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.

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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, cost-effective choices.

Moments

00:00 "Pre-Enrollment Medicare Insights Podcast"

04:21 Career Shift to Medicare Benefits

08:04 Medicare Coverage Gaps Explained

12:05 Medicare Advantage: Weighing Options

13:38 Medicare Advantage vs. Traditional Debate

19:08 Insurance Bids May Extend Duration

21:00 Medicare Approves without Prior Authorization

24:39 Pharmacy Vaccine Billing Issues

27:16 Navigating Insurance Plan Limitations

29:39 Medicare Advantage vs. Traditional Medicare

33:18 Medicare Advantage's Financial Appeal

36:27 "MyCare Ohio: Enhanced Medicare Advantage"

40:08 Medicare.gov: Comprehensive Resource Guide

43:04 Transitioning from Benefits to Medicare

46:00 Retiree Benefits Under Scrutiny

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Recorded in Studio C at 511 Studios. A production of Circle 270 Media® Podcast Consultants.

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Copyright 2025 Carol Ventresca and Brett Johnson

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Listener Disclaimer

The views and opinions expressed by the experts interviewed on this podcast are their own and do not necessarily reflect the views of the podcast hosts or any affiliated organizations. The information provided in these interviews is for general informational purposes only and should not be considered as professional advice. Listeners are encouraged to consult with qualified professionals for specific advice or information related to their individual circumstances. The podcast host and producers do not endorse or guarantee the accuracy, completeness, or reliability of any information provided by the experts interviewed. Listener discretion is advised.