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A Medicare Drug Plan Program Is Ending. Could Your Premium Change?

Wed, 14 Oct 2026 06:00:35 GMT

A Temporary Federal Program That Helped Limit Premium Increases for Some Medicare Part D Plans Will End After 2026.

If you have a standalone Medicare Part D prescription drug plan, you'll want to pay close attention to the information your plan sent you this fall.

The Centers for Medicare & Medicaid Services (CMS) recently announced that it is ending a temporary program that helped keep premiums more stable for participating Part D drug plans. The program was called the Medicare Part D Premium Stabilization Demonstration, and it will end after 2026.

What Is Changing?

Medicare made major changes to the Part D prescription drug benefit beginning in 2025. During that transition, CMS created a temporary program to help participating standalone Part D plans manage some of the financial impact and limit large year-to-year premium increases.

For 2026, the program provided participating plans with additional financial assistance and limited how much their total Part D premiums could increase from the previous year.

CMS has now decided that this temporary assistance is no longer needed, so the program will end after 2026, rather than running through 2027 as was originally anticipated. That means Part D plans will set their 2027 premiums without the additional help provided by this temporary program.

Does This Mean My Part D Premium Will Go Up?

Not necessarily.

Ending the program does not mean everyone's Part D premium will increase. The impact will vary from one plan to another.

To find out whether this change affects you, and by how much, it's important to look at the Part D plans available for 2027 and compare them with your 2026 coverage. Start with the monthly premium, but don't stop there. Changes in deductibles, prescription costs, covered medications and pharmacy networks can all affect what you ultimately pay.

In other words, a higher premium doesn't necessarily mean a plan will cost you more overall, and a lower premium doesn't necessarily mean it will be the least expensive choice for you. What matters is how the plan covers the medications you take and the pharmacies you use.

Although this temporary program is ending, it doesn't mean all federal measures intended to help control Part D premium increases are going away. Other protections remain in place that limit how quickly certain costs used to calculate Part D premiums can rise from year to year.

However, those protections don't put a cap on how much your individual plan's premium can change. That's why it's still important to focus on the details of the plans available to you and compare your 2027 costs and coverage with what you had in 2026.

What Should I Do?

By now, you should have received an Annual Notice of Change (ANOC) from your current plan, explaining what's changing next year. Review it carefully to see whether your premium, prescription drug coverage, out-of-pocket costs, pharmacy network or other plan features are changing.

As you review it, don't look at the premium alone. A plan with a lower monthly premium could end up costing you more if the medications you take are more expensive under that plan or if the deductible has increased. Likewise, changes to a plan's formulary, deductible or pharmacy network could have a significant impact on your overall costs.

As you review your coverage, consider:

Are all the prescriptions I take still covered?
Have my costs (copayments and coinsurance) for those medications changed?
Is my usual pharmacy still in the plan's network, and is it still considered a preferred pharmacy?
Has the deductible or monthly premium changed?
Are there new coverage requirements or restrictions for any of my medications?
How does my current plan compare with the other Part D options available for 2027?

Medicare Open Enrollment runs from October 15 through December 7 . That's your opportunity to compare your current coverage with other available options for 2027 and make a change if another plan better fits your needs.

You don't have to wait until October 15 to start getting organized, though. When your 2027 plan information arrives, make a list of your current prescriptions, dosages and preferred pharmacies. Having that information ready can make comparing your options much easier.

Conclusion

The end of this temporary Medicare program is good to know about, but there's no reason to assume your prescription drug costs are automatically going to soar. The most important thing you can do is review your coverage rather than automatically renewing it without looking at the changes.

We are here to help you assess your options and prioritize your needs. Working with a licensed Medicare professional from our team means you don’t have to figure this all out on your own.

Medicare for Snowbirds: How to Stay Covered in Two States

Wed, 07 Oct 2026 17:48:43 GMT

Learn How Your Medicare Coverage Moves with You

If you're someone who heads south for the winter or splits your time between two homes in different states, you're what the world often calls a "snowbird." And while your dual-state lifestyle might offer the best of both worlds, it can add some complexity to your Medicare coverage.

That’s why a little extra planning may be needed to make sure your Medicare benefits travel with you. Here's what multi-state dwellers need to know to stay covered, avoid surprises, and make the most of their benefits, from Toledo to Tampa.

The Basics: What Medicare Covers Anywhere in the U.S.

If you have Original Medicare (Parts A and B), you're off to a good start. You can see any doctor or use any hospital that accepts Medicare in the United States with no referral required and no network restrictions. Coverage is consistent across all 50 states and U.S. territories.

It gets trickier if you have other types of Medicare coverage, like a Medicare Advantage plan, a Part D drug plan, or Medicare Supplement Insurance (Medigap).

Medicare Advantage Plans: Check the Network

Medicare Advantage (Part C) plans are offered by private insurers, and most operate within a specific geographic service area. These plans often require you to use doctors and hospitals within their local network for routine care, and some require referrals for specialists. It is important to note that Medicare Advantage plans must cover emergency and urgently needed care while you are outside the plan’s geographic service area.

If you live in one state half the year and another the other half, a plan that works in Florida may not cover your routine care in Michigan, or it may cover it at a much higher out-of-network rate.

Questions to ask:

Is your Medicare Advantage plan a PPO (which may offer some out-of-network coverage) or an HMO (which usually doesn't)?
Do both of your locations fall within the plan's service area?
What happens if you need routine care while living in your second home?

Prescription Drug Plans (Part D): Location Matters

Part D drug plans also have networks, specifically, pharmacy networks. A plan based in New York might not include your favorite neighborhood pharmacy in Arizona.

To avoid disruption in your prescriptions:

Choose a plan with nationwide pharmacy access, like a major chain or mail-order pharmacy.
Double-check that your medications are still covered no matter where in the U.S. you are (most drug plans don't cover drugs received outside the U.S. and its territories).
Review your plan's formulary (drug list) and participating pharmacies yearly during the Medicare Annual Enrollment Period (Oct. 15–Dec. 7) to determine if there is a Part D drug plan better suited to your needs and your dual-state situation.

Medigap Plans: More Flexibility for Travelers

If you've chosen Original Medicare and added a Medicare Supplement Insurance (Medigap) policy, you're in luck. Most Medigap plans allow you to see any Medicare-participating provider in the country, making them an excellent choice for snowbirds.

Just remember:

Medigap policies are standardized, but sold by private insurers, and prices may vary by state.
If you make a permanent move to a new state, you may have a guaranteed-issue right to switch to a new Medigap policy without medical underwriting, but this depends on your state and situation. It's worth checking with a licensed agent before you assume you're covered.

Your Primary Residence and Medicare

Even if you live in two states, Medicare requires you to designate a primary residence, typically the address used for taxes, driver's license, and voter registration. This determines your plan eligibility and service area for Medicare Advantage or Part D plans.

If you make a permanent move (not just a seasonal stay), you'll qualify for a Special Enrollment Period to switch plans that better fit your new location.

Staying Connected to Your Care Team: Telehealth

One thing that's made life easier for snowbirds in recent years is the wider availability of telehealth. Many Medicare Advantage plans and providers now offer virtual visits, which means you may be able to check in with your regular doctor even while you're away from home.

Telehealth isn't a substitute for local, in-person care in an emergency, but it can be a helpful bridge for routine checks, follow-ups, medication management, or specialist check-ins while you're at your second home.

Coverage in Emergencies

Medicare will always cover emergency or urgent care in the U.S., regardless of where you are. So if you're visiting your second home and something unexpected happens, you won't be left without coverage.

For Medicare Advantage members, be sure to check your Evidence of Coverage, which describes how Medicare defines emergencies and urgently needed services and how those services must be covered by Medicare Advantage plans.

Quick Tips for Medicare Snowbirds

Here's a quick checklist to help you make the most of Medicare while living in two states:

Work with a Medicare agent. We can help you compare plans in both states and find the right match.
Choose flexible coverage. Original Medicare + Medigap offers the most freedom. If you use Medicare Advantage, consider a PPO plan with a wider service area.
Confirm your drug plan's pharmacy network. Make sure it works in both locations. Before traveling, request extra refills or a vacation supply of your medications, if your plan allows it.
Keep your legal address up to date. Medicare uses your home address to determine eligibility for plans.
Explore remote care. Ask your primary doctor if they offer telehealth visits while you're away.
Understand emergency and urgent care coverage. Know what's covered and what isn't, especially with Medicare Advantage. Save the contact info for urgent care centers near your homes.
Review plan notices every fall. Networks and costs can change each year. Don't assume this year’s plan will still fit your lifestyle next year.

Medicare Scam Calls and Fake Agents Are Getting Harder to Spot

Wed, 23 Sep 2026 16:00:10 GMT

Who's Really on the Other End of That Medicare Call?

The phone rings. The voice on the other end says your name, your age, and your address. It sounds official. It may even sound friendly. And within a minute, you are being asked to confirm your Medicare number. What do you do?

Complaints about Medicare-related scam calls have climbed sharply over the past year. Reports to the Better Business Bureau indicate that these kinds of calls remain a major concern for people Medicare. Some have even described getting dozens of these calls in a single day. Enrollment season tends to make it worse, because legitimate outreach picks up at the same time criminals do.

Here is how these calls tend to sound, and how to protect yourself.

The Three Pitches You Are Most Likely to Hear

Many Medicare scam calls follow similar scripts. Once you recognize a few key patterns, the calls lose a lot of their power.

"You qualify for extra benefits"

A recorded voice says it is reaching out to make sure you receive unclaimed Medicare benefits. The recording asks whether you have Part A and Part B, then transfers you to a live person. The real goal is either to get your personal information or to switch you to a plan you did not ask for.

"Your card is expiring"

The caller warns that your Medicare card is about to expire, or that your coverage could be interrupted unless you verify a few details. Fear and urgency are the strategy here. If you hand over your Medicare number or Social Security number, criminals can use it to steal your identity or bill you for services you never received.

"Something free is on the way"

Free braces. Free hearing aids. Free gift cards or a free smartphone. The offered gift is bait. One woman in Texas received a large box of orthopedic braces she never ordered, and later learned Medicare had been billed more than $700 for them. Her secondary insurer was charged as well, and additional claims were filed for supplies she never requested.

Fraudulent claims can also leave inaccurate information in your medical records, including diagnoses for conditions you do not have.

Fake Agents Are Part of the Problem

Not every scammer sounds like a robot. Some present themselves as licensed insurance agents. They may reference a well-known carrier, quote a plan name, or offer to walk you through your options right now over the phone.

A few things a real agent will not do:

Pressure you to decide something during a first call
Refuse to give you a full name, license number, or office phone number
Ask you to pay by gift card, wire transfer, or a payment app
Tell you that you must act today or lose your coverage
Show up at your door uninvited to sell you a plan

Verifying an agent is simpler than most people expect. Ask for their name and license number, then hang up and call the agency's main office number yourself. You can also check the license with your state Department of Insurance. Anyone who is legitimate will not mind you doing this; they know you need to be careful.

Habits That Keep You Safe

Treat unexpected Medicare calls with skepticism, even friendly ones
Never give your Medicare number, Social Security number, or bank details to someone who called you
Remember that Medicare generally reaches out by mail first and does not call to ask for your Medicare number or banking information
Hang up on anyone who pressures you or claims your coverage is at risk
Read your Medicare Summary Notices and Explanation of Benefits statements and look for charges you do not recognize
Report anything unfamiliar right away

Hanging up may feel rude, but it is the single most effective thing you can do.

If You Think You Already Shared Something You Shouldn't Have

Act quickly, but do not panic. Write down what you shared and when. Review your recent statements. Then report it. You can contact the Senior Medicare Patrol program in your state, call 1-800-MEDICARE, or file a report with the Federal Trade Commission at ReportFraud.ftc.gov.

The Easiest Defense Is a Person You Already Know

Scam calls work because they catch people on their own and unsure. Having a licensed agent you already trust means you have someone in your corner. You have a number you can call to ask whether an offer is real before you respond to it. If you have questions about a call you received, or you want a second set of eyes on your current coverage, reach out to our office. We are here to help you!

HSA and Medicare: How to Avoid a Costly Contribution Mistake

Wed, 16 Sep 2026 16:00:08 GMT

How Medicare Enrollment Can Create Consequences for Your HSA Contributions

Many Americans spend years building savings in a Health Savings Account (HSA), one of the most tax-advantaged ways to save for health care expenses. HSA funds can be used for many qualified medical expenses, including deductibles, copays, coinsurance, prescription medications and certain medical equipment… even when you are on Medicare. That is why HSAs can be such an important part of your retirement planning.

But when Medicare enters the picture, the rules can lead to unexpected tax consequences.

Where Medicare Can Create a Problem with HSAs

Some people continue working after age 65 and remain covered by an employer-sponsored HSA-eligible high-deductible health plan (HDHP). That's allowed. Simply turning 65 or becoming eligible for Medicare doesn't automatically prevent you from contributing to an HSA. The issue begins when you are actually enrolled in Medicare. Once you're enrolled in Medicare Part A and/or B, you generally can no longer contribute to an HSA.

The confusion is that Medicare enrollment doesn't always happen when people expect it to.

One way this can happen is through Social Security benefits. If you're already receiving Social Security benefits when you become eligible for Medicare, you're generally automatically enrolled in Medicare Part A and Part B. While Part B can generally be declined, premium-free Part A usually takes effect automatically. Once Part A coverage begins, you're no longer eligible to contribute to an HSA, even if you're still working and covered by your employer's HSA-eligible health plan.

That means someone could continue making HSA contributions through payroll, or continue receiving employer contributions, without realizing that Medicare coverage has kicked in and made them ineligible to make those contributions.

A second issue can arise when someone delays Medicare while continuing to work and contribute to an HSA. When that person later applies for premium-free Medicare Part A after age 65, their Part A coverage can generally be retroactive for up to six months, but not earlier than the month they first became eligible for Medicare.

This creates a potential HSA problem because a person can't make HSA contributions for months in which they're covered by Medicare. If Part A is applied retroactively, HSA contributions made for those retroactively covered months may become excess contributions, even though the person wasn't aware at the time that Medicare coverage would later reach back to those months.

For example, someone who works past 65, keeps an HSA-eligible employer plan and delays Medicare might continue contributing to an HSA. If they later enroll in Medicare and receive six months of retroactive Part A coverage, some of those recent HSA contributions may no longer be allowable.

That's why it's important for people who work past 65 to coordinate the timing of Medicare enrollment, Social Security benefits, and HSA contributions.

The Potential Tax Consequences

The IRS generally imposes a 6% excise tax on these “excess” HSA contributions that aren't corrected as permitted under IRS rules. The tax can apply for each tax year the excess remains in the account.

In some cases, an individual may be able to avoid the 6% excise tax by withdrawing the excess contribution, along with any earnings attributable to it, by the applicable tax-return deadline and properly reporting the correction.

Because the tax treatment depends on the circumstances and timing, anyone who discovers a possible excess contribution should consider contacting the HSA custodian and a qualified tax professional.

How to Avoid HSA Contribution Problems

If you're approaching Medicare eligibility, planning to enroll in Medicare, or applying for Social Security benefits after age 65, review your HSA contribution strategy ahead of time. The correct time to stop contributing isn't the same for everyone.

For example, if you enroll in Medicare during your Initial Enrollment Period, you generally need to make your last HSA contribution for the month before your Medicare Part A coverage begins. Special rules can apply if your birthday is on the first day of a month.

If you delay Medicare and later enroll in premium-free Part A, Medicare recommends accounting for the possibility that Part A coverage will be retroactive. If you enroll six or more months after turning 65, that generally means stopping HSA contributions six months before the month you apply for Medicare or Social Security benefits.

Because enrollment dates and individual circumstances can vary, confirm the effective date of your Medicare coverage before determining your final HSA contribution.

Your HSA Can Still Be Valuable After Medicare

Enrolling in Medicare means you can no longer make HSA contributions, but it doesn't mean you can't use the money already in your account. You can continue pulling from your HSA after enrolling in Medicare, and withdrawals for qualified medical expenses can generally remain tax-free. HSA funds can therefore continue to be a valuable resource for health care expenses throughout retirement.

The key is planning ahead. Understanding when Medicare coverage begins, and when HSA contributions must stop, can help you preserve the tax advantages you've worked to build.

It's Time to Prepare for Medicare Annual Enrollment

Wed, 09 Sep 2026 16:00:03 GMT

Plan Ahead for the Best Results

As we head into fall, it's time to think about an important Medicare milestone: the Annual Enrollment Period. If you're on Medicare, this is your chance to review your coverage and make changes if your needs have shifted, or if there will be changes to your current plan that you don’t like.

Key Dates for Annual Enrollment in 2026

October 1, 2026: Plan details for 2027 go live. You can start comparing Medicare Advantage (Part C) and prescription drug (Part D) options in your area, though you can't make changes yet.

October 15 – December 7, 2026: Enrollment is officially open. This is when you can:

Join a Medicare Advantage or Part D plan
Switch to a different plan
Drop coverage or switch back to Original Medicare

January 1, 2027: Any changes you made take effect. Make sure you review your new plan documents so you understand your coverage and costs.

What About Medigap?

If you have a Medicare Supplement (Medigap) plan, it works differently. The rules for joining or switching a Medigap plan are more complicated than those for Medicare Advantage and Part D plans. Reach out to us to discuss your options.

How to Get Ready Now

Between now and October, set aside some time to prepare.

Gather recent medical bills and receipts
Make or update your complete list of current medications and doses
List the doctors and hospitals you have used most over the past year
Check your current plan's summary of coverage
Watch for your Annual Notice of Changes (ANOC) from your health insurance company (usually arrives in late September)—this tells you what's changing in your coverage, costs, provider and pharmacy network, and benefits for 2027
Schedule a review session with our team starting October 1—slots fill up fast

The more organized you are, the easier it will be to make confident choices.

Let's Plan Ahead

Whether you want to stick with what you have or explore new options, we can help you understand your current plan, see what else is available, and make sure your doctors and prescriptions and other benefits are covered. Schedule now to meet with us starting October 1st.

If you have questions now about the process and what to expect, reach out anytime. We're here to help make the process as straightforward and successful as possible.

What Medicare Really Covers for GLP-1 Drugs in 2026

Wed, 02 Sep 2026 18:05:54 GMT

A Plain-English Guide to the New $50 Copay Program and How to Get Started

For years, Medicare generally has not covered medications when they are prescribed solely for weight loss. Federal law currently excludes drugs used for weight loss from the standard Part D benefit. However, a new, limited exception to the rule became available on July 1, 2026.

Through a temporary program called the Medicare GLP-1 Bridge program, certain people with Medicare drug coverage may now be able to get select GLP-1 medications intended for weight management for a $50 copay per one-month supply. The Bridge program does not eliminate the underlying Part D exclusion for weight-loss drugs. Instead, it provides a separate, temporary pathway for eligible Medicare beneficiaries.

Read on to learn what the program covers, who could qualify, and how the process works.

Medicare Part D’s Existing GLP-1 Coverage

Before looking at the new Bridge program, it helps to understand GLP-1 coverage up to this point.

Medicare Part D can cover certain GLP-1 medications when they are prescribed for a medically accepted condition other than weight loss. Depending on the particular drug, those conditions may include:

Type 2 diabetes
Certain cardiovascular risks
Moderate-to-severe obstructive sleep apnea
Certain cases of metabolic dysfunction-associated steatohepatitis (MASH), a serious form of fatty liver disease

If your doctor prescribes a GLP-1 for one of these approved conditions, or something other than weight loss, your Medicare Part D plan may cover it. Which specific drugs are covered and what requirements apply depend on your particular plan.

The New Medicare GLP-1 Bridge Program

The Medicare GLP-1 Bridge program is a temporary program scheduled to run from July 1, 2026, through December 31, 2027. It gives eligible people with Medicare drug coverage access to certain GLP-1 medications for the purpose of weight management for a flat $50 copay per one-month supply. The program is available nationwide, including in U.S. territories.

One important note is that the Bridge program operates outside the regular Part D benefit. Medicare pays participating pharmacies through a central processor rather than having your Part D plan pay for the medication. This means your Part D plan does not have to opt into the Bridge program for you to participate.

Which Drugs Are Covered as of August 2026?

As of August 2026, the Medicare GLP-1 Bridge includes these medications when prescribed to reduce excess body weight and maintain weight reduction:

Foundayo — tablet
Wegovy — injection or tablet
Zepbound — KwikPen only (not single-dose vials or pens)

Because the Bridge program is evolving, Medicare may update covered products over the duration of the program.

What About Ozempic and Mounjaro?

The names of these medications are familiar to many people, so you may wonder if they're covered. The answer is no: Ozempic and Mounjaro are not covered through the Medicare GLP-1 Bridge program. Instead, they remain subject to regular Medicare Part D coverage rules and are most often prescribed to treat type 2 diabetes. Wegovy and Zepbound, on the other hand, are versions approved specifically for chronic weight management.

So, if you take a GLP-1 medication for a condition that can be covered under Part D, continue working with your health care provider and Medicare drug plan or Medicare Advantage plan regarding coverage. If, however, you are seeking a pathway to weight management, then the Bridge program may be worth pursuing. The first step is to find out if you're eligible.

Who Qualifies for the GLP-1 Bridge?

To participate, you must be 18 or older, have Medicare drug coverage, and meet one of Medicare's clinical eligibility standards when starting treatment.

You may qualify if you have:

A body mass index (BMI) of 35 or higher
A BMI of 30 or higher plus heart failure with preserved ejection fraction, uncontrolled high blood pressure, or chronic kidney disease at stage 3a or higher
A BMI of 27 or higher plus prediabetes, a previous heart attack or stroke, or symptomatic peripheral artery disease

You may also qualify for coverage of a GLP-1 drug if you started taking a GLP-1 drug prior to the start of the Bridge program and you met the eligibility conditions when you started taking the drug, even though you may not qualify now. For example, if you started taking a GLP-1 drug in January 2025 and at that time your BMI was 35, you may qualify for the Bridge program even if your current BMI is 25.

Medicare has additional clinical definitions and requirements for these conditions. Your health care provider will determine whether you meet the program's criteria.

You generally aren't eligible for the Bridge program if you already get GLP-1 drugs through your Part D coverage or if you have certain conditions for which GLP-1 treatment may be covered through regular Part D rules, including:

Type 2 diabetes
Moderate-to-severe obstructive sleep apnea
Certain fatty liver disease

Having one of these conditions may make you ineligible for the Bridge program even if your particular Medicare drug plan doesn't currently cover the medication. In that situation, regular Part D coverage and exception rules may apply.

You must also have qualifying Medicare drug coverage. That can include:

A standalone Medicare Part D plan
A Medicare Advantage plan with drug coverage
A Special Needs Plan with drug coverage
Certain employer or union Medicare drug plans
The LI NET program

How Do You Get Started?

The process starts with your health care provider rather than your Medicare drug plan.

Talk with your health care provider. Ask whether one of the covered medications is medically appropriate for you and whether you meet Medicare's BMI and health-condition requirements.
If they agree, your provider will send a prescription to your pharmacy. The medication must be prescribed as part of a treatment plan that includes diet and physical activity.
The first fill may take extra time. The pharmacy's initial claim may trigger a prior-authorization request to your provider. Once the required prior authorization is submitted, CMS says an approval or denial will generally be communicated within 72 hours.
Watch for a letter from Medicare. If your prior authorization is approved, Medicare will send you a letter confirming coverage through the Bridge program.
Be prepared to provide your Medicare information at the pharmacy. Your pharmacy may need your Medicare Number or, in some circumstances, the last four digits of your Social Security Number to process the claim.

Once approved, the prior authorization generally remains valid through December 31, 2027, including for refills and dose changes. A new authorization may be required if you change to a different GLP-1 medication covered by the Bridge.

How Does the $50 Copay Work?

The $50 copay works differently from what you normally pay for medications covered by your Part D plan because Bridge program medications are paid for outside your regular Part D benefit.

For medications you receive through the Bridge program:

You pay a flat $50 copay for a one-month supply
The $50 does not count toward your Part D deductible or annual out-of-pocket limit
It will not appear on your Part D Explanation of Benefits or your Medicare Summary Notice
Extra Help does not reduce the $50 copay
The Medicare Prescription Payment Plan cannot be used to spread the $50 cost across monthly payments

Those differences are especially important to understand if you receive Extra Help or are tracking your prescription drug spending toward your Part D out-of-pocket limit.

Your Next Step

If you think you might qualify for the Medicare GLP-1 Bridge, start by talking with your health care provider. Your provider can help determine whether one of the covered medications is appropriate for you and whether you meet Medicare's eligibility requirements.

The GLP-1 Bridge is currently scheduled to end December 31, 2027, so it's also worth discussing how your treatment and coverage options could change after the program period ends.

If you have questions about your current Medicare drug coverage, we're happy to help you understand how your plan works and where the GLP-1 Bridge program may fit in.

This article is accurate as of August 2026. The GLP-1 Bridge program keeps evolving, so it is good to keep an eye out for ongoing updates.

Vision Coverage Matters More Than You Think

Thu, 27 Aug 2026 00:00:02 GMT

The Eye Exam That Does More Than Check Your Prescription

Did you know an eye exam could be the key to spotting a health issue elsewhere in your body? If you haven’t scheduled one in a while, you’re not the only one. Many people put off routine eye care because they assume it is only necessary if their vision seems blurry or they need new glasses or contacts. But a comprehensive eye exam is about far more than reading letters at a distance of twenty feet. It gives a doctor a direct look inside your body, and that view can offer valuable clues about your overall health, not just your eyesight.

Your Eyes Are a Window to Your Overall Health

According to clinical guidelines from the American Optometric Association (AOA), a comprehensive eye exam can help detect early signs of more than 270 systemic and chronic diseases, including:

• High blood pressure

• High cholesterol

• Diabetes

• Glaucoma and macular degeneration

• Select autoimmune conditions

The reason an eye exam can pick up on so much is that a doctor can directly view blood vessels and nerve tissue through your eyes without an x-ray, a CT scan, or any invasive procedure. Subtle changes in those blood vessels or in the optic nerve can be an early warning sign of a health issue developing elsewhere, which is part of why annual comprehensive eye exams are recommended for most adults, not just those who wear glasses or contacts.

Bridging the Gap: Health Insurance Alone May Not Cover You

Knowing the medical value of an exam is the first step, but it’s also important to understand how that care is financed. It is a common misconception that a major medical or health insurance plan automatically covers routine eye care. In practice, most health plans are built to cover care that is considered medically necessary, such as treating an eye injury, managing an eye disease, or diagnosing a specific symptom you report to a doctor. Routine, preventive vision care, like an annual comprehensive eye exam simply to check your eye health and update your prescription, along with the cost of glasses or contact lenses, typically falls outside what a standard health plan pays for.

That gap is exactly where a separate vision insurance plan or a vision rider added to an existing policy can help. Rather than paying the full cost of exams, frames, lenses, and contacts out of pocket, a vision benefit is designed specifically to offset those routine, recurring expenses that major medical coverage generally does not address.

What Vision Insurance Typically Includes

While benefits vary by carrier and plan, most vision insurance policies are built around a similar core structure. Typically, this includes coverage for an annual comprehensive eye exam, usually for a modest copay, along with an allowance or discount applied toward the cost of frames, prescription lenses, or contact lenses. Many plans also offer materials allowances that renew every year or two, discounts on additional pairs of glasses for backup or specialty use, and in some cases, reduced rates on elective procedures like LASIK. Because premiums for vision coverage tend to be low relative to the potential savings on exams and eyewear, it is often one of the more approachable supplemental benefits available.

How Vision Coverage Fits Your Broader Supplemental Strategy

Vision insurance is just one piece of a broader strategy aimed at reducing unexpected out-of-pocket costs and supporting whole-person health, rather than a standalone add-on. One of our licensed agents can walk you through the vision insurance plans and options available to you, help you understand what each plan covers, and help you decide which policy makes sense for your situation and budget.

Medicare and Hearing Aids

Wed, 19 Aug 2026 23:45:01 GMT

What's Covered, What's Not, and Your Real Options

Before you spend a dollar, here's what you need to know: Original Medicare (Part A and Part B) does not cover hearing aids or the exams used to fit them. You pay 100% of those costs yourself.

This isn't a recent change. Hearing aids have been excluded since Medicare began in 1965, when they were treated as "routine" items rather than medical devices. Congress has introduced bills to change this, but none has become law.

The good news: this isn't the end of the story. You have several real paths to more affordable hearing care, along with the hearing services Medicare does cover.

What Original Medicare Does Cover for Your Hearing

While hearing aids are excluded, a few important services are covered.

Diagnostic Hearing and Balance Exams

If your doctor orders a hearing or balance test to diagnose a medical condition, Part B covers 80% of the approved cost after your annual deductible.

One Audiologist Visit Per Year

You can now see an audiologist once every 12 months without a doctor's order for non-acute hearing concerns. This helps with diagnosis, but still won't pay for the hearing aids themselves.

Cochlear Implants and Bone-Anchored Hearing Aids

These are surgically implanted and classified as prosthetic devices, not hearing aids. Medicare covers them when medically necessary—typically for severe hearing loss that conventional aids haven't helped.

Your Best Path to Covered Hearing Aids: Medicare Advantage

If hearing aid coverage matters to you, a Medicare Advantage plan (Part C) is the most common way to get it. These plans are offered by private insurers and are required to cover everything Original Medicare covers, but many also add extra benefits, and hearing is one of the most common.

A number of Medicare Advantage plans now include some kind of hearing benefit. Depending on the plan, that can include a hearing exam, a hearing aid fitting, and an allowance toward the cost of the hearing aids.

A few things to understand before you assume you're covered:

• Benefits vary widely by plan and by location. Two plans in the same area can offer very different hearing benefits.

• Allowances usually reset every year and do not roll over. If you don't use it, you lose it.

• If your hearing aids cost more than the plan's allowance, you pay the difference out of pocket.

• Some plans require prior authorization or limit how often you can get new aids.

To see exactly what a plan offers, you can review its Evidence of Coverage document, talk to your insurance agent, or call the plan directly.

One Thing to Know: Medigap Won't Help Here

A common point of confusion involves Medicare Supplement plans, also called Medigap. These plans only help pay your share of costs for things Original Medicare already covers, such as deductibles and coinsurance. Because Original Medicare doesn't cover hearing aids, Medigap plans generally don't cover them either. If hearing aid coverage is your goal, Medigap is probably not the route to take.

A More Affordable Option: Over-the-Counter Hearing Aids

If you have perceived mild to moderate hearing loss, over-the-counter (OTC) hearing aids may be worth a serious look. Since the FDA established this category in 2022, adults 18 and older can buy them without a prescription, hearing exam, or professional fitting.

You'll find them at retailers like Best Buy, Walmart, Costco, and Walgreens, as well as online. Prices often start around a couple hundred dollars per pair, compared with thousands for traditional prescription devices.

OTC aids aren't right for everyone. They tend to work best for adults with mild to moderate hearing loss who feel comfortable adjusting settings through an app or on the device itself. On the other hand, if your hearing loss is severe, came on suddenly, affects just one ear, or comes with pain, drainage, dizziness, or ringing, it's worth seeing an audiologist or doctor before buying anything. Those symptoms can point to a medical issue that a professional should evaluate and that the right prescription device can address far better.

Other Ways to Lower Your Costs

Even without direct Medicare coverage, several avenues can ease the expense.

• Medicaid. If you're enrolled in both Medicare and Medicaid (dual-eligible), your state's Medicaid program may cover hearing aids. Coverage varies significantly by state.

• VA benefits. If you're a veteran, the Department of Veterans Affairs often provides hearing aids and repairs at a reduced cost for those who qualify.

• HSA or FSA funds. If you have a Health Savings Account or Flexible Spending Account, both OTC and prescription hearing aids are qualified medical expenses you can pay for with pre-tax dollars. However, it is important to note that once you are enrolled in Medicare (either Part A and/or Part B), the IRS prohibits you from contributing to a Health Savings Account, and imposes a 6% tax penalty for any contributions to the HSA made by you (or your employer, if applicable). You may, however, use funds in an HSA to help pay for hearing aids if those funds were deposited in the HSA prior to your enrollment in Medicare.

Hearing Aid Devices: An Important Investment

Original Medicare won't buy your hearing aids, but you are far from out of options. For most people, the practical choices come down to a Medicare Advantage plan with a hearing benefit, an over-the-counter device for milder hearing loss, or assistance through Medicaid, the VA, or health savings accounts. The best fit depends on your degree of hearing loss, your budget, and the plans available where you live.

Would you like help evaluating your options? Just reach out. We are happy to assist you.

Why Getting Older Might Make You Happier, and How to Borrow the Secret Now

Wed, 12 Aug 2026 23:45:00 GMT

The Happiness Story Isn’t What You Grew Up Hearing

For decades, researchers described happiness across a lifetime as a U-shape: high in youth, dipping through the so-called midlife crisis, then climbing back up in your later years. Newer research is complicating that tidy picture, but one finding keeps holding up: older adults consistently report strong emotional well-being, often stronger than people in their 30s, 40s, and 50s. The interesting part isn’t the shape of the curve. It’s why it happens.

It’s Not About Having Fewer Problems

Older adults aren’t happier because life gets easier. Health concerns, loss, and physical limitations tend to increase with age, not decrease. Researchers who study this, including psychologist Laura Carstensen’s work on socioemotional selectivity, point to something different: as people become more aware that time is limited, they naturally shift their attention and energy toward what matters most. Priorities narrow. Petty conflicts matter less. Meaningful relationships and present-moment experiences move to the front of the line.

Older Adults Get Better at Managing Their Emotions

Multiple studies point to something researchers call the positivity effect. Compared with younger adults, older adults tend to pay less attention to negative information, recover faster from stress, and hold onto positive memories more readily. This isn’t denial. It’s a learned skill, built from decades of practice regulating emotions and choosing what to focus on.

Relationships Get Deeper, Not Just Fewer

Research on aging consistently links close relationships with spouses, adult children, and friends to higher happiness in later life. But it’s not about the number of relationships. Older adults tend to trim their social circles and invest more deeply in the handful of relationships that genuinely matter to them. That shift toward quality over quantity shows up again and again as a strong predictor of well-being.

Three Lessons You Can Borrow at Any Age

Trim your circle on purpose. You don’t need more friends. You need a few relationships you actually invest in.

Practice noticing the good. Older adults don’t ignore hard things, they’ve just built the habit of also registering what’s going right. That habit can start at any age.

Ask what actually matters before your calendar fills up. You don’t need to wait until later in life to prioritize the people and activities that matter most to you.

Older Adults Also Tend to Compare Themselves Less

Younger adults often measure their lives against a moving target: a coworker’s promotion, a friend’s new house, a stranger’s highlight reel online. Researchers have found that this kind of social comparison tends to fade with age. Older adults are more likely to judge their lives against their own values and history rather than against other people. That shift alone removes a major source of everyday dissatisfaction, and it’s a habit you can start practicing well before you retire.

A Word of Caution About the Research

It’s worth being honest that this is an active area of study, and researchers don’t all agree on the details. Some recent analyses challenge the classic U-shaped curve entirely, arguing that once you control for survey biases, happiness looks more like a slow decline with a small uptick around the early 60s, followed by a steeper drop in very old age tied to health decline. Other work still finds strong support for a late-life rebound. What almost none of the research disputes is the core idea: older adults, as a group, tend to report meaningfully higher emotional well-being and life satisfaction than middle-aged adults, even while facing more physical limitations. The mechanism, not the existence of the pattern, is what’s still being debated.

It’s Never Too Early to Start

The research is still evolving, and no single study has the final word on exactly how happiness moves across a life. But the underlying lesson holds regardless of the exact curve: emotional well-being isn’t just a matter of circumstance. It’s shaped by where you put your attention and who you choose to spend your time with. Those are habits worth building now, whatever age you’re starting from, and they tend to compound the same way good financial habits do.

Your ANOC Is Coming: Don't Throw This Medicare Letter Away!

Wed, 05 Aug 2026 23:30:03 GMT

What Your Annual Notice of Change Really Means for You

Every fall, if you're enrolled in a Medicare Advantage plan or a stand-alone Part D prescription drug plan, you'll receive an important piece of mail: the Annual Notice of Change, or ANOC. Many people glance at the envelope, assume it's routine paperwork, and tuck it away in a drawer, but this is a letter worth reviewing.

Your ANOC is your plan's official preview of what will change starting January 1 of the coming year. By law, plans must deliver it to you no later than September 30 each year, which gives you time to review it before Medicare's Annual Enrollment Period begins on October 15. Inside, you'll typically find details about premiums, drug coverage, copayments and coinsurance, provider networks, and any coverage changes starting January 1.

Why This Letter Deserves Your Attention

Many people assume that if you've been happy with your plan all year, then you don’t need to do anything and nothing will change. But Medicare Advantage and Part D plans are permitted to adjust their costs and coverage from one year to the next. The monthly premium might go up or down, a medication you've taken for years may move to a different cost tier or no longer be covered at all, or prior approval may now be required. A doctor or specialist you see regularly may no longer be part of the plan's network.

These changes do not require your permission and can significantly impact your coverage. Reviewing your ANOC carefully gives you a critical head start, allowing you to identify specific concerns or areas to address, such as network or formulary changes, before annual enrollment arrives. This ensures that when it comes time to sit down with us after October 1 for your Medicare review, you and your agent can focus on evaluating the aspects of your plan that you already know need your attention.

What Can Actually Change

The ANOC covers more ground than most people expect. Along with monthly premiums and annual deductibles, it can outline new copayment or coinsurance amounts for doctor visits, specialist care, and hospital stays. It will also show whether your medications have moved to a different cost tier, been removed from the formulary altogether, or gained a new requirement like prior authorization or step therapy. Provider and pharmacy networks can change, too, meaning a doctor or pharmacy you rely on today might not be included next year. Even the maximum amount you'd pay out of pocket in a year, and benefits like dental, vision, or hearing can be adjusted, expanded, or reduced. The plan may even add new, additional supplemental benefits in the coming year.

A Quick Example

Consider a longtime Medicare Advantage enrollee named Margaret, who was satisfied with her plan, didn’t open her ANOC, and let her enrollment automatically renew during annual enrollment. It wasn’t until January that she realized her monthly premium had gone up slightly, and more importantly, a maintenance medication she'd taken for years had moved to a higher cost tier. She also discovered that one of her regular specialists was no longer in the plan's network. Had she caught these changes in October, she would have had time to compare plans and talk with a licensed agent before the Annual Enrollment Period closed. But now she was locked into her plan for the rest of the year.

What to Do When Your ANOC Arrives

The envelope will likely be marked with something like "Important Plan Information” or may be labeled “Annual Notice of Change.” Open it and read through the entire letter. Many ANOCs include a side-by-side comparison of this year's plan details versus next year's. Pay close attention to four things in particular: your premium, your specific medications, the providers you see most often, and the benefits you use most or expect to use in the coming year. If anything has changed in a way that concerns you, that's your cue to explore other options. Starting on October 1, you can work with one of our licensed insurance agents to compare plans and prepare for Annual Enrollment from October 15 - December 7.

Common Mistakes to Avoid

The most common mistake is simply not opening the envelope, and assuming that because nothing has gone wrong this year, nothing will change next year. Another is reading only the first page and missing details buried further in, such as formulary or network changes. Some people miss the window and open it too late to take action during the Annual Enrollment Period, which runs October 15 through December 7. Others focus solely on the premium and overlook drug coverage or network changes, which can end up costing far more over the course of a year.

Free, Unbiased Help Is Available

You don't have to sort through your ANOC alone. Starting on October 1, we can walk you through the changes and help you weigh plans that may better fit your needs in 2027. If you'd like more immediate assistance, your State Health Insurance Assistance Program, known as SHIP, offers free resources to help you understand your notice. Either way, any changes you decide to make during the Annual Enrollment Period will take effect on January 1.

Conclusion

Your ANOC may look like just another piece of mail, but it's one of the most useful documents Medicare sends you all year. Reading it carefully, checking your premium, your medications, and your providers, and comparing your options can help you make sure you’ve got a plan that truly fits your needs. Don't throw it away, and don't let it sit unopened. A little attention each fall can go a long way toward protecting your healthcare and your budget in the year ahead.

What Is the WISeR Model — and How Could It Affect Your Medicare Coverage?

Wed, 25 Mar 2026 06:00:05 GMT

Understanding Medicare’s New Pilot Program Focused on Prior Authorization and Medical Necessity

If you’ve heard about WISeR recently and aren’t sure what it means or how it might impact your Medicare care, you’re not alone.

The Wasteful and Inappropriate Service Reduction (WISeR) Model is a new Medicare pilot program designed to curb unnecessary or low-value medical services and improve the efficiency of Medicare spending. It represents a significant change to how some services are reviewed and approved in Original Medicare (Part A and Part B).

What Is the WISeR Model?

WISeR stands for Wasteful and Inappropriate Service Reduction. It is a pilot initiative from the Centers for Medicare & Medicaid Services (CMS), the agency that runs the Medicare Program, that uses advanced technology, along with clinical review, to determine whether certain services are medically necessary before Medicare pays for them.

In simple terms:

Medicare has identified services that are considered high-risk for waste, overuse, or low clinical value.
For those services, prior authorization (approval before treatment) may now be required.
Requests are reviewed using enhanced data tools (such as artificial intelligence and machine learning) alongside established clinical guidelines. It is important to note that coverage decisions under the WISeR model are not based solely on these data tools. A human clinical reviewer is involved in all final coverage decisions when a service is recommended for denial.

The goal is to ensure Medicare pays for care that is medically appropriate and supported by evidence-based standards.

Where Is WISeR Being Piloted?

The WISeR Model is currently being tested in the following six states:

Arizona
New Jersey
Ohio
Oklahoma
Texas
Washington

If you live in one of these states and have Original Medicare, you may be affected — especially if your doctor recommends one of the services included in the program.

Medicare Advantage plans are not part of the WISeR Model, as they already use their own prior authorization and utilization review processes.

Which Services Are Included?

CMS has identified specific services that will require additional review in the pilot states. These include:

Musculoskeletal and Pain-Related Services

Skin and tissue substitutes
Epidural steroid injections for pain management
Facet joint injections
Sacroiliac joint injections
Knee arthroscopy for osteoarthritis
Cervical spinal fusion
Lumbar spinal fusion
Vertebroplasty and kyphoplasty
Arthroscopic shoulder procedures

Neuromodulation and Implantable Devices

Electrical nerve stimulator implants
Peripheral nerve stimulation
Spinal cord stimulation procedures
Implantable pain pumps
Neurostimulator trial procedures
Replacement or revision of implanted nerve stimulators

Other Services

Certain urological procedures for erectile dysfunction
Select wound care services

If one of these services is recommended, your provider may need to obtain prior authorization before Medicare will pay for it.

How Could This Affect Your Care?

If you are enrolled in Original Medicare in one of the pilot states, you may notice:

Prior Authorization Requirements
Your provider may need to submit medical records or documentation before treatment can be approved.

Possible Delays
Reviews may take additional time, which could delay scheduling of a procedure.

Coverage Decisions Based on Medical Necessity
If Medicare determines a service does not meet established clinical guidelines, it may deny payment.

It is important to understand that the purpose of the program is to reduce inappropriate or unnecessary services — not to deny medically necessary care. However, additional review steps may require more coordination between patients and providers.

What Should Medicare Beneficiaries Do?

If you live in one of the affected states, consider the following steps:

Ask your provider whether a recommended procedure requires prior authorization.
Confirm that your medical records clearly document the need for the service.
Carefully review any Medicare notices you receive.
Understand your right to appeal if a service is denied.

Working with a knowledgeable insurance professional can also help you better understand how these changes may impact your coverage.

Where to Learn More

For official information directly from CMS, visit:

https://www.cms.gov/priorities/innovation/innovation-models/wiser

Conclusion

The WISeR Model is a Medicare pilot program designed to reduce waste and ensure certain services meet clinical guidelines before Medicare pays for them. If you are enrolled in Original Medicare and live in Arizona, New Jersey, Ohio, Oklahoma, Texas, or Washington, this program could affect how certain procedures are approved.

Staying informed, asking questions, and maintaining open communication with your provider are the best ways to navigate these changes confidently.

Glaucoma and Medicare

Wed, 18 Mar 2026 06:00:04 GMT

What You Need to Know About Protecting Your Vision

Did you know that about half of people with glaucoma don’t even know they have it?

Glaucoma is often called the “silent thief of sight” because it develops slowly and often with no noticeable symptoms in the early stages. By the time vision changes become obvious, it usually means permanent damage has already occurred.

What is glaucoma? It’s actually a group of eye diseases, not just one single disease. What they all have in common is that they damage the optic nerve, which is the vital connection between your eye and your brain. It’s often associated with increased pressure inside the eye, but it can occur even when eye pressure is normal. Left untreated, glaucoma can lead to permanent vision loss and even blindness.

Early detection and treatment are crucial to slow or prevent further vision damage. That’s why regular screenings are essential if you are at a higher risk for glaucoma based on your genetics or family history.

Why Early Detection Matters

In its early stages, glaucoma typically has no warning signs. There’s no pain or sudden changes in vision. The most common form, called open-angle glaucoma, gradually reduces peripheral (side) vision first. Because central vision remains clear for a long time, it can take quite a while to realize anything is wrong.

Other, less common types, such as angle-closure glaucoma, can develop more suddenly and may cause more obvious and acute symptoms like severe eye pain, headache, nausea, blurred vision, or seeing halos around lights. These symptoms require immediate medical attention.

The only way to know if you have glaucoma is through a comprehensive, painless eye exam that includes specific tests to check:

Eye pressure
Optic nerve health
Peripheral vision
Drainage angle of the eye

According to the National Eye Institute , regular eye exams are critical, especially as we age, because early treatment with prescription eye drops, laser therapy, or surgery can help prevent further vision loss.

Vision lost from glaucoma cannot be restored, which makes early detection essential.

Medicare Coverage for Glaucoma Screenings

Medicare Part B covers glaucoma screenings once every 12 months for people who are considered high risk (see the list below).

The screening must be performed (or supervised) by an eye doctor who is legally allowed to provide the service in your state, such as an ophthalmologist or optometrist.

If you qualify as high risk and receive your screening from a provider who accepts Medicare assignment, Medicare Part B will cover 80% of the approved amount (once your Part B deductible has been met). You would be responsible for the remaining 20% as coinsurance.

It’s important to confirm that your provider accepts Medicare assignment to help minimize out-of-pocket costs. If you have a Medicare Advantage plan, coverage rules may vary slightly, so review your plan details, or ask us to help determine what your coverage is.

Who Is at Higher Risk for Glaucoma?

While anyone can develop glaucoma, certain groups have a higher risk. Medicare considers you at high risk if at least one of the following applies:

You have diabetes
You have a family history of glaucoma
You are African American and age 50 or older
You are Hispanic and age 65 or older

Because risk increases with age, glaucoma screening becomes even more important for Medicare beneficiaries.

Protecting Your Vision Starts with a Conversation

If you fall into a high-risk category, talk with your primary care provider or eye doctor about scheduling a glaucoma screening. Your vision plays a major role in your independence, safety, and overall quality of life. When it comes to your eyesight, waiting for symptoms isn’t a safe strategy. A simple, painless screening once a year could help preserve it for years to come.

If you have questions about how your Medicare coverage works, including preventive screenings like glaucoma testing, reach out to review your benefits and make sure you’re taking full advantage of what’s available to you.

Delicious Foods That Fight Diseases

Wed, 11 Mar 2026 06:00:02 GMT

Eat for your health

Eating well is one of the simplest ways to support long-term health. While no food can cure or prevent disease on its own, many everyday foods contain nutrients that help strengthen the immune system, reduce inflammation, and support overall wellness. The good news? Many of these foods are both familiar and delicious.

Colorful Fruits and Vegetables

Fruits and vegetables are packed with vitamins, minerals, and antioxidants that help protect the body from cell damage. Berries like blueberries, strawberries, and raspberries are especially rich in antioxidants that support brain and heart health. Leafy greens such as spinach and kale provide essential nutrients like vitamins A, C, and K, along with fiber that supports digestion and cardiovascular health. A simple rule of thumb is to add more color to your plate—each color offers different health benefits.

Healthy Fats That Support the Heart

Not all fats are created equal, and healthy fats play an important role in fighting disease. Fatty fish such as salmon and sardines contain omega-3 fatty acids, which are known to support heart health and help manage inflammation. Plant-based options like walnuts, chia seeds, flaxseeds, and avocados provide similar benefits and are easy to add to meals or snacks.

Whole Grains and Plant Proteins

Whole grains and legumes help fuel the body while supporting stable blood sugar and digestive health. Foods like oats, quinoa, brown rice, beans, and lentils are high in fiber and nutrients that may reduce the risk of heart disease and support weight management. These foods also help you feel full longer, making them a smart choice for everyday meals.

Herbs, Spices, and Gut-Friendly Foods

Small additions can make a big impact. Garlic has long been associated with immune support, while turmeric contains curcumin, a compound known for its anti-inflammatory properties. Fermented foods such as yogurt, kefir, sauerkraut, and kimchi contain probiotics that support gut health—which plays an important role in immunity and overall wellness.

Small Changes, Big Benefits

Healthy eating doesn’t require drastic changes. Simple steps like adding an extra serving of vegetables, choosing whole grains more often, or enjoying fish once or twice a week can support better health over time. When paired with preventive care, good nutrition becomes another powerful way to invest in your well-being.

Eating well should be enjoyable, not stressful. With so many tasty foods that also support your health, fighting disease can begin with something as simple as your next meal.

Medicare Extends Hospital-at-Home and Telehealth Coverage

Tue, 03 Mar 2026 23:07:48 GMT

What It Means for Patients

Recent federal legislation has provided multi-year extensions for two Medicare programs that expanded access to care beyond traditional clinical settings:

the Acute Hospital Care at Home Program (often called Hospital-at-Home) and Medicare telehealth flexibilities . These changes come after prior pandemic-era waivers were set to expire, and they offer more stability for patients and providers alike.

What Was Extended?

Hospital-at-Home through 2030

The Acute Hospital Care at Home Program, which allows certain hospitals to deliver inpatient-level care in a beneficiary’s home, has been extended through September 30, 2030 . This means patients who qualify can continue to receive hospital-level services—such as treatment for infections or recovery support—without being physically admitted to a facility. For many older adults or individuals with mobility challenges, this model can reduce stress, lower risk of hospital-acquired complications, and improve overall comfort during recovery.

Telehealth Flexibilities through 2027

Medicare’s expanded telehealth benefits—originally adopted during the COVID-19 public health emergency—have been extended through December 31, 2027 . These flexibilities include:

Coverage for telehealth services delivered to beneficiaries in their homes
Expanded list of provider types eligible to deliver care virtually
Continued coverage for audio-only telehealth when appropriate
Ability for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to serve as telehealth distant-site providers

These extensions preserve the ability for beneficiaries to see doctors, specialists, therapists, and other providers using video or phone visits without returning to more restrictive pre-pandemic regulations.

Why These Extensions Matter

Greater Access and Convenience

For Medicare beneficiaries, especially in rural areas or with limited mobility, these extensions mean continued access to care without the need for transportation or in-person visits. Virtual visits have become a lifeline for routine check-ins, chronic condition management, mental health care, and follow-up appointments, often saving time and reducing costs.

Hospital-at-home programs bring a similar advantage for higher-acuity care. Rather than being hospitalized, eligible patients can receive equivalent treatment at home, supported by coordinated medical teams. This model has been shown to offer improvements in patient satisfaction and potentially reduce the risks associated with traditional hospital stays.

Stability After Policy Uncertainty

These extensions come after a period of uncertainty, during which telehealth and hospital-at-home waivers briefly lapsed — and then were reinstated — due to funding and appropriations negotiations in Congress. Long-term extensions give providers important certainty when planning care models and technology investments, and they give beneficiaries reassurance that these expanded care options will continue without abrupt interruptions.

Looking Ahead

Advocates on both sides of the aisle have emphasized the value of telehealth and hospital-at-home services, arguing that they should become permanent parts of the Medicare program. While the recent extensions do not yet make these flexibilities permanent law, they do represent a significant step toward longer-term integration of virtual and in-home care options into the health care system.

This blog is for informational purposes only and reflects federal health policy as of early 2026. Individual coverage can vary based on specific Medicare plans and eligibility.