Using Medicare Advantage Trial Rights: What Beneficiaries Need to Know
Choosing Medicare coverage is a major decision. For some beneficiaries, enrolling in a Medicare Advantage (MA) plan feels like a smart move comprehensive benefits, low or $0 premiums, and added perks like dental, vision, and fitness programs. But what happens if you try Medicare Advantage and realize it’s not the right fit? That’s where using Medicare Advantage Trial Rights can be a valuable safety net.
Medicare built specific protections that allow certain beneficiaries to “test” a Medicare Advantage plan without being locked in forever. Understanding these rights can give you confidence when making your coverage decision.
What Are Medicare Advantage Trial Rights
Medicare Advantage Trial Rights are special protections that allow eligible beneficiaries to switch back to Original Medicare (Part A and Part B) and purchase a Medigap (Medicare Supplement) plan if they decide MA isn’t working for them. These rights prevent beneficiaries from being denied Medigap coverage or charged more due to health conditions during this trial period.
Who Qualifies for Medicare Advantage Trial Rights
You may qualify if:
1. You are new to Medicare and you first enrolled in a Medicare Advantage plan.
If you joined an MA plan when you first became eligible for Medicare at age 65, you have a 12–month trial period. If you decide within that year that MA is not for you, you can switch back to Original Medicare and have Medigap guaranteed issue rights.
2. You dropped a Medigap plan to enroll in Medicare Advantage for the first time.
If you previously had a Medigap plan and switched to an MA plan for the first time, you again have 12 months to change your mind. If you return to Original Medicare, you have the right to get the same Medigap plan you had before (if it’s still available) or a comparable plan.
Watch a YouTube video – Medicare Advantage vs. Medicare Supplements
Why Trial Rights Matter
Trial rights offer peace of mind. Medicare Advantage plans work well for many people, but provider networks, prior authorization rules, and cost-sharing structures may not suit everyone. Trial rights allow beneficiaries to explore coverage options without long-term risk.
For example, someone who values nationwide access to doctors or has upcoming health procedures might discover that Original Medicare plus Medigap better suits their needs. With trial rights, they can make the switch confidently.
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How to Use Your Trial Rights
If you decide to switch back from Medicare Advantage to Original Medicare:
Contact Medicare or your plan to disenroll
Apply for a Medigap plan, citing your trial right
Choose a standalone Part D prescription drug plan (PDP) if needed
Timing is key; make sure you act within your 12-month window to secure guaranteed Medigap eligibility.
Medicare Advantage can be a great choice, but it’s not one-size-fits-all. Medicare Advantage Trial Rights give beneficiaries a valuable opportunity to try MA coverage with a safety net. If you’re unsure which route is best, speak with a licensed Medicare professional who can help evaluate your health needs, budget, and coverage preferences.
Understanding your rights empowers you to make confident, informed decisions about your Medicare journey.
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Deductibles and Other Medical Costs: What They Mean for Your Healthcare Budget
Healthcare terms can feel confusing, especially when it comes to how much you’ll actually pay for medical services. One of the most important pieces to understand when choosing insurance, or reviewing your current coverage, are deductibles and other medical costs.
These costs directly impact what you spend before your insurance steps in and how much you’re responsible for throughout the year. Understanding them helps you plan better, compare plans accurately, and avoid unexpected medical bills.
What Is a Deductible
A deductible is the amount you must pay for covered healthcare services before your insurance begins to share the costs.
For example, if your deductible is $2,500, you pay the first $2,500 of covered medical expenses yourself. After you meet your deductible, your insurance typically starts paying a portion of costs (often through coinsurance).
Think of the deductible as your first layer of financial responsibility in your insurance plan.
What Are Out-of-Pocket Costs
Out-of-pocket costs are expenses you’re responsible for when receiving care. They may include:
- Deductibles
- Copayments (fixed dollar amounts per service)
- Coinsurance (a percentage of the cost of services)
- Non-covered services
When comparing plans, look not only at the deductible but also the overall cost-sharing structure. A low-deductible plan may have higher premiums but lower out-of-pocket expenses when you receive care and vice versa.
Understanding the Out-of-Pocket Maximum
Most health insurance plans also include an out-of-pocket maximum (OOPM). This is the most you’ll pay in a policy year for covered services. Once you reach that limit, your insurance covers 100% of eligible expenses for the remainder of the year.
This limit is an important financial safeguard, especially for individuals with chronic conditions or unexpected medical events.
Watch a Video on Medicare IRMAA & Part B SEP Rules
Why Your Deductible and OOP Spending Matter
Knowing your deductible and out-of-pocket maximum helps you:
- Budget healthcare expenses
- Select a plan that fits your needs
- Avoid surprises when receiving care
- Plan ahead for prescriptions, specialists, or procedures
- Understand how preventive services are covered (This is key; many preventive services are covered before deductible!)
Tips for Choosing the Right Plan
When evaluating health plans, consider:
- How often you visit doctors
- Whether you take ongoing prescriptions
- Expected medical needs (e.g., planned surgery, therapies)
- Monthly premium cost versus potential annual expenses
- Your comfort level with risk and unexpected bills
People who expect regular medical care may benefit from lower deductibles and higher premiums. Those who rarely seek care may prefer a lower-premium, higher-deductible option.
Deductibles and out-of-pocket costs aren’t just insurance jargon; they are vital components of your financial health plan. Understanding them helps you to make smarter decisions and choose coverage that protects both your health and your wallet.
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If you ever feel uncertain about comparing plans or estimating potential costs, don’t hesitate to ask questions. Being informed is the first step to confident healthcare decisions. That is why working with a licensed insurance agent is so important.
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The Value of Medicare Agents and the Service They Provide
When individuals approach Medicare eligibility, they often discover just how complex healthcare decision-making can be. With dozens of plan types, varying costs, evolving coverage rules, and aggressive advertising from every direction, choosing the right Medicare coverage can feel overwhelming. That’s where licensed Medicare agents bring tremendous value.
Medicare agents act as trusted advisors, providing clarity, guidance, and personal advocacy. Their goal isn’t just to help someone enroll in a plan; it’s to ensure clients understand their benefits and feel confident in their healthcare choices year after year.
Simplifying a Complicated System
While Medicare is an essential program, it isn’t always easy to navigate. Beneficiaries have questions such as:
- Original Medicare or Medicare Advantage?
- What’s the difference between a Medigap plan and a Medicare Advantage plan?
- Do I need a Part D prescription drug plan?
- What are my costs? What doctors can I see? Will this plan cover my prescriptions?
A Medicare agent breaks this information down into clear, understandable terms. They help clients compare plan options side-by-side, explain key terms like premiums, deductibles, and maximum out-of-pocket costs, and ensure beneficiaries avoid costly mistakes such as missing enrollment deadlines or choosing plans that don’t fit their needs.
Personalized Guidance
Every Medicare beneficiary has unique needs; health conditions, prescription needs, doctor preferences, budget considerations, and lifestyle factors. Independent Medicare agents take the time to understand these factors and recommend plans that offer the best fit, not just the best marketing.
Many agents represent multiple carriers, allowing them to provide unbiased comparisons and advocate for the plan that truly serves the client best.
Watch a quick YouTube video comparing Medicare Advantage vs. Medicare Supplements
Year-Round Support and Advocacy
Medicare decisions don’t end at enrollment. Plans can change their provider networks, drug formularies, premiums, and benefits from year to year. Agents ensure beneficiaries stay informed and help them:
- Review plans annually during the Annual Enrollment Period
- Understand billing and claims issues
- Navigate carrier customer service challenges
- Access additional benefits and programs that can reduce healthcare costs
This ongoing support is one of the most valuable services agents provide and it’s often at no cost to the beneficiary, since agents are typically compensated by the insurance carriers.
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Protection Against Misinformation
Medicare marketing is everywhere, and not all of it is accurate. Agents serve as a reliable source of truth, cutting through misleading ads and high-pressure sales tactics. They are licensed, trained, and required to follow strict compliance rules designed to protect Medicare beneficiaries.
A Partner in Your Healthcare Journey
Medicare agents don’t just enroll people in plans, they build long-term relationships. They offer peace of mind, help clients understand their benefits, and stand by their side when questions or challenges arise.
Agents, stay up-to-date on the our latest webinars an agent events.
For many seniors, working with a Medicare agent means having a trusted professional who knows their needs, understands the system, and is committed to helping them access the best possible care.
Why Selling GTL Advantage Plus Plans Is a Smart Move for Insurance Agents
As the Medicare and senior insurance markets continue to evolve, one product category remains consistently valuable; hospital indemnity insurance. When it comes to hospital indemnity coverage, Guarantee Trust Life (GTL) stands out as a trusted leader with its Advantage Plus plan. Why offer GTL Advantage Plus plans; it’s a strategic growth opportunity for agents serving Medicare Advantage clients.
Let’s explore why selling GTL Advantage Plus plans can strengthen your business and protect your clients.
A Solution to Medicare Advantage Cost-Sharing Gaps
Many Medicare Advantage plans come with low or $0 premiums, but they also include deductibles, copays, and out-of-pocket costs that can surprise clients during hospital stays. GTL Advantage Plus helps close that financial gap by offering cash benefits paid directly to the policyholder when they are confined to a hospital or receive certain outpatient services.
For your clients, this means:
- Financial help when hospital bills add up
- Funds they can use for medical or non-medical needs (transportation, bills, groceries, etc.)
- Peace of mind knowing their Medicare Advantage cost-sharing is covered
For you, this means providing real value and building deeper trust with your customers.
Flexible and Feature-Rich — Built for Today’s Market
GTL Advantage Plus stands out because of its flexibility and robust benefit options, including:
- Daily hospital confinement benefits
- Observation stay coverage
- Ambulance and emergency room benefit options
- Skilled nursing facility benefits
- Cancer and lump-sum benefit riders
- Short, simple application process and easy underwriting
This flexibility makes the plan easy to fit into a wide range of client needs and budgets.
Easy Sell With Medicare Advantage — Without Replacing Coverage
Hospital indemnity insurance is one of the easiest products to cross-sell during Medicare Advantage discussions. You’re not asking clients to replace coverage; you’re enhancing what they already have.
This means smoother conversations and higher client satisfaction. Plus, GTL plans often pair naturally with popular MAPD designs, making the value immediately clear.
Watch a YouTube video on GTL product sales
Strong Commissions & Year-Round Sales Opportunities
Selling GTL Advantage Plus isn’t just good for clients; it’s good for your business. Advantages include:
- Competitive commissions
- Sales opportunities outside of AEP (work year-round!)
- Fast approvals and efficient e-applications
- Strong retention and persistency
Agents can use the Advantage Plus plan to keep revenue flowing consistently, not only during busy enrollment seasons.
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Trusted Company & Agent-Friendly Support
GTL has been serving policyholders since 1936; a testament to its financial strength and service commitment. Agents benefit from:
- Reliable claims processing
- Friendly agent support
- Great technology tools
- A reputation that builds client confidence
When you represent GTL, you align with a company that values agents and provides the tools needed to succeed.
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Relocating to a new state can be exciting, but if you rely on Medicaid for your healthcare, the process requires careful planning. Medicaid is a state-administered program, meaning benefits cannot be transferred directly from one state to another. Maintaining Medicaid when you move is essential for those who rely on that extra assistance. However, with preparation, you can make the move without losing coverage.
Understanding How Medicaid Works
While the federal government sets the foundation for Medicaid, each state runs its own program with unique eligibility rules, income limits, and coverage options. Because of this, Medicaid benefits do not automatically carry over when you move. You must close your case in your current state and reapply in your new one.
The good news: there are no residency waiting periods to apply. Once you’ve established your new address, you can submit your Medicaid application right away. In some states, nursing home residents must meet a short length-of-stay requirement (for example, 30 days) before applying for long-term care Medicaid.
Avoiding Gaps in Coverage
Many people worry about a lapse in care when switching states. While coverage in your old state ends once you move, most states offer Retroactive Medicaid; up to three months of backdated coverage for eligible medical expenses before your application month. This helps bridge the gap while your new application is being processed.
Watch a YouTube video on OEP, SEPs and Late Part B Enrollments
How State Rules Differ
Although income and asset limits vary by state, the differences are usually not drastic. If you qualify in one state, you’ll likely qualify in another. However, there are exceptions. For instance, in 2025:
- New York allows a single Medicaid (age 65+ or disabled) applicant up to $32,396 in countable assets.
- Florida limits countable assets to $2,000 for long-term care Medicaid.
- California has no asset limit for Medicaid (Medi-Cal).
If your new state has stricter limits, you may need to spend down or restructure assets to regain eligibility.
Beyond finances, states also define medical need differently. Each sets its own criteria for a “nursing home level of care.” One state might require help with two daily living activities, while another requires three. If your new state’s requirements are stricter, you may no longer meet the functional criteria.
Steps for a Smooth Transition
- Research Early: Contact the Medicaid office in your new state before moving. Learn about income limits, medical requirements, and available programs.
- Gather Documentation: You’ll need proof of residency, income, and identity to apply.
- Time Your Move: Consider moving near the end of the month so your old coverage ends as your new one begins.
- Get a Functional Assessment: If you need long-term care, have your care level assessed before canceling your old Medicaid.
- Seek Professional Help: A Certified Medicaid Planner can guide you through financial restructuring and application preparation.
Click here for help finding a certified Medicaid planner
Medicaid isn’t portable between states, but with smart timing and preparation, you can relocate without losing essential healthcare benefits. Close your old case properly, apply quickly in your new state, and stay informed about eligibility differences. Working with a Medicaid planning professional can make the transition smoother and protect your coverage during your move.
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HMO POS Medicare Plans: Flexibility Within a Network
There are many types of Medicare advantage plans to choose from; including HMO POS Medicare plans mentioned. HMO POS stands for Health Maintenance Organization–Point of Service. While it sounds complicated, the carriers designed these plans to provide a balance between affordability and flexibility.
Let’s break down what that means and how it might benefit Medicare beneficiaries.
What Is an HMO-POS Plan
An HMO-POS Medicare Advantage plan is a type of Medicare Advantage (Part C) plan that combines the cost-saving structure of a traditional HMO with some of the flexibility of a PPO (Preferred Provider Organization).
Like a standard HMO, members typically have a primary care physician (PCP) who coordinates their care. They also provides referrals for specialists within the plan’s network. However, the “POS” or Point of Service, feature lets members seek care outside the network in certain situations, though often at a higher cost.
How It Works
Here’s how an HMO-POS plan typically operates:
- In-Network Care: You’ll get the highest level of coverage when you use doctors, hospitals, and specialists within the plan’s network.
- Out-of-Network Care: You may be able to see an out-of-network provider, but you’ll usually pay more for those services.
- Referrals: In most cases, beneficiaries need a referral from their primary care doctor for specialist visits; even if they’re going out-of-network.
- Cost-Sharing: Costs for out-of-network care are higher and may include additional copays or coinsurance, depending on the service.
This design gives members the ability to stay within a coordinated network for predictable costs while maintaining the option to go outside the network if they need extra flexibility.
Watch a video on the Discontinued Medicare Advantage Plan Special Enrollment Period
Benefits of an HMO-POS Plan
- Lower Premiums: Many HMO-POS plans offer competitive premiums compared to PPO plans.
- Coordinated Care: Having a primary care provider manage your overall care helps ensure treatments and prescriptions work together effectively.
- Flexibility for Travel or Specialists: Members who occasionally need to see an out-of-network specialist or receive care while traveling appreciate the added flexibility.
Things to Consider
While HMO-POS plans offer more freedom than a traditional HMO, it’s still important to review the plan’s rules and costs:
- Out-of-network care is not always covered for every type of service.
- You’ll need to confirm what types of care the POS option allows outside the network.
- Costs can add up if you frequently go out-of-network. These plans are best for those who primarily stay within one area but want a flexibility.
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Is an HMO-POS Medicare Plan Right for You?
If you value affordable premiums and coordinated care but want the option to seek care outside your plan’s network, an HMO-POS Medicare Advantage plan may be a great fit. It offers the best of both worlds — structure when you want it, and flexibility when you need it.
Before enrolling, compare the provider networks, out-of-network rules, and total costs to make sure the plan meets your healthcare needs and lifestyle.
Agents, stay up-to-date on the our latest webinars an agent events.
HMO-POS Medicare Advantage plans give beneficiaries a smart blend of structure and freedom; ideal for those who want reliable care coordination with the occasional option to step outside the network.
Medicare SSBCI vs. VBID: What’s the Difference
Two major innovations in the Medicare Advantage (MA) program; special supplemental benefits for the chronically Ill (SSBCI) and the Value-Based Insurance Design (VBID) Model, both aim to improve outcomes for beneficiaries with chronic conditions. However, they differ in purpose, eligibility, benefits, and future outlook. Here’s what you should know about Medicare SSBCI vs VBID and how they compare.
What Is SSBCI
The Special Supplemental Benefits for the Chronically Ill (SSBCI) program was created under the Bipartisan Budget Act of 2018. It allows Medicare Advantage plans to offer non-traditional, non-medical benefits designed to help people with serious chronic illnesses maintain or improve their health and daily function.
To qualify, a beneficiary must:
- Have one or more complex chronic conditions,
- Be at high risk of hospitalization or other negative outcomes, and
- Require intensive care coordination.
Unlike standard Medicare benefits, SSBCI may cover services such as healthy groceries, home air-quality equipment, pest control, transportation, or home modifications. These benefits address social factors that affect health, such as nutrition, housing, and access to care.
Watch a YouTube video on the prescription payment program
SSBCI benefits are optional, meaning not every MA plan offers them. Plans also decide what types of benefits to include and who qualifies. CMS is increasing oversight to ensure these benefits are supported by evidence showing they can improve or maintain a member’s health or function.
SSBCI represents a shift in Medicare Advantage toward whole-person care; addressing more than just medical needs.
What Is VBID?
The Value-Based Insurance Design (VBID) Model, launched by the CMS Innovation Center, allowed participating Medicare Advantage plans to align cost-sharing and benefits with the clinical value of care. The goal was to lower barriers to high-value care (like preventive services or chronic disease management) while discouraging unnecessary spending.
VBID gave participating plans flexibility to reduce copays, expand supplemental benefits, and even test hospice care integration within MA. These features often targeted individuals with chronic illnesses, low income, or those living in underserved areas.
However, VBID was a demonstration model, not a permanent part of Medicare. In 2025, CMS announced it will end the VBID Model after determining that program costs to Medicare were higher than anticipated. While the model is ending, many of its design ideas; like targeted cost-sharing and flexible benefits, are expected to influence future MA benefit structures.
SSBCI vs. VBID: A Quick Comparison
| Feature | SSBCI | VBID |
|---|---|---|
| Purpose | Provide non-medical benefits to chronically ill MA members to improve health and function | Align benefit design with clinical value; lower cost-sharing for high-value care |
| Eligibility | MA enrollees with complex chronic conditions and intensive care coordination needs | Enrollees in participating MA plans, often with chronic or low-income status |
| Benefits | Groceries, home modifications, air-quality equipment, transportation, pest control | Reduced copays, targeted benefits, flexibility for chronic condition care |
| Scope | Permanent MA program option; varies by plan | CMS Innovation Model; limited participation |
| Status | Active and expanding with stronger oversight | Ends after 2025 due to high program costs |
| Impact Goal | Address social determinants of health | Improve outcomes by rewarding high-value care |
Why It Matters
Both programs reflect a growing focus on integrated, person-centered care in Medicare Advantage.
- For beneficiaries: SSBCI can provide meaningful extra help for daily living and health support, but eligibility rules apply. Not everyone in an MA plan will qualify.
- For VBID participants: The model’s end may change how some plan benefits are structured in 2026, but many innovations are expected to remain.
- For all MA enrollees: When comparing plans, look beyond premiums and copays. Review whether a plan offers SSBCI or other supplemental benefits that fit your personal needs.
Always review your plan’s Summary of Benefits and Evidence of Coverage to see if SSBCI options are available, and confirm your eligibility with the plan.
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SSBCI and VBID have both pushed Medicare Advantage toward smarter, more holistic care. While VBID will conclude in 2025, SSBCI continues to grow; helping address many factors that shape health outcomes. Together, they represent Medicare’s evolving goal: not just to pay for medical care, but to help beneficiaries live healthier, more independent lives.
Humana Medicare 2026 OTC Benefits: How to Use and Access Them
Many Humana Medicare Advantage (Part C) plans include an over-the-counter (OTC) allowance to help members save on everyday health items. Fortunately, Humana Medicare 2026 OTC benefits provides members more ways to maintain their health while managing out-of-pocket costs.
What the OTC Benefit Covers
Humana’s OTC benefit allows members to buy non-prescription health and wellness products at no cost, up to a set allowance. Covered items typically include:
- Pain relievers and cold medicines
- Vitamins and supplements
- Dental care items like toothbrushes and toothpaste
- First-aid and wound-care supplies
- Digestive aids and bladder-control products
Depending on the plan, members may receive a monthly or quarterly allowance to spend. Some plans offer rollover options, while others require that unused funds be used within the benefit period.
Watch a YouTube video on Medicare Advantage vs Medicare Supplements
How to Access Your OTC Benefit
- Confirm Eligibility – Log into your MyHumana account or review your Summary of Benefits to confirm your plan includes an OTC allowance. You can also call the Member Services number on your Humana ID card.
- Know Your Allowance – Find out how much you receive and how often it renews. Available benefits vary by plan and region.
- Shop for Eligible Items – You can use your OTC funds in several ways:
- Humana Spending Account Card – Many plans load your allowance onto a prepaid card you can use at participating retailers.
- Mail Order or Online Catalog – Some plans require ordering through CenterWell Pharmacy’s OTC catalog or online store.
- Use It Before It Expires – Most allowances expire at the end of each benefit period or at year-end. Check your balance often to avoid losing unused funds.
Tips to Maximize the Benefit
- Review Plan Changes Annually: OTC benefits and amounts can change each year. Always read your Annual Notice of Change (ANOC) each fall.
- Shop Early and Smart: If mail order is required, place orders early to allow for shipping time.
- Combine Benefits: Some Humana plans that include Healthy Options or grocery allowances encourage clients to take advantage of all available extras.
- Keep Receipts: If questions arise, documentation helps confirm eligible purchases.
- Ask for Help: Members can contact Humana Member Services or their licensed agent for guidance.
Why This Benefit Matters
Humana’s OTC benefit helps reduce the cost of everyday health items, adding value to Medicare Advantage coverage. For 2026, these allowances highlight Humana’s focus on affordability and wellness. When clients understand and use these benefits fully, they save money, improve their health, and feel more satisfied with their plan.
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Protecting Medicare Consumers And Agents
Across the country, both Medicare and Affordable Care Act (ACA) consumers and the independent agents who serve them are facing new challenges. Many insurance carriers are reducing or eliminating commissions, restricting access to plan applications, or changing payment structures. These practices can disrupt fair competition and limit the ability of agents to provide clear, unbiased help to beneficiaries. Ther have been many people wondering; who is protecting Medicare consumers and agents amidst all this change.
To address this growing concern, NABIP has stepped forward as a strong advocate for both consumers and agents. On October 21, 2025, NABIP sent a letter to the National Association of Insurance Commissioners (NAIC) and all state insurance commissioners, urging a coordinated response to protect fairness in the Medicare and ACA markets.
NABIP’s concerns include:
- The use of “zero-commission” or drastically reduced commission structures on select plans
- Limiting or removing access to plan applications for appointed agents
- Making mid-year commission changes without proper notice
- Steering consumers toward carrier-preferred products by discouraging certain plan sales.
According to NABIP, these tactics not only manipulate markets but also restrict consumer choice and weaken the role of licensed, independent agents. Agents are essential to helping seniors and individuals with disabilities navigate complex coverage options and make informed decisions.
Watch a YouTube video on Medicare Advantge plans going non-commissionable
NABIP referenced the Idaho Department of Insurance as a model for other states
Idaho’s Bulletin No. 25-06 clarified that carriers must keep plan applications accessible to both agents and consumers, prohibit mid-year commission changes, and ensure commissions included in filed products are paid as approved. NABIP is urging every state to adopt similar protections to maintain fairness and transparency.
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Independent agents are a cornerstone of consumer protection. They act as trusted advisors who focus on client needs; not corporate preferences. When compensation is reduced or access is restricted, consumers lose guidance, choice, and confidence in the system.
NABIP continues to work with regulators nationwide, offering documentation, examples, and testimony from licensed producers. Its goal is clear: to ensure accountability, preserve competitive markets, and protect the vital connection between consumers and the professionals who serve them.
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Understanding Coordinated Care: How It Improves Health
When it comes to your health, it’s not uncommon to see several doctors, specialists, or therapists over time. But have you ever wondered who’s making sure everyone is on the same page about your care? That’s where understanding coordinated care comes in. This is an approach designed to keep healthcare connected, organized, and focused on the patient as a whole.
What Is Coordinated Care
Coordinated care is a healthcare model that ensures all members of the care team; from primary care providers to specialists, hospitals, and even pharmacists, work together to manage overall health. The goal is simple: to deliver high-quality care that meets healthcare needs while reducing confusion, delays, and unnecessary costs.
Instead of treating each health concern in separately, coordinated care looks at your entire health picture. It’s a team-based, patient-centered approach that emphasizes communication and collaboration across all your healthcare providers.
Watch a YouTube video on the Discontinued Medicare Advantage Plan Special Enrollment Period
How Coordinated Care Works
In a coordinated care system, one provider (often your primary care physician or a dedicated care manager) takes the lead in managing your treatment plan. This person acts as your main point of contact and ensures that:
- Providers share test results and medical records to forma treatment plan
- Treatments don’t overlap or conflict
- You understand your medications and next steps
- Your transition between care settings; such as from hospital to home, goes smoothly
This kind of teamwork helps prevent medical errors, unnecessary repeat tests, and medication mix-ups that can happen when care is fragmented.
Examples
- A person living with diabetes might see a primary care doctor, an endocrinologist, and a nutritionist. In coordinated care, these professionals communicate regularly to align medications, diet recommendations, and follow-up visits.
- After a hospital discharge, a care coordinator might help schedule follow-up appointments, review discharge instructions, and ensure the patient fills their prescriptions; reducing the chance of readmission.
- Many Medicare Advantage and Accountable Care Organizations (ACOs) use coordinated care models to deliver more efficient and effective care for members.
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Why Coordinated Care Matters
Coordinated care isn’t just about organization; it’s about better outcomes. When providers share information and work together, you benefit from:
- Improved overall health
- Fewer hospital visits
- Lower out-of-pocket costs
- Greater satisfaction with your care
Most importantly, it ensures that care reflects your personal goals, preferences, and lifestyle because no one’s health journey looks the same.
Coordinated care is about putting the patient back at the center of the healthcare experience. By connecting the dots between your doctors, specialists, and support services, coordinated care leads to smarter, safer, and more compassionate healthcare.
Whether you’re managing a chronic condition or just want a smoother healthcare experience, coordinated care helps ensure that every part of your health story fits together the way it should.
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Medicare Drug Cost Cap 2026
Beginning in 2025, Medicare introduced one of the most significant changes to prescription coverage in years: a yearly limit on out-of-pocket costs for medications under Medicare Part D. This change continues in 2026, with a slightly higher limit on the Medicare drug cap 2026 designed to help beneficiaries manage rising prescription expenses.
What Is the 2026 Medicare Drug Cap?
In 2026, the Medicare Part D out-of-pocket cap will be $2,100. Once a beneficiary pays $2,100 in out-of-pocket costs for covered prescription drugs in a calendar year, they will owe nothing more for those medications for the rest of the year.
This cap includes deductibles, copays, and coinsurance for covered Part D drugs, but it does not include:
- Monthly Part D premiums
- The cost of drugs covered under Medicare Part B (such as infusions administered in a doctor’s office)
- Medications not on the plan’s formulary
Whether someone has a stand-alone Part D plan or a Medicare Advantage plan with drug coverage, the cap applies to all covered prescriptions.
Why This Change Matters
Before this new system, Medicare beneficiaries had no upper limit on out-of-pocket drug costs. This meant that those with chronic illnesses or expensive specialty medications could spend thousands each year with no relief.
The new $2,100 cap gives beneficiaries greater financial protection and predictability. Once the limit is reached, cost-sharing ends, offering peace of mind for those managing ongoing or high-cost prescriptions.
The increase from $2,000 in 2025 to $2,100 in 2026 accounts for inflation and rising drug prices. This cap is part of the Inflation Reduction Act (IRA), which aims to make medications more affordable and includes additional measures like insulin cost caps and Medicare drug price negotiations.
How the Cap Works
Here’s an example:
Suppose Mary, a Medicare beneficiary, pays copays and coinsurance for her medications throughout 2026. Once her total out-of-pocket spending for covered Part D prescriptions reaches $2,100, she won’t have to pay anything else for those drugs for the rest of the year.
However, it’s important to note that costs for non-covered or Part B drugs won’t count toward the cap. Also, her monthly plan premiums remain separate and will continue.
Watch a YouTube video explaining the drug cap
What Beneficiaries Should Do
Even with this welcome protection, it’s crucial to review your plan each year during the Medicare Annual Enrollment Period (October 15 – December 7). Here’s what to consider:
- Check your plan’s formulary: Make sure all your prescriptions are covered.
- Compare plan costs: Premiums, deductibles, and copays can vary widely between plans.
- Track your spending: Plans will monitor your progress toward the cap, but keeping your own records is wise.
- Explore payment options: The new Medicare Prescription Payment Plan allows beneficiaries to spread out their drug expenses evenly throughout the year instead of paying large costs upfront.
A Step Toward Affordability
The 2026 Medicare drug cost cap is a milestone for millions of Americans who depend on prescription medications. While it doesn’t eliminate all costs, it offers much-needed relief and certainty for those facing high drug expenses.
By understanding how the cap works and reviewing coverage carefully, Medicare beneficiaries can make informed decisions and take full advantage of this new protection.
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Wellcare Spendables Card 2026
The Wellcare Spendables Card continues to be a popular feature of many Wellcare Medicare Advantage (MA) and Dual Eligible Special Needs (D-SNP) plans. The Wellcare Spendables Card 2026 has expanded how and where members can use the card, making it even more valuable for managing everyday health expenses.
What Is the Spendables Card
The Spendables Card is a preloaded debit-style card given to eligible Wellcare members. It includes a monthly or quarterly allowance that can be used for approved health-related purchases. Depending on your plan, the card can pay for:
- Over-the-counter (OTC) health items like pain relievers, cold medicine, or vitamins
- Dental, vision, and hearing costs such as exams, eyeglasses, or dentures
- Healthy groceries and nutritional drinks
- Home safety items like grab bars or bathroom supports
- In some plans, gas, rent, or utility assistance for qualifying members
The allowance amount and eligible categories vary by plan and state, so it’s important to review your plan’s 2026 Summary of Benefits.
What’s New for 2026
1. Expanded coverage: More plans now let members use their Spendables balance on dental, vision, and hearing expenses, not just OTC items.
2. Broader retail network: Members can use their cards at more than 66,000 national retailers, including major pharmacies and grocery stores.
3. Integrated rewards platform: The Spendables Card now connects with the Wellcare Rewards program, so eligible members can manage both benefits through one system.
4. Added flexibility for chronic conditions: Members qualifying under Special Supplemental Benefits for the Chronically Ill (SSBCI) may use their allowance for gas, home safety, rent, pest control, or utility assistance.
Watch a YouTube video about the drug cap
How to Use the Card
After activation (via the member portal, app, or phone), you can use the card like a debit card at approved stores or providers. Common uses include:
- In-store or online OTC purchases at participating retailers
- Paying providers directly for covered dental, vision, or hearing costs
- Purchasing groceries or home items if your plan allows healthy food or safety benefits
If your total purchase exceeds your allowance, you’ll need to pay the difference. Unused balances may roll over month to month but generally expire at year’s end.
Why It Matters
The Spendables Card helps reduce out-of-pocket costs for everyday health needs while giving members flexibility and convenience. It also supports social determinants of health, recognizing that access to food, transportation, and home safety are vital to well-being. For dual-eligible and chronically ill members, the expanded benefits can provide meaningful support beyond medical care.
Key Questions to Ask
Before using your card, confirm:
- How much is my monthly or quarterly allowance?
- What items and services are eligible under my plan?
- Does my plan include healthy food, utilities, or rent benefits?
- Will unused funds roll over?
- Which stores and providers accept the card?
Example in Action
Mary, a Wellcare D-SNP member, receives a $100 monthly allowance. She buys OTC cold medicine and uses the remaining balance toward her dental copay. The next month, she uses part of the card to purchase fresh produce from an approved grocery retailer. Any leftover funds roll into the following month, helping her stretch her allowance through the year.
Final Thoughts
The Wellcare Spendables Card is a strategic benefit that can help Medicare Advantage and D-SNP beneficiaries pay for a wider range of health-supporting purchases in 2026. Going beyond traditional medical care, it reflects a broader view of wellness and takes into account social needs like home safety, food, housing and utilities (for eligible members).
If you or someone you’re helping is enrolling in a Wellcare plan for 2026 or already a member, it’s well worth taking the time to understand exactly how the Spendables card works under their specific plan, what the dollar amount is, what it covers, how to use it; and make a plan to use its allowance wisely.