The Kitchen Table on Syam Adusumilli

Your Medicare Plan Is Changing

Sun, 15 Mar 2026 00:00:00 +0000

If you have a Medicare Advantage plan, there is a reasonable chance something about it changed this year, or will change next year. Your premium might be higher. A benefit you counted on might be gone. In some counties, the plan itself may have stopped offering coverage entirely.

None of this happened by accident. The federal government changed how much money it pays to Medicare Advantage insurers, and those insurers responded by pulling back on the extras they had been offering to attract members. Understanding what changed, and what it means for you, is the first step toward making sure you have the right coverage.

Summary: Your Medicare Plan Is Changing

Sun, 15 Mar 2026 00:00:00 +0000

If you have a Medicare Advantage plan, there is a reasonable chance something about it changed this year or will change next year. Your premium might be higher. A benefit you counted on might be gone. In some counties, the plan itself may have stopped offering coverage entirely. None of this happened by accident. The federal government changed how much money it pays to Medicare Advantage insurers, and those insurers responded by pulling back on the extras they had been offering to attract members.

If You Have Medicare and Medicaid

Sun, 15 Mar 2026 00:00:00 +0000

About 12 million Americans are covered by both Medicare and Medicaid at the same time. If you are one of them, you have two programs that were designed separately, often run by different agencies, and have never been fully connected. Getting them to work together for your benefit has been one of the more complicated challenges in American health policy, and the federal government has spent the past several years building new tools to do it better. Some of those tools are now in your hands.

Summary: If You Have Medicare and Medicaid

Sun, 15 Mar 2026 00:00:00 +0000

About 12 million Americans are covered by both Medicare and Medicaid at the same time. If you are one of them, you have two programs that were designed separately, often run by different agencies, and have never been fully connected. Medicare pays for doctor visits, hospital stays, and prescription drugs. Medicaid can pay for things Medicare does not cover, including dental care, transportation, personal care aides, and long-term services that help you stay at home. When you have both, Medicare pays first and Medicaid fills in some of what Medicare leaves out. The problem is that these programs do not naturally communicate with each other, and the result can be fragmented care, coverage gaps, and confusion about who to call when something goes wrong.

Your Doctor and the New Prior Authorization World

Sun, 15 Mar 2026 00:00:00 +0000

If you have a Medicare Advantage plan, you have probably encountered prior authorization at some point. It is the process where your insurance plan has to approve a procedure or service before your doctor can perform it. For many people, it has meant delays, denials, and extra phone calls at moments when they were focused on their health.

A new program called WISeR is now bringing a version of this process to Original Medicare for certain procedures in six states. If you live in New Jersey, Ohio, Oklahoma, Texas, Arizona, or Washington and you have Original Medicare, parts of this article apply directly to you. If you live elsewhere, or if you have Medicare Advantage rather than Original Medicare, the section on how these two systems compare is still worth reading, because it bears directly on one of the most consequential coverage choices you can make.

Summary: Your Doctor and the New Prior Authorization World

Sun, 15 Mar 2026 00:00:00 +0000

If you have a Medicare Advantage plan, you have probably encountered prior authorization, the process where your plan has to approve a procedure or service before your doctor can perform it. A new program called WISeR is now bringing a version of this process to Original Medicare for certain procedures in six states. If you live in New Jersey, Ohio, Oklahoma, Texas, Arizona, or Washington and have Original Medicare, this change applies directly to you.

Prescription Drug Costs

Sun, 15 Mar 2026 00:00:00 +0000

More has changed about Medicare prescription drug coverage in the past two years than in the previous decade. A hard cap on what you can spend on drugs each year is now in effect. The federal government is negotiating prices directly with drug manufacturers for the first time in Medicare’s history. A program to cover certain weight-loss medications is moving forward. And a new initiative is bringing international drug pricing into Medicare’s framework.

Summary: Prescription Drug Costs

Sun, 15 Mar 2026 00:00:00 +0000

More has changed about Medicare prescription drug coverage in the past two years than in the previous decade. A hard cap on annual out-of-pocket drug spending is now in effect. The federal government is negotiating drug prices directly with manufacturers for the first time. A program covering certain weight-loss medications is moving forward. And a new initiative is bringing international drug pricing into Medicare’s framework.

The most significant change is the $2,000 annual out-of-pocket cap on Part D prescription drug costs, effective starting in 2025. Before this cap, there was no ceiling on what you could spend. People on expensive cancer drugs, biologics, or specialty medications were sometimes spending $5,000, $7,000, or more per year on prescriptions. That structure no longer exists. Once you have paid $2,000 in covered drug costs in a calendar year, counting your deductible, copayments, and coinsurance, your plan pays 100 percent for the rest of the year. Medicare also introduced the Medicare Prescription Payment Plan, which lets you spread drug costs across monthly payments rather than paying them all when you fill prescriptions. If you tend to hit high drug costs early in the year, this option smooths out the cash flow. The total you pay does not change, only the timing.

Staying Home Longer

Sun, 15 Mar 2026 00:00:00 +0000

Most people, when asked where they want to receive care as they age, say the same thing: at home. Not a nursing facility. Not an assisted living complex. Home. Medicare has always covered some of what that requires, but never all of it, and the gap between what the program covers and what people actually need to stay safely at home has always been significant.

That gap is getting harder to navigate right now. Some of the supplemental benefits that Medicare Advantage plans added over the past several years to help bridge it are being cut. At the same time, policy changes at the federal level are expanding certain home-based services for people who qualify. Understanding what is covered, what is being reduced, and where to find the help that Medicare does not pay for is the core of what this article addresses.

Summary: Staying Home Longer

Sun, 15 Mar 2026 00:00:00 +0000

Most people want to receive care at home as they age, not in a nursing facility or assisted living complex. Medicare has always covered some of what that requires, but never all of it, and the gap between what the program covers and what people actually need has always been significant. That gap is getting harder to manage right now. Some supplemental benefits that Medicare Advantage plans added to help bridge it are being cut. At the same time, certain home-based services are expanding for people who qualify.

The Medicare You Were Promised vs. The Medicare You Are Getting

Sun, 15 Mar 2026 00:00:00 +0000

Medicare Advantage was sold as the better Medicare. Lower premiums, sometimes zero. Dental. Vision. Hearing aids. Gym memberships. Transportation to appointments. All of it wrapped in one simple card from a familiar insurance company. For millions of people, it made obvious sense to sign up. By 2024, more than half of all Medicare beneficiaries were enrolled in a Medicare Advantage plan.

The promise was real enough when it was made. Plans had the money to fund those extras, and competition for members kept the offers generous. What has changed is the financial environment those plans operate in, and the way plans have responded. Benefits are being cut. Plans are exiting markets. Doctors are leaving networks. Prior authorization is delaying care. And many people who enrolled years ago under one set of expectations are discovering that the coverage they have today looks meaningfully different from the coverage they thought they signed up for.

Summary: The Medicare You Were Promised vs. The Medicare You Are Getting

Sun, 15 Mar 2026 00:00:00 +0000

Medicare Advantage was sold as the better Medicare. Lower premiums, sometimes zero. Dental, vision, hearing aids, gym memberships, transportation. All wrapped in one card from a familiar insurance company. For millions of people it made obvious sense, and by 2024 more than half of all Medicare beneficiaries were enrolled. The promise was real enough when it was made. Plans had the money to fund those extras. What has changed is the financial environment, and many people who enrolled years ago under one set of expectations are discovering that their coverage today looks meaningfully different from what they thought they signed up for.

Policy to Practice

Sun, 15 Mar 2026 00:00:00 +0000

The people described in this article work under many titles. SHIP counselors. Care coordinators at health systems and community health centers. Patient advocates at cancer centers and dialysis facilities. Social workers in hospital discharge planning. Benefits counselors at Area Agencies on Aging. Plan navigators at community organizations serving low-income and dual eligible populations. What they share is a position between policy and person: they understand what the rules say, and they sit across the table from someone trying to figure out what the rules mean for their life.

Summary: Policy to Practice

Sun, 15 Mar 2026 00:00:00 +0000

The people this article addresses work under many titles: SHIP counselors, care coordinators, patient advocates, hospital social workers, AAA benefits counselors, plan navigators. What they share is a position between policy and person, understanding what the rules say and sitting across the table from someone trying to figure out what the rules mean for their life. The Medicare policy environment of 2025 and 2026 is generating more complexity for that work than any recent period, with multiple major changes in effect simultaneously and interactions that are not always obvious.