By Susan Stewart, Licensed Insurance Agent
I completed my fourth Annual Enrollment Period (AEP) on December 7. Each one has been more difficult than the last. Today, I offer my opinion of the Annual Enrollment Period (AEP) and what I see in the Medicare industry in 2026.
There is always a lot of hype about the changes “next year.” Carriers present the best of what’s to come. They compete against each other for your business and mine. But want to know what I’ve actually seen?
- Ever-narrowing networks. Major hospitals cannot reach contractual agreements with carriers who no longer accept or participate. Doctors’ offices are increasingly moving toward being part of a group rather than operating on their own, which gives them more negotiating power. Some refuse to accept Medicare Advantage plans at all. Some refuse to network with HMOs, even though HMOs account for 80 percent (or more) of plans available this year.
- Reduced benefits and increased costs. This year, people are saying that “Medicare wants to return to being just healthcare without the bells and whistles.” Really? Is dental care no longer essential to physical health? Can a person on a fixed income afford to pay $400 a day to be in the hospital for three, five, or seven days? A food card. Are these things “bells and whistles”?
THIS is my angst. My opinion. It’s all about money.
Facilities, whether they are hospitals, medical practices, physical therapists, or healthcare providers, need to be paid. They want to make money. However, so do carriers, who want to pay healthcare providers as little as possible. In between are the millions of staff who keep the wheels moving, who also need to bring home a paycheck. Everyone from the janitor with the important job of cleaning hospital floors, the receptionist at your doctor’s office, the highest-paid surgeon, nurses, therapists, administrative staff, and…people like me who work in the insurance industry.
It’s not as simple as people having access to healthcare. What does “access” even mean? Yes, healthcare is there. But can people go to the doctor? Can they afford their medication? How does a person pay off several thousand dollars in medical debt when they can hardly buy boxed macaroni and cheese? They don’t, and that leads to them skipping medical care when they need it. It’s messed up.
This is the reality beneficiaries face. From an insurance agent’s perspective, the exact people Medicare is supposed to cover remain unseen in the clash over who gets paid and how much profit they can show investors.
As a human being with genuine feelings for my clients’ well-being, I hear their stories every day. Sometimes they haunt me. Sometimes I cry with them. Sometimes I go home sad and angry over things outside my control: The Part B premium increased by 9.7 percent this year, from $185.00 to $202.90. The Social Security COLA, however, was only 2.8 percent. The gap between those two numbers means that millions will lose Medicaid coverage and will have to pay their Part B premium. I heard from one person who depends on Social Security and has gone without heat and lights since September. What is he supposed to do in this situation? He’s just one person among millions. Need I even say more?
I offer no solution. I can just see the complexity of the problem. How do I cope? I think about my own retirement and how I’m going to manage on a fixed income when I can so clearly see the challenges that lie ahead for me, too. I can try to encourage others, to always speak truthfully and kindly. I can listen and care. I can live a healthy life, both financially and physically.
How can you cope? Try to encourage yourself and others. Accept help when it’s offered. Ask for help. Speak truthfully and kindly. Listen to and care about others’ experiences, helping where you can. Be wise with your spending and take care of your body to increase your health. Do what you can with integrity and mindfulness. Does that fix the root problem? No. But it’s a place to begin. I can control so little, but I can control my response. And so can you.