Medicare Made Clear, Personal, and Local
"Get Unconfused About Medicare"
Medicare Made Clear, Personal, and Local
"Get Unconfused About Medicare"
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If you’re facing changes to your current Medicare plan for 2026. Don’t rely on confusing websites or one-size-fits-all advice for agent in another country.
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What's New for Medicare in 2026?
The Centers for Medicare & Medicaid Services (CMS) has finalized sweeping changes that affect Medicare Advantage (MA), Part D, and Supplement plans in 2026. These updates aim to increase consumer protections, improve affordability, and clarify plan rules.
Below is a summary of the most important updates you should be aware of:
CMS Final Rule Changes You Should Know
💊 Drug Price Negotiations Will Continue
CMS will keep pushing forward with prescription drug price negotiations under the Inflation Reduction Act.
✅ Discounts of up to 79% on key medications (for diabetes, heart disease, and more) begin in 2026.
✅ The list will expand in 2028—helping you save even more on your monthly medications.
🔒 Stronger Protections from Surprise Denials
CMS now limits when Medicare Advantage and Part D plans can deny claims after services have already been approved.
✅ If a service is pre-approved, your plan generally cannot reverse course and deny it later—unless there's clear fraud or error.
✅ This reduces the risk of surprise medical bills and protects your right to appeal.
📝 Easier Appeals and Timely Notifications
New rules ensure enrollees must be notified in advance if their claims are denied.
✅ This gives beneficiaries more time to appeal and reduces delays in receiving needed care.
🏥 Possible Medicaid Cuts
Proposed budget plans in Congress include deep cuts to Medicaid (Medi-cal), which may affect:
- Low-income Medicare beneficiaries
- Long-term care services
- Help with Medicare premiums or copays
📢 If you rely on Medicaid (Medi-cal), now is the time to monitor changes and explore available local resources like contacting us for more information.
🚫 GLP-1 Drugs for Obesity Not Covered
While drugs like Wegovy and Ozempic are covered for diabetes and heart disease,
❌ Medicare will not cover them solely for weight loss in 2026.
📌 Talk to your provider about what treatment options are covered for your condition.
📢 Disclaimer:
The information above is based on CMS’s Final Rule for 2026 as of its release date. Rules, carrier availability, and drug coverage may change. Always consult Medicare.gov or your licensed insurance agent for the most current and personalized information. This content is provided for educational purposes and does not constitute legal, medical, or financial advice.
📌 What Should You Do Next?
- Review your current coverage before AEP 2025 begins (Oct. 15).
- Stay informed on insurance carrier changes.
- Reach out for help by working with a local agent.
Still Have Questions?
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About Medicare Plan Options
Original Medicare
Part A - is your hospital coverage and
Part B - is your doctor coverage.
Medicare Supplements
Also known as Medigap plans, fills in the gaps of coverage with Original Medicare.
Medicare Advantage
Commonly known as Part C, combines Parts A & B, and D. Can be HMO's or PPO's.
Medicare Part D
Part D is a stand-alone plan that covers your prescription drugs and often combined with Medicare Supplement plans.