My Madicare advocate

From the Frying Pan... into 2026 Medicare.

2026 is going to feel like going from the frying pan into the fire in some respects: I’m talking about drug coverage changes, the allowance “grocery card” you keep hearing about, and how to fill some of holes in Medicare Advantage.

I don’t like this any more than you do but here’s the cold truth: Part D sucks. If you don’t need medications, you still need a drug plan, or you WILL be penalized for not having one.

I’ve heard many, many times, “I don’t take drugs/medication so why do I need a drug plan?”

Because if you don’t have one you will be penalized 1% of the average cost of a drug plan in the U.S. PER MONTH, COMPOUNDED, until you get one.

And when you get one, they will send you a penalty bill, and you will pay that for, basically, the rest of your life. There is only one way to get out of that penalty. If you are eligible for Extra Help through Social Security the penalty is waived - but you have to make less than roughly $1300 a month to get Extra Help.

You can apply at www.ssa.gov/medicare/part-d-extrahelp or call Social Security at 800.772.1213 to apply. To find out how much your penalty might be (in the event you never got a drug plan) go to https://themedicarefamily. com/calculators/part-d-penalty/ . Remember that the

The New Maximum: $2100 for 2026

Three (3) years ago we had $5530 max out of pocket with a “donut hole” where you paid a LOT, before getting to the catastrophic phase and paid nothing on drugs. 2025 began the new system: $2000 max, a federal payment plan option to level out your payments over the 12 months, and no donut hole. Once the $2000 is met, you go straight to zero copay on everything. In 2026, it’s much the same but with a $2100 max. However, sad to say, the cost of drug plans has gone up. One UHC plan in Cass County went from $89 to $113.

Calculating Costs & Enrollment

It’s no fun shopping online for this kind of thing but that is what you will have to do this year - and you have until December 7 to shop and choose a new plan. Here are some sites to help you cut to the chase. Go to the digital edition of the newspaper online to access these links.

United Healthcare UHC Prescription Drug Plans - Cass County Humana Humana Drug Coverage - Cass County Wellcare Wellcare Drug Plans - Cass County Each one will ask you to add your medications and will give you the cost of the plan, and the copays. So, you have two costs: Premium and the Monthly drug costs.

Sometimes it is less expensive to take a drug plan with more premium because the copays are much lower than a plan that lasts little or no premium but much higher copays. So, get comfortable, get your list of medications, and plan on spending an hour. Add the premium to your monthly copays to get a true cost for your medications by the month.

“Why can’t I just call you?” This is so hard to say but while you are welcome to call me for help, I cannot enroll you. You will have to enroll through the carriers directly because they have chosen to not compensate agents for this time-intensive work as of October 1, 2025.

I’ll be happy to answer your questions and if you’re really in the weeds, I’ll do what I can to help you sort out your particular situation. But enrollment will have to be with the carriers. Just call the enrollment phone number for the carrier of your choice and they will have one of their employee/agents do your enrollment.

The Grocery Card

You may have had a grocery/rent/utility benefit in the past, right up until the end of 2025; chances are that has changed in one of two ways. Either the benefit has been reduced for your plan or in 2026 you will only be able to get over-the-counter spending for that benefit. Here’s why: grocery benefits are being reserved for individuals with chronic conditions ONLY.

I’ve seen many plans that have cut a $300 grocery/rent/ utility benefit down to $175 or less. Plans that were over $100, cut down to $40.

Some plans have been redesigned with not even an OTC benefit at all. So once again, call or text me for an appointment to review your benefits for 2026 because they can be vastly different.

Here is a short list of some, not all, chronic conditions that are being approved, with a doctor’s verification, and this can vary by carrier.

Cardiovascular/Heart Disease Diabetes Chronic Kidney Disease (CKD) End-stage Renal Disease COPD Chronic high blood pressure Chronic high cholesterol Cancer Chronic and disabling menta health conditions Immunodeficiency, immunosuppressive, and HIV/ AIDS Dementia Neurologic Disorders Obesity, overweight and metabolic syndrome Stroke Hemotological disorders Spinal Cord, limb loss, paralysis and arthritis, stroke or anything that causes functional challenges Much more.

This is just a short list - if your condition is not here don’t worry.

But remember that the grocery benefit is part of Medicare Advantage plans and just a small part at that. It is not based on income or whether you have Medicaid: only whether you have a chronic condition.

As always, bring me your situation and let me see what is available to you for your specific circumstances; sometimes you can get more month through a Part B Rebate of up to $177/month than you can on a grocery card. That amount is dependent on where you live: in Cass County the max seems to be $125-130/month reduction of the part B premium for 2026 - which will be $206.50 up from $185 during 2025.

Filling Medicare Advantage “Holes” If you have Medicare Advantage or plan to get it this year for 2026, be aware that there are several significant financial issues... and a way to help you deal with them. Hospital Copays, Skilled Nursing Copays, and the Outpatient Copay are the three I’m referring to.

You can fill those through a Hospital Indemnity plan and it is pretty inexpensive.

Around $50-60/mo for one person. Coverage will match your hospital copay (if you have a $295/day for 6 days, it is set up to match that), up to $1000 for an outpatient experience (most copays are between $225 and $450), and $200 a day for skilled nursing days 21-100 (that copay is usually $218 per day). Christus plans are the only ones with a zero-hospital copay - a gift to our communities throughout Texas only. That and as much as $4000 in dental, transportation benefits, and a low max out of pocket make Christus a great choice for this area - we are all using Christus facilities anyway, so why not get the most benefit out of it?

Medicare Supplement plan G will pay 100% of your costs over and above Medicare A and B, but you pay a premium of around $140 to start when you turn 65 for a full plan G - that is with Physicians Mutual. Other carriers will start lower but jump signifiantly in year 2, 3, and 4. Medicare Advantage only provides 20 days of skilled nursing at zero copay - after that it’s $218 a day. So if you want to stay independent, or you simply don’t have anyone who can step in and take care of you after those first 20 days, be sure to ask me how a hospital indemnity plan can save your bacon... and your independence.

I am licensed, appointed and certified with many carriers but I work for you. So please call me with your questions and needs - I will be forthright and do my best to find solutions for you that work.

Until Dec. 7th I›ll be at Walmart at the booth from 8 a.m. to 5 p.m. on Tuesday and Thursday - or give me a call. You can also find a wealth of information at www. medicarethrive.com.

May the Lord richly bless you until we meet again. Amy

Amelia (Amy) Gunstanson is a Navy Veteran with 30 years’ experience in life and health insurance, the last 6 years in Medicare specifically. She is the Principal Agent/ owner of Medicare Thrive in Atlanta, TX, serving Cass and surrounding areas. She is federally certified, licensed in 20 states and appointed/certified with many major carriers including Kemper Life, Humana, United Healthcare, Physicians Mutual, Christus, Aetna, Cigna Blue Cross and more. You can call or text questions or requests for appointments to 430-999-2271 or on the web at www.medicarethrive. com.