Medicare & the ACA for December and Beyond

December 8th marks the end of the Medicare Annual Enrollment Period.

During this time, you have had the opportunity to make changes to your Medicare Advantage Plan (Part C) or a Medicare Prescription Plan (Part D).

These changes will go into effect on January 1, 2026

Review your new plan carefully. Even if you have stayed with the plan you had in 2025, there will be differences. Look out for copay’s, Rx tiers, doctors in network, dental, vision, hearing, over the counter and fitness.

Medicare Open Enrollment –

January, February, March

Medicare realized that seniors may have “something happen” – new doctors, change in health, updated RX – now and into the first of the year.

If you have an Advantage plan, you have one and only one opportunity from January 1st to the end of March to change to another plan which better suits your needs. Review your 2026 coverage carefully, take it out for a test drive and see how it works.

Five Star Plans

Medicare evaluates how well a plan is working to benefit those Medicare beneficiaries enrolled; Star Ratings. Five Star Plans at the top of their service metrics are awarded this distinction. You may enroll in these plans anytime during the year.

One company’s plans, in particular, has achieved 5 Stars for four years in a row. They offer a plan with a strong “Part B Premium Giveback “. This puts money back on to your Social Security benefit. The plan has low copays for doc’s, specialists and hospital stays. Coincidentally, this is the plan I picked for myself.

ACA, Marketplace, ObamaCare

This year the enrollment period runs from December 15 and has a January 1 effective date. We have another month until January 15 for February 1 dates.

At this writing, we are still in the blind as to the extension of “Enhanced Premium Tax Credits”, which has not been resolved. If Congress does not act, these subsidies will decrease dramatically.

That said, we are developing options and techniques to minimize the impact of increasing health insurance premiums (25% - 50%). Beyond the subsidy issue, there is one positive change. All “ Bronze “ plans are compliant to open and fund a Health Savings Account.

These are tax advantaged accounts, the contributions are tax-deductible and then those funds are immediately available to pay medical expenses. You can change from a Silver or Gold plan to a Bronze plan and lower your monthly premium.

Use those dollars to fund an H.S.A and pay for medical expenses in tax free dollars. Plus you can lower your Adjusted Gross Income for increased subsidies and lower tax burden.

There are also separate plans that pay dollars directly to you if you have an accident or a covered hospital stay. These plans cushion those higher deductibles.

We have been working with clients on the Marketplace from day one. Call us and let’s discover your options together.

Dave Trout

Trout Insurance

Full Service, Local, Independent

29 N Main St. Weaverville, NC

828-279-4681

dtroutinsurance@aol.com

www.TroutInsurance.com