Medicare Enrollment

2026 Medicare Enrollment: Preparing for Medicare A, B, D, Medigap vs. Advantage, and Key Deadlines

 Mike Roth discusses preparing for Medicare enrollment ahead of turning 65, explaining the seven-month Initial Enrollment Period and how waiting can delay coverage. He outlines Medicare Part B (physician/clinic care, preventive services, diagnostics, and certain clinic-administered drugs), its typical monthly premium and cost-sharing, and Medicare Part A (inpatient hospital, limited skilled nursing/rehab rules, and hospice), including key hospital cost amounts and the importance of qualifying inpatient status. The episode reviews Part D prescription coverage, late-enrollment penalties, and the drug cost cap. It compares Original Medicare plus Medigap versus Medicare Advantage (Part C), highlighting subsidies, extra perks, out-of-pocket maximums, network limits, travel and provider acceptance issues, and potential denials/delays for imaging and care. Resources include Medicare.gov Plan Finder, the “Medicare & You” handbook, Social Security, and SHIP counselors, plus key enrollment dates and cautions about switching and guaranteed-issue rights.

00:00 Medicare Enrollment Prep

01:24 Part B Basics and Costs

03:15 Part A Hospital Coverage

05:08 Part D Drug Plans

05:53 Medicare Advantage Explained

08:45 Advantage vs Original Medicare

11:21 Networks and Denials

13:38 CMS Wiser and AI

15:00 Extra Perks and Tradeoffs

17:16 Getting Help and Plan Finder

21:07 Enrollment Dates and Switching

24:17 Wrap Up and Contact Info

Transcript

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Mike Roth ai: 0:09

This is Mike Roth. On episode number three of creating a better life for seniors, and today's episode is all about the 2026 Medicare enrollment period for plans beginning January 1st, 2027. 11,000 Americans are turning 65. Each day, which makes them eligible for Medicare. What should they be doing in the months ahead of time to prepare for signing up for Medicare just before their 65th birthday?

Bill Kadereit: 0:46

The Medicare initial enrollment period runs for a total of actually seven months at three months before your birthday, if you're turning age 65, your birthday itself, and then three months after your birthday. Now that's if you're turning age 65 for the first time. So the example would be if your birthday's in August, if you enroll in May, your coverage can begin August the first. So preparation is going to give you time to make the right decisions and you won't have to panic or worry about, whether you're making the right decisions for yourself, if you prepare. So the bottom line is every month you wait to push out your coverage.

Mike Roth ai: 1:23

Most people ask about Medicare Part B first because it covers doctor's visits.

Bill Kadereit: 1:30

It covers doctor's visits, which include appointments, routine checkups. And surgeries in-house outpatient care clinics ERs, and same day surgery. Now, people get confused by that because if you have cancer, for example, a cancer clinic is really in Medicare. B most people think it's in hospital and it's not. And your drugs in these clinics are not included in Medicare, D either. The drugs in these clinics are considered Medicare B expenses and are billed that way. And so same day surgery is another example. Preventative screenings are another Medicare B feature, and that's for your flu shots, for your annual visits, wellness visits and then there are tests and diagnostics, lab tests, x-rays, MRIs. That covers all of the Medicare B services. Basically, if you're going to see a physician, whether it's in his office or in a clinic of some kind, that's Medicare. B, if you go to a hospital or a nursing home that's not B. Okay.

Mike Roth ai: 2:36

Is there a cost for participants who want to buy Medicare Part B?

Bill Kadereit: 2:41

Yeah, typically the, the annual premium for most people is$202 and 90 cents per month. High earners, people who earn above 109,000, if you're single or 218,000 in a joint return, they pay additional. And that can be up to$689 a year depending upon how high your income is. The annual deductible for 2026 is $283. Is also a factor and you have to pay that co-insurance. After a deductible, you typically pay a 20% co-insurance for approved services. As far as part A is concerned, that's inpatient hospital care room meals, nursing medication and so forth. Home healthcare, part-time skilled nursing and therapy is also included. Skilled nursing facilities they're between the home care and the hospital. Most people go there for rehab and it's a short term after a qualifying three day minimum inpatient stay. Be careful of that because if you are in the hospital and they don't classify you as having been there three minimum inpatient days, if they say you're just under observation. For two days and an inpatient one, then you would not qualify for a nursing facility. So that's an important issue. Hospice care support and pain relief for terminally ill patients is also included in part A.

Mike Roth ai: 4:03

All that is in part A.

Bill Kadereit: 4:04

There's no monthly premium, I should say. If you've paid your Medicare taxes for at least 10 years, there's no premium for Part A. However, if you should be hospitalized. it'll pay $1,736 per benefit period. Now, a benefit period is one to 60 days. But when you exceed those limits, you're gonna pay $434 a day. If you have 61 to 90 days cost you do have to remember that the hospitalization can be expensive unless, of course your Medicare advantage or your Medigap coverage is taking care of those, but those are out-of-pocket numbers.

Mike Roth ai: 4:41

So you mean supplemental care policies?

Bill Kadereit: 4:44

Yes. Medigap is synonymous with supplemental care policies. And that's your coverage beyond Medicare a and b standard.

Mike Roth ai: 4:52

And The coverage per day is really the important number, isn't it, bill?

Bill Kadereit: 4:56

Yeah. If you exhaust the number of days all out, up front, one to 60 days, the 61 to 90 day cost for that period of 29 days is $434 a day.

Mike Roth ai: 5:07

Let's talk about, medicare Part D or what most people call the drug plan. Tell us about how that works.

Bill Kadereit: 5:15

Medicare Part D is a plan that was instituted in 2003 prescription drug plans. Now you can be in Medicare. Part D as an individual, or in the case of Medicare Advantage plans, a Medicare Part D plan can be included in your Medicare a and b services. They provide normally at a lower premium rate as a result of government funding for that. And then if you want to, you can change your mind after enrolling, you have exactly 30 days to do that if the Medicare. Part D is an optional private program for prescription drugs.

Mike Roth ai: 5:53

Bill why don't you tell us about the different Medicare Advantage, benefits and costs. And how they differ from traditional Medicare. What about deductibles and other things?

Bill Kadereit: 6:06

Start to start with everyone in Medicare has Medicare A and B. B original Medicare requires that you would also carry some other supplemental coverage to cover the 20% that Medicare does not against. In Medicare Advantage plans, they're actually called Medicare C because it's a combination of A and B and most times they don't pay a premium because there's a subsidy that covers that. And also they have prescription drug plans that are included in them as opposed to original Medicare A and B, where you have to buy it independently.

Mike Roth ai: 6:44

Okay. I guess that's one of the reasons people think the advantage plan is an advantage.

Bill Kadereit: 6:49

That's true. As a matter of fact, it's a major reason why people look at them because they know they're getting a, basically a free prescription drug plan, whereas everyone else has to pay maybe $30 a month.

Mike Roth ai: 7:01

So the drug plans and the advantage plans are free. The drugs are.

Bill Kadereit: 7:07

They're not free of the taxpayer because the government has arranged to subsidize private insurance plans. Pay them enough money in rebates so that they can use those rebate dollars that are taxpayer funded to purchase the premium for anyone in a Medicare Advantage plan who has a prescription drug plan? That included in it. And so therefore, instead of having to pay that premium, they don't have to pay it and they save 20, $30 a month. But in effect, it's not the insurance company that does it. It's the government underwriting the premium. And yes, so that's an advantage to people in a Medicare Advantage plan.

Mike Roth ai: 7:46

In 2026 what, tell us about the out-of-pocket costs that are capped.

Bill Kadereit: 7:52

The capping prob, that program was implemented in 2025, and now this year at $2,000 a year, and this year it's $2,100 a year. Basically, the bottom line on that is you can't pay more than that much money in any given year.

Mike Roth ai: 8:08

Anyone buying prescription drugs that are advertised on television?

Bill Kadereit: 8:12

Yeah, that's true.

Mike Roth ai: 8:13

They find that out real fast.

Bill Kadereit: 8:15

Especially if the label's about two pages long, After Medicare covers your drugs you have to enroll in a Part D plan. Even if you take zero medications right now, you have to go through 63 days or more without drug coverage. You face a permanent late penalty of 1% for every month. You. And the, the message here is that during this enrollment period, you have to be prepared to make a decision. The earlier you start, less confusion, there will be when it's time to evaluate and make decisions.

Mike Roth ai: 8:45

Bill, let's try to delineate the differences between traditional Medicare

Bill Kadereit: 8:50

Yeah.

Mike Roth ai: 8:50

Yeah.

Bill Kadereit: 8:51

the major differences are that a Medicare Advantage plan has an out-of-pocket maximum. Typically these, both, these plans are the same in that there's a plan A and plan B, usually a premium deductible, and all that is about the same for everyone. But when you get to a Medicare C plan, which includes prescription drugs and other benefits you actually benefit to the extent that you have to pay only up to a maximum this year. It's around 5,000 minimum, but up to $9,900 in some places in the country that you have to come out of pocket before you actually get the insurance company to pay anything. That what happens is that in many cases, people basically say I'm not gonna be sick, so I'm only gonna pay $150 a year even if it's $2,100 under Medicare in the plan. I'm healthy. What they don't count on is when they really get sick, there's a, a saying that's going around that's, a Medicare advantage of plans are just fine as long as you don't get sick. Because if you get sick, you're paying up to that maximum every year. So divide your total out of pocket of 5,000 by 12. 12 months, that's your monthly premium equivalent. If you were paying, buying a Medigap plan that would cover you, and the Medigap plan has to be purchased by people who are in original Medicare, not Medicare and PI think that's the biggest difference. The other significant difference to me is that Medicare Advantage plans have an average of $2,500 a year. The insurance companies get to spend on these free benefits for Medicare Advantage plans like prescription drugs, eyeglasses, dental gym memberships, and so forth that others in Medicare a and B do not get

Mike Roth ai: 10:41

well to me the big difference with between traditional Medicare and the Advantage plans is that if you travel outside of your own county. Sometimes

Bill Kadereit: 10:53

yes,

Mike Roth ai: 10:54

you'll be stuck with Big medical bills.'cause the doctors in this new location inside the United States right, will not be part of the group and you'll be treated as an out of group patient and it'll be much higher deductibles and fees that you have to pay. Whereas traditional Medicare almost any place you go in the States is covered.

Bill Kadereit: 11:15

Yeah.

Mike Roth ai: 11:16

And you have a freedom of choice. You don't need referrals.

Bill Kadereit: 11:20

That's right. In many hospitals, as like Shans in Florida, cancer Place centers and in around the country, yeah, they will not even accept Medicare Advantage plans. They just won't contract with them because they're not, because of that lack of coverage, they will not pay up to what Medicare pays. So that, that is a significant problem. These are called selection problems. Basically networking problems. In, in, in preferred provider organization, PPO, private plans. You can go out of network, but you can only go out of network to the extent that you meet certain limits so that you can, they usually rate it. You can be out in network and out of network combined up to a certain maximum. But there are still limitations even in the preferred provider plans. This is a big issue for a lot of people and for some it's not an issue. So yes, that's deterrent from keeping people to sign up for those plants.

Mike Roth ai: 12:15

I heard a story of a lady who needed to have her, a kidney removed ' cause of cancer and she had a surgeon and she was going to be having it done down at Moffitt in Tampa. And her advantage plan said that's out of network and you can't do it. You have to get a different doctor. We're not gonna pay anything.

Bill Kadereit: 12:35

And we have another thing going around now, of course all this upcoding but didn't denial of coverage. A lot of this denial of coverage of doctors who say, you need a CRT scan. You need A-A-C-O-T-C and, because I can't see how big that tumor is, or I can't tell whether it's malignant or not in your brain. and Medicare says no. Medicare advantage providers and HMO plans in particular are going to, at a minimum, delay it and to try to get. To see if it's justified when they won't take the doctor's opinion. I think it's a terrible thing, especially when it's a life-threatening potential issue.

Mike Roth ai: 13:10

And on the other side, as a traditional Medicare subscriber if I need a MRI or a CAT scan the doctor wires that over and virtually the next day, that's convenient for me.

Bill Kadereit: 13:24

Yeah,

Mike Roth ai: 13:24

It seems like a world of difference that people are being denied care by the carriers. That they're the carrier's being paid, but the carrier doesn't wanna pay out the money. So they try to delay it.

Bill Kadereit: 13:37

That's very true. And I will mention now though, that the scary thing is that CMS has trials going under what's called a wiser wi

Mike Roth ai: 13:46

CMS.

Bill Kadereit: 13:47

Center for Medicare and Medicaid Services in Washington, DC That's the organization that runs Medicare CMS. They are now in the process of making a study in original Medicare of whether or not they should implement the the same logic that. Medicare Advantage plans implement. Have someone at a desk somewhere in Chicago decide whether or not a doctor in Texas should authorize an MRI or not.

Mike Roth ai: 14:15

That's crazy.

Bill Kadereit: 14:15

Yeah, it is crazy. And we have the NRN has we wrote letters and lobbied and sent action alerts to everyone in Washington despite that they passed the, they did not, they would not pass a bill that would stop the wiser program. So it's continuing right now. There's a risk that could happen also to original Medicare.

Mike Roth ai: 14:35

Yeah. that seems to me to be unreasonable rationing of medical care

Bill Kadereit: 14:40

yeah.

Mike Roth ai: 14:40

It's a terrible idea.

Bill Kadereit: 14:42

Yeah. And they're using AI technology. To determine when and when you should accept or deny. And the AI machines don't have all of the experience. They don't have all the data in there yet. And how can they get in the doctor's head to know when it's necessary or not? So

Mike Roth ai: 14:58

now,

Bill Kadereit: 14:58

okay,

Mike Roth ai: 14:59

but what about these extra perks that some of these plans are, the advantage plans are getting, like

Bill Kadereit: 15:04

vision

Mike Roth ai: 15:05

or

Bill Kadereit: 15:06

Authorized in Chronics Act of 2017 was legalized in the 2018 Bipartisan Budget Act, and in there they authorized 18 additional benefits that the government would fund or that the government authorized private plans to use rebate money. To pay for people, only people in Medicare Advantage plans, which gives them a marketing advantage.

Mike Roth ai: 15:32

Yeah.

Bill Kadereit: 15:32

So

Mike Roth ai: 15:33

some of the things make sense.

Bill Kadereit: 15:34

Yeah.

Mike Roth ai: 15:34

Dental make sense,

Bill Kadereit: 15:35

but now they're admitting that all those benefits they approved.

Mike Roth ai: 15:39

Yes. They're

Bill Kadereit: 15:39

not really chronic attack, chronic disease, just some of them. And as I mentioned in an earlier podcast, 80% of all that Medicare pays out. To all providers. On behalf of all claims in Medicare, 80% of the money paid out is only paid on behalf of claims for people that are the only people, only 25% of the people. So 25% of the people consume 80% of all the billings Medicare pays. And those are the older, chronic chronically ill people. People, you don't have a heart problem in a pacemaker like I have. You don't. I've had a brain bleed. You don't have those kind of problems when you're 65 years old, and that's where most of the people have been when they signed up for Medicare. Now they're getting older and the costs are going up and they're really in a squeeze.

Mike Roth ai: 16:27

So the Medicare Advantage plan,

Bill Kadereit: 16:29

yeah,

Mike Roth ai: 16:29

participants get hurt more as they get older.

Bill Kadereit: 16:32

as we age, we incur illnesses of all kinds.

Mike Roth ai: 16:36

Yes,

Bill Kadereit: 16:36

but the and injuries as well.

Mike Roth ai: 16:37

But their out of pocket is higher.

Bill Kadereit: 16:39

Their premiums get higher. Now I, just as an example, one of these irrelevant benefits they pay for is that I have a friend that I know in Chicago, they pay his green fees.

Mike Roth ai: 16:50

Sure.

Bill Kadereit: 16:50

Part of the exercise program.

Mike Roth ai: 16:52

Exercise

Bill Kadereit: 16:52

Be healthy. So it's basically a,

Mike Roth ai: 16:54

I know some of the programs pay for groceries. Okay.

Bill Kadereit: 16:57

Over the

Mike Roth ai: 16:58

counter. Over the counter at the pharmacies, right? Yeah. Now the back end of that is it leads to medical rationing. So you have to

Bill Kadereit: 17:06

yeah.

Mike Roth ai: 17:06

Recognize what you're getting into. Okay. Recommendation to people is always go traditional Medicare and then buy the best supplement plan you can have. Yeah. So maybe we should tell people how they can get some help in choosing a plan to enroll in.

Bill Kadereit: 17:23

if you've never been in Medicare before, you're not 65 get a neighbor who is do grade age 65 or a friend, someone and get a copy of "Medicare and You" because if you're in Medicare every year, Medicare updates. And sends to everybody that is in Medicare, a copy of the Medicare and You Handbook.

Mike Roth ai: 17:46

Okay. So they get the Medicare enrollment book

Bill Kadereit: 17:48

right

Mike Roth ai: 17:49

now. If they need to get help officially from the Social security administration, how do they do that?

Bill Kadereit: 17:55

The best way to enter the process at age 65 is to call. 808 7 7 2 1 2 3 3. We will present all this on our website for you so you can get these numbers, but you call the Social Security Administration and they will give you the re, the references to medicare.gov to go through the signup procedures.

Mike Roth ai: 18:13

For medicare.gov. that's the central hub for all information. The telephone number again is (800) 633-4227

Bill Kadereit: 18:26

And the third source is your own. Your state health insurance agency called the Ship Coordinators. If you look in the back of the Medicare and new book. You can get the phone number for your ship coordinators in every state. They also work one-on-one with enrollees to help you. Yeah, and I would see further when this podcast is posted, everything that is in our presentation today, we'll be posted on the, you can have ac, you'll have access to it,

Mike Roth ai: 18:53

Now Bill, what, what kind of information should people have about buying Medicare or Medigap plans from independent insurance agents? What's your advice?

Bill Kadereit: 19:05

The question is how do you get the best information because you're not, you don't have the advantage of being able to call Medicare or get a Medicare, a new handbook or listen to this, tell this broadcaster because we don't have access to manage a everybody in the country together. So primarily what's happening is plans are being terminated. Across the company country because the cost of Medicare Advantage plans is catching up with them. As people get older, they get sicker and they use more benefits. Now people are sicker, they're incurring illnesses, more billings, and so plans are becoming unaffordable. We are going to see prop premiums go through the roof. So the best thing you can do is go to medicare.gov, go to Plan Finder, knowing all you know about your own plan, know about your own health condition, know about you know how you feel, what is your family history and so forth. And engage for yourself what plan type you want. If you want a Medicare Advantage plan or if you want a drug plan, or if you want a Medigap, a supplemental plan, which was the original question here you go to this plan finder and you put in your age, your sex your zip code and whether you smoke or not, you don't have to put your phone number or anything in there. You say, I want this kind of plan. And CMS provides a list of that plan type for your county that's available, and they list it in order

Mike Roth ai: 20:34

of lowest price to highest price. That's medicare.gov. Second. Okay. Some of these. When you're looking at the Medicare site directly, you get to choose which plan that you want to use that covers what you want covered at the price that's reasonable for you. I think that's really the important

Bill Kadereit: 20:57

message. And one important element there is that you're you buy direct from the insurance company. You don't buy through your agent. Okay. And he basically, you cut out the commission.

Mike Roth ai: 21:05

Now's a

Bill Kadereit: 21:06

big deal.

Mike Roth ai: 21:06

Let's talk about this year's 'cause it's coming right up. And

Bill Kadereit: 21:10

this is what we're being getting prepared for, as you can see October 15th through December 7th. So between October the now and October the 15th. This is the kickoff. this is our first attempt to try to give people some advantages to get started early.

Mike Roth ai: 21:27

Okay.

Bill Kadereit: 21:27

so then there's also an enrollment period, January one through December through March 31 for Advantage plan, open enrollment period.

Mike Roth ai: 21:36

Okay. So people can change if they want from a traditional Medicare plan. To an advantage plan between January 1st and to

Bill Kadereit: 21:44

Yes.

Mike Roth ai: 21:45

March

Bill Kadereit: 21:45

31st. Yeah. And the most important caveat there is if you switch to a Medicare Advantage plan and you're in one for more than a year, you can't switch. Then after that you'll, if you pay, it's gonna, you're gonna pay through the homes.

Mike Roth ai: 21:57

You're not, the only way that you're going to be able to get back for most people

Bill Kadereit: 22:02

Yeah.

Mike Roth ai: 22:02

Who don't move, is if you are canceled by your original insurer and. You get a what kind of a letter is it with guaranteed rights, guaranteed issue to go back over to Medicare. So sometimes, and we mentioned this earlier, if you get canceled by your plan carrier because the plan is terminated in your particular zip code, you actually are lucky because you can then turn around and go from advantage back to traditional Medicare

Bill Kadereit: 22:30

and you can do it without. With knowing you cannot be refused. They cannot deny you coverage. No matter whether you're on your deathbed. They cannot deny you coverage no higher than anybody else in the marketplace. If you don't get that guarantee issue you can be in real trouble and many times your agent doesn't steer you in the right direction. But we're gonna talk about this subject. This is our last subject of the series here probably in about three or four weeks. And we're gonna talk in depth about guarantee issue rights, what you should do when you're notified what's supposed to be in these letters. And we want you to notify us at our contact point, which we'll tell you later when we get into that issue. So this time we're going to the attorney General's office and say, why aren't you suing the insurance companies? Because the A CMS has the authority. To assess $5,000 fines per person, and if to anyone who manipulates these mini minimum stamp legal standards, and they can imprison them for up to five years in jail, and we're gonna say, why isn't that being done?

Mike Roth ai: 23:41

Okay. Bill we, I think we have one more thing to talk about for enrollment in the drug plans today. Drug plans open to enrollment when.

Bill Kadereit: 23:50

Oh, at the t it's part of the Medicare enrollment process.

Mike Roth ai: 23:52

So it's Jan,

Bill Kadereit: 23:53

October 15th. Uhhuh,

Mike Roth ai: 23:54

October 15th.

Bill Kadereit: 23:55

Yeah. But you can buy a drug plan at any time because Mo, all of these plans you can buy at any time because they're private plans. Okay. But it's Medicare that have Medicare plans under the guise of Medicare payments and so forth that have, you're have to be enrollment because you have A and B coverage. In Medi, you're gonna be paid by Medicare. Then you have to go through the enrollment during the enrollment period.

Mike Roth ai: 24:16

Okay. So I guess the important thing is don't miss the open enrollment period. If you think you might want to change plans and I think you need to watch our next video coming up at about two weeks on guaranteed issue rights denied. Okay. Bill, anything else we need to add for

Bill Kadereit: 24:34

today? No, I think we've covered quite a bit. If you have any questions, please go to our email message nl n message@msn.com or call 1 8 6 6 3 6 0 7 1 9 7. Creating a better life for seniors. Welcome. Goodnight.

Mike Roth ai: 24:55

And let 'em take a look at the page and go to the website and decide whether or not they want to join. Become part of the

Bill Kadereit: 25:00

Absolutely.

Mike Roth ai: 25:00

The independent advocacy movement for seniors.

Bill Kadereit: 25:03

Absolutely

Mike Roth ai: 25:04

good.