Episode 313: Medicare in 2026: What to Know Before You Turn 65 with Cameron Giardini

Medicare is a cornerstone of most retirement plans, but it’s also a brand-new system for people who’ve spent decades on employer coverage. Melissa Joy, CFP® sits down with Cameron Giardini of to break down what Medicare is, when you actually need to enroll, and how to avoid the most common (and costly) mistakes.

They cover the major coverage paths (Original Medicare + Medicare Advantage vs Medigap), why your first enrollment decision at 65 can affect your options later, and what higher earners need to know about IRMAA surcharges. Cameron also explains a key HSA pitfall, shares what’s changing heading into 2026, and points listeners to free education resources to start learning without overwhelm.

What You’ll Learn

• What Medicare is (and isn’t), and when it typically starts
• When to begin planning, and how to check eligibility and costs
• When you can delay Medicare past 65 without penalties
• The key decision: Medicare Advantage vs Medigap (and what each really means)
• Why your first Part B enrollment window matters for lifetime flexibility
• What IRMAA is, how it’s calculated, and how to appeal it after retirement
• How HSAs interact with Medicare and what not to do at 65
• What’s getting more expensive in 2026 and why “choice” may continue shrinking
• How adult children can help parents by first identifying what coverage they actually have

Connect with Cameron: https://gmedicareteam.com/

Youtube: www.youtube.com/@GiardiniMedicare

The previous presentation by PEARL PLANNING was intended for general information purposes only.  No portion of the presentation serves as the receipt of, or as a substitute for, personalized investment advice from PEARL PLANNING or any other investment professional of your choosing. Different types of investments involve varying degrees of risk, and it should not be assumed that future performance of any specific investment or investment strategy, or any non-investment related or planning services, discussion or content, will be profitable, be suitable for your portfolio or individual situation, or prove successful. Neither PEARL PLANNING’s investment adviser registration status, nor any amount of prior experience or success, should be construed that a certain level of results or satisfaction will be achieved if PEARL PLANNING is engaged, or continues to be engaged, to provide investment advisory services. PEARL PLANNING is neither a law firm nor accounting firm, and no portion of its services should be construed as legal or accounting advice. No portion of the video content should be construed by a client or prospective client as a guarantee that he/she will experience a certain level of results if PEARL PLANNING is engaged, or continues to be engaged, to provide investment advisory services. A copy of PEARL PLANNING’s current written disclosure Brochure discussing our advisory services and fees is available upon request or at https...

Transcript

Welcome And Today’s Focus

SPEAKER_02 0:01

Welcome to the Women's Money Wisdom Podcast. I'm Melissa Joy, a certified financial planner and the founder of Girl Planning. My goal is to help you streamline and organize your finances, navigate big money decisions with confidence, and be strategic in order to grow your wealth. As a woman, you work hard for your money, and I'm here to help you make the most of it. Now let's get into the show. For many, if not most of us, Medicare is a part of the retirement plan. And that is a completely new healthcare regime that often people need extra guidance. Today's guest, Cameron Giardini, is just that person. He's the educator and guide when it comes to Medicare choices. Cameron is an independent Medicare broker and educator with Giardini Medicare. He is the Medicare rabbit hole guy who turns complex rules into practical guidance. And we've had him on the podcast in the past, as well as Joanne Giardini. And glad to have you back again for another What's Going On with Medicare this time for 2026. Welcome, Cameron.

SPEAKER_00 1:14

Thanks for having me, Melissa. It's always uh there's always something happening. So I feel like we can come back every year.

SPEAKER_02 1:19

I mean, everybody eventually that is, you know, kind of a working US citizen often plans to use Medicare in retirement, but we don't use it till we get there. So it leaves a lot of, you know, kind of wanting for education. There's some decisions and choices to make.

SPEAKER_00 1:37

And so people say maybe it's at age 62, maybe six they you hear rumblings of it with your friend group, and that's about it.

SPEAKER_02 1:44

Yeah, it's water cooler cooler conversation.

SPEAKER_00 1:46

I have heard of that when I was camping. I've heard people talking at campfires about when Medicare might start. So did you stop, or did you just listen in?

SPEAKER_02 1:54

Or what were you thinking?

SPEAKER_00 1:55

Oh no, it was dark. I was just listening and eavesdropping on it. So it's a good example, though. You never you can never escape it.

SPEAKER_02 2:02

Well, why don't we start there? If somebody is just like, okay, I've probably heard of it. Is it Medicare? Is it Medicaid? What is Medicare and when does it start?

SPEAKER_00 2:11

Yeah, so Medicare is strictly speaking, is for well, for the vast majority of people, it's when you turn 65. That's when you're eligible for Medicare. Now, eligibility and cost, it depends a little bit on your work history, as you alluded to. As long as you meet the 40 quarters, basically 10 years of working through your record or a spouse's, you qualify for premium-free part A of Medicare. And then you also have part B of Medicare. But either way, it's designed for adults age 65 and older. And it's just really, it's just health insurance. You know, it's another type of health insurance for those people that are age 65 plus. It was, of course, designed to take over after employer insurance, assuming most people are retired at that point. And uh there is another part of it. I don't, I hate to say just 65 plus, because if you do receive social security disability under age 65 for a couple of years, or if you have ALS or end stage renal disease, you can get Medicare before age 65. But for again, most people just think of it as health insurance for those 65 plus. I have so many people about income, not Medicaid. Yeah.

SPEAKER_02 3:22

65 becomes an a retirement, it used to be, you know, kind of considered full retirement age, but it still is when it comes to health insurance. We had a separate episode recently talking about pre-age 65 health insurance, which can get very, very expensive. But then you kind of drop down, um, but you also need to make some choices. So, first of all, if you're a if someone's a listener or their family member is a listener's family member is approaching age 65, at what point in time do you suggest they need to really get serious about educating themselves and making decisions?

When To Prepare And Broker Role

SPEAKER_00 4:00

I would say to get serious about it, it's really six months before you turn 65, is what we recommend. And serious doesn't mean you're going through hours of content and going down a bunch of rabbit holes that I tend to go down myself, but it's really just okay, what will it cost me? Um, am I am I just eligible for it? Can you compare or can you verify your work history? Just make sure you're good to go on costs and eligibility. And then it's just trying to figure out your so you can go to your social security portal and your SSA.gov portal. It should say whether or not you qualify for premium free part A of Medicare. I know I can even see that in mind. And again, it's not most people do. I'm not here to scare people into thinking you won't qualify. Typically, people qualify. Yeah. But you can do that, and then you can just figure out okay, what does Medicare cost? Kind of the base rates, because it does come with a premium. Most people there, a lot of people do think it's free just based on what you've paid in taxes over time. So it's familiarizing yourself with when you can sign up, what it's going to cost, and some of the options. But definitely six months beforehand. Uh, don't do it three months, or don't do it three years, don't do it four years. A lot of people tend to do that as well. And they say, okay, I narrowed it down, and then by the time it's four years from now, all the plans are different. So just relax and probably six months to a year.

SPEAKER_02 5:20

Perfect. And just for full disclosure, GRD Medicare, you're an insurance broker, you're helping people to analyze their choices. You are compensated with a commission that is similar to what any any person placed in the insurance. It's not like a new cost if you use an insurance broker versus if you purchase it directly, you know, at your pharmacy or something like that. It's it's the same cost. Is that right?

Do You Need Medicare At 65

SPEAKER_00 5:48

Yeah, and we're not affiliated with the government. I'm not here to try to trick people and saying we work with the government. We're not ship counselors, if you've ever heard of that. Those are just independent volunteers that help people. They're not compensated. But yeah, like Melissa was saying, we are compensated by the insurance companies. We are brokers, so we work with dozens of different insurance companies. But if you call them directly, the insurance company, or if you call us, it is the same exact price of what you're getting.

SPEAKER_02 6:15

Perfect. And then what are some of the options? You mentioned A and B, but what are some of the choices that people will make? I guess we should first mention many, if not most people will start at age 65. Um, if you work for a large employer and you're still employed, would you start then? Or what what are the options for those people?

SPEAKER_00 6:38

Yeah. So just to go back real quick, the biggest thing, like I said, with the six months, it's do you need Medicare is a thing that Joanne and I always say. It's just taking a step back and saying, okay, I get it at 65, but do I need it? And that sounds dumb because why wouldn't you need it, right? Why would you not want something you qualify for and you benefit from? But just because you can get it at age 65, it doesn't always mean you do need it. So if you're working at a large employer or if your spouse is working at a large employer and you're covered by their plan, then you can typically delay Medicare past age 65. I mean, we've had people up until age 80 not even collect Part B or not even enroll in their Part B of Medicare, just because that does come with a cost. You know, you are paying for Part B most of the time. So if you have decent health insurance through that large employer, it might make sense to delay it. So that's where that six-month conversation comes into play of talking to us or talking to anybody and figuring that out. And the large employer, just to clarify, it's it's determined by 20 or more employees. So it's not even a thousand-person employer. You might be thinking large is actually pretty small when you think about it.

SPEAKER_02 7:50

So right. So if you're at a small employer, if you're retired, oftentimes you in in many, if not most cases, you're going to be enrolled, but there can be some exceptions.

SPEAKER_00 8:03

Yeah, it's really it's covered by active employer coverage through yourself or a spouse is really more of the technical definition. So, like Melissa said, active employer doesn't mean retiree if you're part of the big three auto workers and you're retired at 60, waiting to 65. You might have coverage through a former employer, but that's not active employer coverage. Or if it's under 20, those small employers, you'll almost certainly want Medicare to go with it at least.

SPEAKER_02 8:30

Perfect. And then I know there's some additional choices or elections. Um, can you take us through some of the considerations?

Medigap Versus Medicare Advantage

SPEAKER_00 8:38

As far as timing goes, or just or like what you're signing up for. Yeah. Yeah. So it's really A and B, that that is Medicare. I'm not even going to get into what they cover, what they do, because it's pretty easy to find that. Basics and standards. Yeah, it's pretty, it's it's pretty standard for everybody. So A and B, whenever you talk about those letters, just think Medicare. And again, if you think Medicare, think health insurance, whatever makes it easy to break down for you. And then beyond that, it's really you'll probably hear about 80-20 coverage. People say, Okay, I know Medicare covers most things, but not everything. I I need something else, right? They they vaguely know that there's probably something else they need to do, really, or else we wouldn't have a job. Because if Medicare covered everything, there would be nothing. It's one choice discussed. Yeah, it would be but uh so when you have Medicare, original Medicare A and B, from there you really have the path to either go with Medicare Advantage or to go with a Medicare supplement. And just for the sake of keeping things simple in this podcast, it's Medicare Advantage is like that private alternative to Medicare. It's through insurance companies. Pretty much any time you see a commercial, if it talks about extra benefits, if it talks about low premiums, if you see a billboard in Michigan, it's probably Medicare Advantage. Those are heavily advertised, and that's the one path you can go. It's more, I guess, typical with what you think with health insurance. You have the low cost, you pay as you go, and you have a max out of pocket, those kind of things. And then there's Medicare supplements on the other side, completely different path you can take. And that is also known as Medigap. And basically, it is designed to help cover the remaining 20% not covered by Medicare. So two different ways you can do it. And yes, there's nuances and a bunch of weird little plans out there, but that's for 90% of the city. Those are the biggies. Yeah, those are the the first ones to start with that. Like, okay, I can decide between one of these two.

SPEAKER_02 10:38

Which of those coverages tends to cost more in terms of your premiums?

SPEAKER_00 10:46

I would say Medicare supplements, Medigap. Yeah. There's always, like I said, edge cases. People will say, well, technically, but yeah, it's Medigap.

SPEAKER_02 10:54

And do you get for those additional costs any are there any extra like I mean, insurance is really a risk mitigator, or are there any extra coverages that you get in exchange for that additional cost?

SPEAKER_00 11:09

I don't know about extra. It's always hard how you define extra coverage because people will think of extras as like dental and stuff above what Medicare itself would normally cover. So really not extra in that sense with Medigap. But when you're talking about, I would say good cover, not good, it's hard it's hard to say it, but comprehensive coverage. They always talk about the Cadillac of coverage and and all that when it comes to Medigap, but it's going to typically result in the lowest out-of-pocket cost when you need medical care, is how I would think about it. So it's not extra, like it's not flashy, but it's gonna cover your core medical costs really well.

SPEAKER_02 11:48

More extensively in in some or many cases. Would it also give you more choices on who you receive your care from?

SPEAKER_00 11:57

Yeah, I would say, well, again, there's TPO plans. I know everything is like I hate to say it depends all the time, but yes, generally with Medigap, you can see any provider in the country that accepts original Medicare. Okay. And that is a lot of providers. It never really has perfect stats on it, but yes, you have the flexibility nationwide to see pretty much any provider that you want to see.

SPEAKER_02 12:23

And what does your network look like for Medicare Advantage um plan holders?

SPEAKER_00 12:30

Yeah, it'll heavily depend on the type of plan. So just like I said, how it's more of your traditional insurance as you think of it, you have more HMO PPO style plans. So you could have an HMO, for example, in Metro Detroit. It might be, you know, Henry Ford in Ascension. It's just those are our hospitals, those are our doctors, and that's it. Or you could have a PPO plan with a huge company, and they say, Yeah, you can go to any of our providers nationwide, and you can even go out of network if a provider is willing to treat you and bill our plan. So it can really heavily, heavily bury.

SPEAKER_02 13:05

But neither one is going to be as as uh accessible or as I don't want to say freeing, but you know, you're gonna have the least amount of restrictions with Medigap when it's so potentially more um, and you know, we use this with a hedge, but typically more flexibility with Medigap, but also um you would typically have an additional cost or a higher cost.

SPEAKER_00 13:27

Definitely. The key is don't don't think of a PPO. A lot of people really confuse the two PPO, because you think PPO, you think freedom. That's normally when you're working, your choices are PPO, HMO, and it's pretty basic. And you think, okay, PPO, I can go out of network, I can do a lot of stuff and go wherever I want. So people will think, oh, I want a Medigap plan because it's a PPO, but it's not. It's it's Medigap. You can just go anywhere they accept Medicare. Whereas a PPO plan, that is going to be Medicare Advantage, and it's close. I mean, you can you can have a lot of flexibility, but you're still not guaranteed to see out-of-network providers with a PPO.

Networks, Costs, And Prior Auth

SPEAKER_02 14:05

And then I've also heard some incentives. Um like one of my friends mentioned to me, oh, my parents get grocery coupons with their or they get food paid for with their Medicare advantage. Um what are can you talk about some of the like incentives, I guess, to choose and also you know, the trade-offs of well, why wouldn't you just go where they you know give you the food rations or something like that?

SPEAKER_00 14:35

I mean, I'll I'll be a little bit of a Debbie Downer because now Medicare makes it, we can't legally say specific extra benefits that come with Medicare Advantage. That was kind of a new thing a year or two ago. Okay. Even mentioning the words, they're like don't sell. Yeah, enticing people. But if you've seen, I'll say if you've seen ads, if you see anything about extra benefits, generally speaking, and you think, okay, why is a Medicare Advantage plan offering that? And is that even possible? The answer is usually a mix of yeah, it is possible, but they are also cherry picking kind of the the best benefits you can find around the state and saying, hey, maybe, maybe you can qualify, maybe you can get this plan, which maybe, but it's not that likely that you're going to get those top-of-the-line extra benefits. A lot of times it's even for people with Medicare and Medicaid, where they get a lot of those extra incentives that Melissa was talking about. So if you see it, those are real, but just know it's it's probably not as flashy and as it's not going to be what you actually get. Maybe within a role in one of those plans.

SPEAKER_02 15:35

The asterisk may be very long, and my kids like to make fun of the um commercials that are like you may die when you take this. Exactly. Okay.

SPEAKER_00 15:44

It's like you could get this, but if you have this, this, this, this, and it's more for people with chronic conditions and a whole host of different things. Got it. But overall, the the trade-off for Medicare Advantage that you were alluding to, the two biggest things are that you might have higher out-of-pocket costs compared to Medigap. So if you're hospitalized, if you do need those chronic condition conditions treated, then you may have more out-of-pocket costs. Got it. Or uh prior authorization. That's a huge one, and all the headlines and people always want to avoid that. But really, prior authorization is more on the Medicare Advantage side of things.

SPEAKER_02 16:20

Okay. That's helpful. Sometimes I hear people say, Oh, we're gonna look for the lowest cost plan because we're really healthy. Um and you know, for every all of us probably have most of us have pre-existing conditions at age 65, but um there's healthy, you know, approaching approaching um retirement insurance coverage. And um then, you know, you could have very serious conditions. Um what is so important? Why is 65 important to make a decision? Um, you know, in terms of how it plays out for the rest of your life.

SPEAKER_00 17:00

Yeah, it's really so it's when you start part B of Medicare. It gets weird, but a lot of people it is at 65, like we talked about. But it's really when you're first, it's when you're 65 and older, or or older, I should say, and you enroll in Medicare Part B for the first time, that's when you get your Medigap open enrollment period. And there's way too many enrollment periods, there's way too many acronyms. But if you can try to remember your Medigap open enrollment period, it only happens when you first start Part B at 65 or older. And during that time, you can basically get any Medigap plan you want without health questions. So you could have a cancer diagnosis, Alzheimer's, whatever it is, you can get a Medigap plan during that time. And then after that, after that six-month window is up, like Melissa was saying, you would have to qualify for a new Medigap plan in most cases if you want to get one in the future. So if you go into 65 or when you first start Medicare, just thinking about now, and you say, I want this plan, low cost, I'll worry about the rest later. And then three years from now, you have more medical bills piling up and health conditions. That's when if you try to get Medigap, you might not be able to. So you really have to take that, keep that in mind when you're first starting Part B.

SPEAKER_02 18:17

Got it.

The One‑Time Medigap Window

SPEAKER_00 18:18

What other And it does depend on every state. Sorry.

SPEAKER_02 18:21

No, that's helpful.

SPEAKER_00 18:22

Yeah. Every state, like if you're in New York, for example, you can pretty much get Medigap anytime. That is a super unique situation, but uh definitely check with your state's rules.

SPEAKER_02 18:31

And I assume that you or other um Medicare consultants know state by state. That's why you don't cover typically every state or everyone.

SPEAKER_00 18:44

Yeah, we work in like 15 to 20 states usually, and then we have other partners that work all across the country because yes, you could be in Connecticut and it's totally different than Rhode Island. So it's heavily, it heavily varies, which is another thing at six months is talk to somebody before you turn 65 and say, what unique rules should I know about in my state? It's just another thing you wouldn't even think about.

SPEAKER_02 19:06

Perfect. So then for if you're a listener and you're also like maybe you're still working or you're a higher earner, um, you have your premiums, but then also there's this additional potential cost that's kind of a tax. Um called IRMA.

SPEAKER_00 19:23

Maybe we can call it that, but it yeah, it's a tax.

SPEAKER_02 19:26

Well, I think about it on tax forms. So um tell me a little bit about um, you know, kind of some of the means testing that is associated with Medicare.

SPEAKER_00 19:36

Yeah, the biggest thing, like Melissa was saying, is you should know IRMA, which is the income-related monthly adjustment amount. Thanks for just explaining that. Yeah. It's just a fancy way of saying if you earn above a certain threshold or above different thresholds, then you might be charged more for your Medicare premiums. And just so you know, Medicare or IRMA, it would apply to both Part B of Medicare and then part D, which is the drug coverage, which we won't really get into in this one, but just know it can apply to both of those parts of Medicare. And I'll pull up the numbers. Um I don't remember off the top of my head what I'm saying.

SPEAKER_02 20:12

I know they change every year. So just um if you're in Cameron's in my world, inflation adjustments are good in terms of helping um to you know change with the times, but because those numbers change every year, I've just quit memorizing them because exactly um there's just too many numbers in my head.

State Rules And Enrollment Nuance

SPEAKER_00 20:33

There's always gonna be, yeah, and then they're gonna change. And and as I pull up the chart here, so just looking at it, basically, if you're a single or if you file individually your taxes and you are less than, or if you're I should say more than$109,000 as an individual, that is when you could be subject to Irma surcharges. And then if you're above$218,000, if you file joint with somebody else, that is where Irma can come into play for you. And there's different thresholds above that. You'll definitely want to check with us or somebody else or Melissa to figure out where you fall into those categories. But the really a couple key things to know about Irma is that one, it's looking at your income from two years ago. So this is really counterintuitive because you might be thinking it's your income now, but it's what the IRS and what uh Social Security actually have on file for you, which typically is going to be two years in the past.

SPEAKER_02 21:27

So it's if we were recording in 2026 and it would look at 2024, which it everybody should have filed their tax return by at least by October last year.

SPEAKER_00 21:36

Yeah. So you'd you'd be looking at 2024. So if you talk to Melissa and just say, hey, I'm at 250,000 joint, then we can say, okay, based on those 2024 earnings, here is where you're likely to fall in that IRMA surcharge category. And then the other biggest thing to know is you're not stuck with that Irma all the time. Or really a lot of the time, we help people appeal it. And One of the easiest examples of an appeal, there's different life events as they call it, but a really classic one is retirement because a lot of people they'll come to us and they'll say, Well, I I'm not making close to that this year, right? I'm retiring. It's 2026. I'm starting Medicare. Why should I not gonna pay the amount for 2024? And for most of you, you don't have to if that's the case. You can file an appeal, it's a really easy process with a small form that we can help you with. And basically you submit it to Social Security. You would say, Hey, here's my estimated income for 2026 based on my work stoppage. And typically they'll be able to lower that to reflect your current income instead of 2024. So just know that.

IRMAA Surcharges And Appeals

SPEAKER_02 22:41

And I keep those numbers, even though I don't have and by the way, there's thresholds. I think there's four or five different like kind of levels that gets more expensive if you go into the highest level is 750,000 joint income and 500,000. And what and how much is that adding on to the premium? Do you have that pulled up or it's okay if not?

SPEAKER_00 23:02

But yeah, it would add all the way. So it would add this is an additional$487 per month on top of your part B premium. Per person, correct? If they're both um exactly. So so even if your spouse was the one earning all the money, again, it's joint if you file joint. So don't think it's only going to affect one of you.

SPEAKER_02 23:22

Yeah, and I I take this into consideration when we're considering social security filing age when um a lot of people, you know, kind of read on personal finance on the internet, approaching retirement. It's like, should I do Roth conversions? It's like maybe. Um, but you need to consider you you could pull one lever and create another, you know, kind of whack-a-mole issue.

SPEAKER_00 23:46

Um and you know that you also don't want to do everything, you know. Sometimes people try to do too much to avoid Irma. So exactly. If you can make the more if you can make extra money, by all means, it's probably gonna come out more than what you're gonna pay in Irma. Yeah.

SPEAKER_02 23:59

And it may come back to hit you when your RMD, when your RMD age at 72, 73, or 74, or at 73 or 75. Um, so yeah, lots to consider.

SPEAKER_00 24:11

That's why we usually just hope you had somebody help you like Melissa, who planned, because we're that's not what we do. We we tell you how to appeal it and what it might be, but we just hope you had somebody else like her before that.

SPEAKER_02 24:22

Well, and likewise, I mean, the the complexity keeps us employed um and bringing value to the conversations. Um, another thing that's interesting, tell me how health savings accounts and Medicare um interact.

SPEAKER_00 24:37

Gosh, they were so close to fixing this last year, I think, in one of the bills that was proposed. But I don't know, whoever somebody's anti-HSA in Medicare. But basically, once you're enrolled in any part of Medicare, you cannot contribute to your HSA any longer. So this usually comes into play if you are turning 65. If we go back to that large employer example, let's say you're still working, you have good employer coverage, you have an HSA, everything's going well, you're happy with it. But then you look at part A of Medicare, which we already said usually costs you no premium per month. So a lot of people out there, they'll just blanketly say, Well, get part A when you turn 65 because it doesn't cost you anything. But what it could cost you is your ability to fund that HSA going forward. So if you apply for part A for no reason really, because you're still working at age 65, and then you plan on, you would have to stop your or stop or prorate your HSA contributions really for the rest of your time that you're enrolled in Medicare and that HSA plan.

SPEAKER_02 25:41

So as you approach age 65, tread very carefully on your HSA contribution considerations.

SPEAKER_00 25:46

And it gets really funky if you have a spouse and they're like I won't even get into that. Just uh talk to us or somebody else if you have a spouse that's younger, older, and making those contributions. And just know what you can use your you can still use your funds if you're enrolled in Medicare. I don't want you to think you have to rush to spend it all. Exactly. You can't make those contributions. You you even can't if you're turning 65 in July, you can't just plow in a whole year's worth of contributions if you're signing up for Medicare. You have to prorate it and you would have to do like six months worth of those maximum contributions for that year. So and then once you're on Medicare, you can use the funds for basically everything except for Medicare supplement premiums.

SPEAKER_02 26:29

Perfect. So what um I know healthcare costs are in the news. Um Medicare is often in the news. Medicare and Medicaid are a huge portion of government budgets. Um tell me what's like kind of some bullet points of you know, like news headlines on Medicare for 2026.

SPEAKER_00 26:52

Um everything's getting worse, unfortunately.

SPEAKER_02 26:55

Sounds like 2025 was really difficult for Medicare providers. Like were things getting more expensive or less coverage?

HSAs And The Part A Trap

SPEAKER_00 27:03

It's just medical inflation and so all the underlying cost of everything is going up with healthcare, which in turn always makes it way its way back to the plans. It makes its way back to us. Even for agents, no one really cares, but a lot of the plans are cutting commissions to us because of that, and they're getting squeezed.

SPEAKER_02 27:21

But really, I mean, I guess the reason people care about that is you want credible educated people to be in the business to assist.

SPEAKER_00 27:31

And if uh Yeah, we can only assist you if we get the commission. I mean, I would love to do it for free, but we just can't. We have employees and it's like everybody else. So we need that. And if you want the you want the help of brokers going forward, that is something that it could be impacted depending on if those cuts if they continue. But yeah, it's it all comes down to everyone's just being squeezed on in all sides because Medigap plans, gosh, if we had this conversation three years ago, I would have said if you have a Medigap plan, they do increase every year the premiums. And we used to say, you know, 5%, 7%, that's probably something to expect. But now in Michigan, I we've already looked at dozens of companies and it they're averaging about 20% increases for this year. Interesting. Yeah, four or five times of what we would have expected in the past. So those are getting super expensive. It is causing some people to have to go to Medicare Advantage because they simply can't afford the Medigap plan.

SPEAKER_02 28:28

And you can go that direction without underwriting.

SPEAKER_00 28:32

Yeah, you can always get Medicare Advantage without health questions. Okay. So some people are forced to do that. And then, but Medicare Advantage, now I just literally yesterday the government put out their, we'll call it a forecast, I guess, their funding forecast for Medicare Advantage. It's not set in stone by any means, but they basically are forecasting to keep their reimbursements flat for next year in 2027. So they already look at 2027. And if they keep it flat, based on how much prices are going up, it really ends up being a negative for the the plans, for the providers, the plans, the yeah, yeah. That's it's for the for the insurance companies. So the insurance companies then they have to they have to do something. They have to cut commissions, they have to trim benefits, they have to raise premiums. So it's not like Medicare Advantage is avoiding it either. But yeah, the theme is everything's getting worse, and we just gotta do the best we can to go with what we got.

SPEAKER_02 29:26

Yeah, I mean, I it's a similar theme to what people hear in pre-65, what people hear with people working in in medicine and healthcare. Um, I wish it were better than that.

SPEAKER_00 29:37

The ACA subsidies were all over the news. Um the Medicare ones are well, you're you're not a healthcare stock is they that was in the news today, but yeah, it's always something.

2026 Landscape: Costs And Cuts

SPEAKER_02 29:47

Yeah, so it's uh definitely healthcare and medicine is you know, if affordability is the key word for Americans um in terms of how they feel the way the country's going, then um there continue to be challenges in these conversations.

SPEAKER_00 30:03

Anything structural, it's been the trend for a few years.

SPEAKER_02 30:06

So yeah, for sure. Anything structural people should be aware of that it could be adjusted or people already on Medicare other than knowing like there's a reason that seems like your coverage is getting skinnier, but anything else that people should be aware of?

SPEAKER_00 30:23

Structurally, no, that not coverage-wise, really. It's it's more of the premiums will go up to compensate. I the guess the biggest because Medigap plans, their coverage isn't going to change. The deductible will increase slightly, but it's still a really low low deductible in the grand scheme of things. But it's the premiums, it's the drug coverage, choice. I think choice is gonna be the hardest thing. I know a few years ago we probably had 15 uh well, probably 20 drug plans that I can think of in Michigan, and now we have like 10. And realistically, only three or four of those are like actually competitive. Okay. So choice is gonna be the biggest structural change that I can foresee.

SPEAKER_02 31:04

Interesting. Well, I know that you are constantly educating. That's a part of kind of the value proposition that you offer. Where can people who are listening and maybe they're starting this um Medicare journey? And I also mentioned to you as we were preparing for the episode, I have so many clients and also I know listeners who are in a cohort where they may, you know, kind of hop on to see what's going on with mom and dad. And um, you know, what would if if they're like, what is this coverage for mom and dad? What what do you tell them they should look into or things like that?

SPEAKER_00 31:43

Yeah, the biggest thing for parents is figure out what they have. You know, a lot of people come to us and they say, My parents have Medicare and I need help. It's like, okay, well, there's we talked about there's choices, there's advantage, there's Medigap. Just if they have a if they have an ID card or if they have anything showing what they might have, please just find that out first. Um, the other thing with your parents or anybody you might be trying to help with Medicare is think about if they actually have a problem with their coverage. A lot of times people will frantically come to us if somebody's in the hospital or skilled nursing and they'll say, we need to do something. They're they're getting all these treatments and and really there's no issue on the side of their plan.

SPEAKER_02 32:21

You know, it's just that it's gonna be their plan is yeah, there's maybe a deductible payment, but in many cases for extensive, you know, in-hospital treatment. Um it's not like there's a hundred thousand dollar bill that comes unexpectedly a year later or anything like that.

SPEAKER_00 32:39

No, if you do get that, of course, definitely. That is a problem that you should definitely reach out to people. Yes. Yeah. But uh don't don't panic too much. I mean, just figure out what they have, what their expected costs should be. Of course, we'll try to see if there's options to make them change plans or help them change plans, but a lot of times it's just understanding what they have. Most people have pretty good coverage. Uh it's very rare that I would think somebody truly is getting, like you said, tens of thousands of dollars of bills with Medicare, regardless of what they have.

SPEAKER_02 33:07

So yeah, I think a worse situation would be like a fumble on that initial enrollment, right? Where somebody messed up on um, you know, kind of getting in the system or things like that.

SPEAKER_00 33:18

So yeah, you might not have drug coverage because for a while some people you you do get penalized if you don't have prescription drug coverage. And I've had people that for 20 years they just no, you know, I don't I don't take meds, I don't want to pay anything. I just I'm gonna use coupons and then that's great until you do need a real medication. That's I mean, medications can be ten thousand dollars a month. Right. So that is a much bigger issue. I would say not getting something, that's where you'll run into issues down the road. But as long as you have something in place, it'll all work itself out.

Fewer Drug Plans, Less Choice

SPEAKER_02 33:49

Perfect. And then if we can circle back to where I started to go and then uh no, it's my fault. I I sent us off on a tangent, which there are so many tangents because there is so much complexity in a system that is still it's it's set up to you know, kind of do the job of of paying for healthcare, but it it there's just a lot of nuances when you have A, B, C, D, you know, the alphabet soup and things like that. But um, you have kind of an education portal. I know um both YouTube, your website, and um Joanne's on TikTok too. So give me a little um details of where people can follow up um and educate their self themselves. And I know even though you said, you know, don't do all your research four years out, some of the engineers in the room may be, you know, like ready to roll up their sleeves and do just we already know you have your spreadsheet.

SPEAKER_00 34:41

It's okay. I would, yeah, it happens to the best of us. But um, yeah, thankfully our name is hard to spell, which I guess is bad and good. But if you just search GRDNI Medicare, which is G-I-A-R-D-I-N-I Medicare, pretty much anywhere you'll find us if it's it's gonna be us. You know, nobody else, you shouldn't confuse it with a different agency, but you can search that on any Google, socials, whatever, or if you go to MedicareLaunchpad.com, that is something we created. We call it the launchpad because that is where you can start your Medicare journey. So if you go to that website, it will link to all of our resources and more, just like the ones Melissa talked about. So that's your best bet to get in touch with us.

SPEAKER_02 35:25

And you kind of have a course, like some video courses, a lot of video education, um, talking just like that's there we discussed. Um, you know, there's I've referred people to your Irma video kind of explaining how to uh appeal if you have a different change in income. Um and one Geni or D Medicare website, two people could schedule an initial consultation if needed. Is that correct?

SPEAKER_00 35:51

Yeah, you can absolutely go to our website, gmedicare team.com. Uh thankfully, we have so much content out there. I mean, you could learn for hundreds of hours without ever having to talk to us because I know no one wants to be sold anything, and I'm the same way. I don't I would be the last person to book a sales call with somebody, but check out our content first, and I think you'll you'll like what you see.

SPEAKER_02 36:11

Perfect. That's so helpful, um, Cameron. Thank you so much for joining us today. And um hopefully we'll have you again soon because we always love, you know, kind of building on this content.

Helping Parents And Avoiding Penalties

SPEAKER_00 36:26

We'll see what the 2027 numbers come out to actually be, and I'm sure we'll talk again.

SPEAKER_02 36:30

Fingers crossed for good news, but we'll see.

SPEAKER_00 36:33

Stop doing that. But yeah, thank you for listening.

SPEAKER_01 36:46

Thank you for listening to the Women's Money Wisdom podcast. If you found value in this episode, the best way that you can support the podcast is to forward an episode to a friend or leave a review. Go to ProPlan.com and the podcast link to get all the resources and links mentioned. This presentation by Pro Planning is intended for general information purposes only. No portion of this presentation serves as the receipt of or a substitute for personal investment advice from ProPlanning or any other investment professional of your choosing. Copies of Pro Planning's current rent and disclosure brochure and form CRS discussing our advisory services and fees are available upon request or on our website platform at proplan.com. The information that we share is meant to educate and inspire, not serve as personalized financial advice. Everyone's situation is unique, so be sure to consult with your own financial professional for guidance that fits your life. And just so you know, the opinions shared in this podcast are Melissa's own and those of our guests. They don't necessarily represent any organizations with which Melissa is affiliated. For more important disclosures, please go to our webpage at proplan.com.