We made it! A new year and time to make changes.

Some of you made changes last year during open enrollment. Some did not. Sadly, someone may have made changes for you that you are not aware of and may not find out until months down the road.

The Switcheroo 

You may not have the plan(s) you think you have. During open enrollment you may have talked to someone at a drug plan carrier who was very courteous and offered to help you enroll in a specific Part D plan.

Maybe they did just what you wanted, maybe not.

They COULD have enrolled in a Medicare Advantage plan without your knowledge or consent. This has happened before and it is very difficult to unwind. Unless you caught it early, preferably before the end of December, you could be stuck in a plan you don’t want and no way to get back to your Medicare supplement (Medigap) plan.

How will you know which plan you will have in 2026?

Log into your Medicare account via Medicare.gov. On the home page, https://www.medicare.gov/my/home scroll down to My Plans and make sure it shows Medicare Part A & Medicare Part B. Immediately to the right, look for Drug Insurance Part D and verify it has the name of your 2026 PDP carrier. Finally, to the right of your drug plan, under OTHER INSURANCE it should have the name of your Medigap carrier.

If any of these do not match what you EXPECT to have in January, contact me by email . . . bob.vineyard@gmail.com.

You cannot have a stand alone Part D plan and Medicare Advantage (MAPD) at the same time. You cannot have a Medigap plan and MAPD at the same time.

If all looks fine you should be OK, but to be sure, repeat this process to verify coverage between December 25th and January 1.

Why Do Heart Attacks Increase During the Holidays?

The holidays are supposed to be a time of good cheer, but winter festivities may also bring an increase in cardiovascular risks. More people die from heart attacks during the last week of December than at any other time of the year.

Multiple factors may contribute to this spike in heart attacks during the holidays, such as the increased stress that occurs this time of year, overindulgence in alcohol and rich foods, and even cold weather exposure.

People also tend to delay treatment for heart health symptoms over the holidays, potentially leading to worse outcomes. If you’re already at risk of heart problems, you shouldn’t let Christmas or the other winter holidays throw you too far off your healthy living game plan.

https://www.everydayhealth.com/heart-attack/heart-attack-why-heart-attacks-spike-during-the-holidays

Why Are Hospitals and Doctors Dropping Medicare Advantage Plans?

Despite our best efforts to find common ground over eight months of negotiations, Johns Hopkins Medicine and UnitedHealthcare have concluded contract negotiations without reaching an agreement. 

This was not about money or small administrative issues. 

UnitedHealthcare refused to agree to reasonable terms that would ensure you receive the care you need, when you need it, without excessive delays or denials. We could not sign a contract that allows an insurance company to prioritize their profits over our patients’ health.

United's current practices create real barriers to your care:

Excessive prior authorization requirements that delay the treatment you need.

Frequent treatment denials that force you and your doctors to fight for care.

Administrative burdens that take our physicians and nurses away from focusing on your treatment.

Delayed payments that force us to spend time chasing compensation instead of caring for patients.

https://www.hopkinsmedicine.org/united-coverage

Does Medicare Cover a Long Term Stay in an SNF?

Medicare Part A covers up to 100 days of medically necessary care in a skilled nursing facility (SNF) each benefit period. Your out of pocket costs during a covered SNF stay are:  

Days 1–20: You pay $0 each day after the $1,736 Part A 2026 deductible is satisfied. (Medigap plan G pays this deductible for you.)

Days 21–100: You have a daily copay of $217.00  in 2026 . . . Medigap G plan pays this for you.

Past 100 days, you will be responsible for the full cost of the stay.

Medicare SNF coverage may be extended in some circumstances:  

If you are receiving medically necessary physical, occupational, or speech therapy, Medicare Part B may continue to cover those skilled therapy services.

Medicare will not pay for your room and board beyond 100 days. Ask your provider  if you qualify for therapy at home through Medicare’s home health benefit, or if you could safely receive therapy as an outpatient.

Click this link for more information about Medicare SNF coverage.

https://www.medicare.gov/publications/10153-medicare-coverage-of-skilled-nursing-facility-care-508.pdf

In Closing . . .

Time to say goodbye to 2025 (if you have not already). As most of you know, you can reach out to me anytime about any questions or concerns you have about Medicare. As of this writing, bob.vineyard@gmail is the only reliable email address so make that not in your contact file.

Forward this newsletter to anyone who feel will find the topics helpful. And referrals are ALWAYS appreciated.

Take care,

Bob & Rachel