Key Takeaways:
- Many Medicare Advantage plans are switching from PPOs to HMOs, limiting provider flexibility and requiring referrals for specialist care.
- Out-of-network visits may no longer be covered, meaning patients could pay the full cost without a referral.
- Medicare Supplement (Medigap) premiums are rising steeply,
- with increases jumping from the usual 3–7% up to 11–15%, and as high as 40% in some states.
- Fewer independent agents for Part D enrollment means more people must use Medicare.gov to sign up for prescription drug plans, though the process has been simplified.
- Special Enrollment Periods (SEPs) now allow some individuals to change plans outside of the annual open enrollment window if they meet qualifying conditions (such as moving or losing coverage).
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1. PPOs Are Disappearing — HMOs Are Taking Over
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More insurance companies are dropping PPO plans and shifting to HMO models.
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PPOs allow you to see out-of-network providers (often with higher cost sharing).
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HMOs restrict you to a provider network; going out-of-network usually means you pay full price unless you have a referral.
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For you, this means network matters more than ever. If your doctors aren’t in-network, costs could spike.
2. Medicare Supplement Costs Are Rising Fast
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In past years, annual premium increases hovered around 3–7%. Now we’re seeing 11-15% increases in many markets.
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Luckily for Georgia, we’re not seeing the 40% increases that some other states are seeing.
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3. What’s New with Part D
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Some insurers have dropped field agents in favor of captive agents. That means many people now enroll via Medicare.gov.
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The good news: Medicare simplified its Part D plans. When you enroll:
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First, enter your ZIP code.
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Then choose “Part D – Prescription Drug Plans” (avoid the “Advantage” option in that menu).
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4. Can You Change Your Medicare Plan Outside Annual Enrollment?
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Yes, there are many times that you may be able to change your plan outside of Open Enrollment (October 15 – December 7).
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If you’re unhappy with your current plan (for reasons like network changes, cost increases, etc.), there may be exceptions for switching.
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If you’re unsure, reach out to Bonnie at Insurance and Other Red Tape.
5. Next Steps?
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Reach out to your Medicare Advisor. If you don’t have one, we love working with Bonnie at Insurance and Other Red Tape.
- Don’t stop at evaluating your Medicare Plan, take a look at your Estate Plan as well. Is your will as old as your kids? Schedule a Free Legacy Planning Meeting to take the first step towards peace of mind!
