pay the small Part B deductible, giving you total “cost predictability.”

#healthinsurance #medicare #medigap #medicareadvantage #surprise, AZ #Sun City, AZ

The “Part G” Paradox: Why This Medigap Powerhouse Is the 2026 Gold Standard

Andy |

If you’ve been scouring the internet for “Medicare Part G,” I have some good news and a tiny “well, actually” for you. First, the correction: there is no Medicare Part G. Medicare has “Parts” (A, B, C, and D) that come from the government. What you’re looking for is Medicare Supplement Plan G (also known as Medigap).

Now, the good news: you’ve accidentally stumbled upon what most experts consider the “Gold Standard” of Medicare coverage in 2026. If you value predictability, flexibility, and never having to wonder if your doctor is “in-network,” Plan G is your new best friend.

What is Medicare Supplement Plan G?

Think of Original Medicare (Parts A and B) as a solid foundation for a house, but one that’s missing a few windows and maybe a front door. You’re responsible for deductibles, 20% coinsurance, and “excess charges” that can turn a simple procedure into a financial headache.

Plan G is the high-end renovation that fills almost every one of those gaps. It is the most comprehensive plan available to anyone new to Medicare since 2020.

The Big Benefits: What’s Covered?

In 2026, Plan G remains the heavyweight champion of coverage. Here’s the breakdown:

Why Choose Plan G Over the Competition?

1. The “No Surprises” Budget

With Plan G, your only major out-of-pocket medical expense for the year is the Medicare Part B deductible ($283 in 2026). Once you pay that first $283, the plan covers 100% of your Medicare-approved expenses for the rest of the year. No $20 copays, no “facility fees,” just peace of mind.

2. Freedom of Movement

Unlike Medicare Advantage (Part C), Medigap Plan G has no networks. If a doctor, specialist, or hospital anywhere in the U.S. accepts Medicare, they accept your Plan G. You don’t need a referral to see a cardiologist in another state or a surgeon across town.

Summary: Why Buy Plan G?

Looking for a Medigap plan in Sun City, Arizona? I can help!

American Insurance Benefits – Andy Orlikoff

623-742-3878

www.azhealth.us

#healthinsurance #Medigap #Medicare

8 Sneaky Medicare Penalties That Can Cost You Big (And How to Avoid Them)

Andy |

Katy Willis

Older woman with white hair looking at paperwork worried

Avoid higher Medicare bills by steering clear of key traps.

You work hard, save what you can for retirement, and then hit 65, only to find out that one missed deadline can increase your Medicare premiums for the rest of your life.

This isn’t obvious when you’re first signing up for Medicare. But these penalties can easily cost you significant money and potentially derail your retirement plan.

If you know the rules ahead of time, you can avoid wasting your retirement savings on sneaky Medicare penalties.

Part A late enrollment penalty

Most people pay $0 for Medicare Part A because they or a spouse paid Medicare taxes for at least 10 years. But if you don’t have enough work credits, you may have to buy Part A and pay a monthly premium instead. In 2026, that’s $311 or $565, depending on how many work credits you have.

If you fall into this group and delay signing up, your Part A premium goes up by 10% for twice the number of years you went without coverage. If you or your spouse doesn’t have enough work credits for free Part A coverage, plan for this during the initial enrollment period, which starts three months before the month you turn 65 and ends three months after.

Part B late enrollment penalty

Part B covers things like doctor visits, outpatient care, lab tests, and equipment. In 2026, the standard monthly premium is $202.90 per month.

But if you sign up late and don’t qualify for a special enrollment, that premium can jump and stay higher for life. You’ll pay an extra 10% for every full year that you could’ve had Part B but didn’t, for as long as you have Part B.

The key to protection is “credible coverage” from current work. If you’re 65+ and covered by an employer health plan from a company with 20 or more employees, you can usually delay Part B without penalty and then enroll during a special enrollment period after your job-based coverage ends.

Part D late enrollment penalty

Medicare Part D helps cover prescription drugs. You don’t have to take a Part D plan at 65. But going without drug coverage or not having a creditable plan can trigger a penalty of around 1% of the national base premium per month that you don’t have coverage.

With the 2026 base premium being $38.99 in 2026, if you went 20 months without coverage, your penalty would be an increase of 20%, or roughly $7.80 extra per month for life.

To avoid triggering this penalty, either enroll in Part D when you first qualify or make sure any other drug coverage you have is considered creditable.

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HSA contribution penalties once you’re on Medicare

Health savings accounts (HSAs) have tax-deductible contributions, tax-free growth, and tax-free withdrawals for qualified medical expenses. But once you enroll in Medicare Part A or B, your HSA contribution limit drops to zero, even if you still have a high-deductible health plan through work.

Any contributions after Medicare enrollment count as excess contributions and are subject to a 6% excise tax every year until you withdraw them. You may also suffer an extra 10% tax and back taxes if you sign up for Medicare during the HSA testing period, which is usually one full year from when you sign up for your HSA.

Other ways you could end up paying more for Medicare

Not every extra Medicare cost is labeled a penalty, but some mistakes can end up feeling like one. For example, if you miss your initial enrollment period and don’t qualify for a special enrollment period, you may have to wait for the general enrollment period.

In that case, your coverage may not start until later in the year. That can leave you paying full price for care in the meantime, only to owe late-enrollment penalties on top.

Income-related monthly adjustment amounts (IRMAA)

If your income is higher, Medicare charges more for both Part B and D through income-related monthly adjustment amounts (IRMAA). In 2026, the first IRMAA tier starts for single filers earning more than $109,000 and joint filers earning over $218,000.

For the first tier, you’ll pay an extra $81.20 per month for Part B and $14.50 for Part D, or roughly $1,150 per year per person. At the highest tier, you could pay around $6,936 in extra premiums per person per year.

Some retirees avoid or minimize IRMAA by spreading large IRA withdrawals across several years, using Roth accounts, or making qualified charitable distributions from IRAs. You may also get IRMAA reduced or removed if your income has dropped sharply due to a significant life change, such as retirement, widowhood, or divorce.

Losing your Medigap guaranteed-issue rights

Medigap (also called Medicare Supplement insurance) helps pay Original Medicare’s deductibles, copays, and more. For many people who want the freedom to see almost any doctor that takes Medicare, Medigap is what makes that possible.

You get a six-month Medigap open enrollment period that starts when you’re 65 or older and enrolled in Part B. During that time, insurers can’t deny you a policy, charge you more because of your health, or make you wait for coverage of pre-existing conditions. After that window, in most states, insurers are allowed to use medical underwriting, review your medical history, charge higher premiums, or even refuse you coverage.

Ignoring who pays coverage first

Many people keep employer coverage, Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage, or a retiree plan after 65 and assume it will keep paying their medical bills. But Medicare usually pays first when an employer has fewer than 20 employees. And, once you’re eligible for Medicare, many COBRA and retiree plans also expect Medicare to pay first.

If you don’t enroll in Part A and B when you should, your plan can deny claims or claw back past payments, and you can face big bills plus permanent late penalties. When Medicare is supposed to be the primary, plan to enroll in Part A and B on time, even if you keep your other coverage.

Bottom line

Most Medicare penalties are the result of missing deadlines, skipping coverage, or not understanding how income and HSAs interact with the rules. The problem is that once they hit, they’re often impossible to reverse.

You can avoid wasting money on Medicare penalties by knowing your enrollment dates, income level, HSA contributions, and Medigap timing. If you’re unsure, it’s worth getting advice from a professional.

We can help with your Medicare Insurance in Arizona!

www.azhealth.us

Andy Orlikoff

623-742-3878

Time is Running Out: Navigating the 2026 Health Insurance “Rate Cliff”

Andy |

It’s January 19, 2026, and if you haven’t secured your health insurance for the year yet, the clock isn’t just ticking—it’s practically screaming. While Open Enrollment for the Health Insurance Marketplace officially closed for most of the country on January 15, a few states (like California, New York, and New Jersey) have extended deadlines through the end of the month.

Whether you missed the deadline or were simply paralyzed by the “sticker shock” of this year’s prices, you aren’t alone. 2026 has brought some of the most significant changes to the health insurance landscape in nearly a decade.

The Perfect Storm: Rate Hikes and Subsidy Cuts

If you logged into the Marketplace this year and saw a premium that looked like a mortgage payment, there’s a reason for it. We are currently facing what experts are calling the “2026 Rate Cliff.”

For many, the “Affordable” Care Act simply doesn’t feel affordable anymore.

A Flexible Alternative: Short-Term Medical (STM)

If the Marketplace has priced you out, or if you missed the window to enroll, Short-Term Medical plans have become a go-to alternative for 2026.

Unlike the restrictive rules of previous years, many states now allow for extended STM plans that provide up to 3 years of coverage (through renewable 364-day terms).

Why consider Short-Term Medical?

Note: These plans are best for healthy individuals. Because they are not ACA-compliant, they typically use medical underwriting and may not cover pre-existing conditions or maternity care.

Bridging the Gap with Supplemental Coverage

Because many of the “affordable” plans for 2026—including Bronze and Catastrophic plans—come with very high deductibles, Supplemental Coverage is more important than ever. These plans pay cash directly to you to cover your deductible if the worst happens:

Don’t Go It Alone: Talk to a Local Broker

Navigating the 2026 market is like walking through a minefield. This is not the year to “DIY” your health insurance. A local independent broker is your best resource—and the best part? Their services are usually free to you.

A local broker knows which hospital networks are actually participating in which plans and can help you weigh the risk of a Short-Term plan versus an ACA plan.

How to find a pro:

When you search for a broker in your area, look closely at their Google Reviews. * Are they responsive?

A high rating from your neighbors is the best insurance that you’re getting honest advice.

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