Open Enrollment Is Here: Are You Ready?

Caitlin Whyte (Host): This is Weekly Dose of Wellness, and I'm your host, Caitlin Whyte. With me is Jose Juarez, a Medicare Outreach Manager with Memorial Care. We will be talking all about how open enrollment is coming soon and what you can do to prepare. Now, Jose, start us off. Can you break down what open enrollment is and why it's such a big deal for Californians reviewing their health coverage, especially for those over 65.

Jose Juarez: Open enrollment. It's actually annual election period or annual enrollment period. And it's very Important for, for Medicare recipients, to review their current Medicare plan. There's a lot of changes in 2025 and there's more changes in 2026.

So I highly encourage everyone, to do a plan comparison, review their, their benefits because changes are coming some are going to be good, some are going to be bad.

Host: Even with those changes ahead, Medicare can already feel like alphabet soup. Can you walk us through parts A, B, C, and D in some plain language?

Jose Juarez: Absolutely. So Medicare Part A, that's your hospitals. Medicare Part A has no monthly premium. That's if you've worked in the US legally for about 10 years, which equals to about 40 credits. Part B on the other hand, does have a monthly premium. It does vary by your income. So if you're wealthy senior, your Part B premium will fluctuate based on on your income.

Part C is your Medicare advantage plans, right? So these are your choices. You see a lot of commercials advertising Part C. These are your Medicare Advantage plans. They are HMOs and some PPO plans. Part D is your prescriptions, prescription drug plans. How Medicare's broken down, so you have A, B and D included in Part C. If you go on a Medicare supplement plan, you have A, B and you have to go out and get a standalone drug plan.

Host: You know, we often hear about open enrollment and the annual election period. So what's the difference between the two and who needs to pay attention to each?

Jose Juarez: Absolutely. So annual election period, it's considered annual election period where you can select a new health plan for the following year. So any Medicare recipient that is already on a Medicare plan, during October 15th through December 7th, this is considered your annual election period.

Now from January 1st, through March 31st, this is considered open enrollment. So you get one more chance to switch your plan during that timeframe from what, January 1st through March 31st, just in case, your doctor prescribed a new prescription and maybe your current plan doesn't have that medication in the formulary.

There's a lot of opportunities for you to change, right? So if, God forbid, you get diagnosed with a chronic condition throughout the year, it opens a special enrollment period. If you move counties, it allows you to have a, a special enrollment period as well.

Host: Now, Jose, we're seeing more older adults and caregivers in that sandwich generation leading toward Medicare Advantage. Why is that?

Jose Juarez: Yeah, so Medicare Advantage plans have become very popular, one because of cost, right? Medicare Advantage plans are zero monthly premiums for the most part. It does include your part D, your prescriptions, at no extra cost. Again, for 2026, some plans on Part D will have some deductibles. So that's why it's very important for you to look at your current plan and do a plan comparison for 2026, especially when it comes to your prescriptions.

If, you're taking the prescriptions and you decide price hike in 2025, expect the same or more in 2026. The MOOP is going up, your maximum out of pocket when it comes to prescription drug plans. It is going up next year. So, it's, it's just very important to select the plan based on your medications you currently take.

Host: Gotcha. Well, for those of us under 65 who are still on commercial plans, what should they be doing now to prepare for their transition to Medicare?

Jose Juarez: What I've seen in the past three, four years that a lot of employer plans are going more PPO, right? So I feel like on a PPO plan, the cost is more on the consumer, on the patient. So it's always good to even if you're under 65, start planning, and, and start maybe shopping around for Medicare, right?

Because what I've seen in the past is, you can do a plan comparison, stay on your current employer plan and do a plan comparison. Maybe there's a Medicare plan that offers the same benefits or better at a lower cost, which will still allow you to keep your doctors, your specialists, the hospitals that you like.

So there's definitely other options out there for you.

Host: Now you mentioned those changes that are coming up in 2026, so could you tell us what are some of the biggest updates or changes that are coming to Medicare and commercial plans in this new season, and are there new benefits being added to Medicare Advantage plans or changes in that prescription drug coverage under that part D, that could impact out of pocket costs in 2026?

Jose Juarez: Yes. So that's been a, a very hot topic. Prescriptions, it's, you know, it was a hot topic in 2025, 2026 it's even more.So some of the biggest changes for those that were on a PPO Medicare Advantage Plan, a lot of those PPO plans are going to, are not going to be available anymore in 2026.

Another big change is as far as benefits go, I know a lot of people. You know, we're looking at those extra benefits over the counter gym membership, dental benefit. A lot of those benefits are going to be cut with some of the insurance companies. Some other insurance companies are going to have very rich dental benefits, but also they're formulary, right?

So it's going to be a give and take. What's more important, your prescriptions or maybe some dental work. Your maximum out of pocket for Part D that is going up a hundred dollars. Another big change, part B premiums are also going up quite a bit for 2026. I don't have the data yet as to how much the Part B premium will be, but as soon as we have it, we are going to be updating our website, and we're going to be hosting numerous educational meetings throughout the community.

Host: Great. Well, one example, let's say someone's doctor is no longer in network, or their prescriptions have changed or their premium has gone up. How could they tell if their current plan still fits their needs.

Jose Juarez: Yeah, and that's a great question. You know, doctors are retiring or leaving from one medical group to another. Those that are on a, on a Medicare advantage plan, you can change medical groups year round, right? So if you know your doctor's leaving to another medical group, it's good to call the other medical group or call your doctor and see if they do accept your current health plan.

So you're don't think for once, although it's a Medicare Advantage plan, it's an HMO, you're not locked in with that doctor or that medical group itself. And now as far as your prescriptions, right, so say throughout the year you get prescribed a, a or you get diagnosed with a chronic condition, either diabetes or, you know, heart, it opens a special enrollment period because we know, that your, your health is going to change right. Now you have to take other prescriptions that your current plan doesn't cover. So it does open a special enrollment period here for you to shop around and see what plan has the best formulary for those new medications you're going to be taking.

Host: Great. And can you share how flexible provider options, virtual care services, or that plan switching support really helps people balance their own care with caring for loved ones.

Jose Juarez: Yeah. So with Memorial Care, it's amazing what we're doing. All access virtual care,and that's for primary care visits, 24/7 nurse line, virtual urgent care visits. So it's amazing what we're doing for not only for our members, but for everybody out there, right?

If you have an insurance, we'll go based on your copay. If you don't, you don't have to be a member of Memorial Care to have access to the service.

Host: Wonderful. Now, this is a lot of information that we covered today and there's even more we could keep talking about. So I know you guys also host educational classes. Can you tell us more about those?

Jose Juarez: Yes. So we are hosting numerous Medicare meetings throughout Orange County, LA County. What Medicare is, how to enroll, how do I avoid some penalties? The big changes coming with Part D, your prescriptions, we'll be able to verify all your medications, find the best plan for your needs that has your medications, and perhaps, hopefully, you know, have those extra benefits that you're interested in, like vision, dental, hearing aids, transportation, over the counter benefit, gym membership.

So some of these plans are, are still going to be pretty good. They are still going to be rich in benefits. There are going to be some changes, so we are going to have to do more, more research based on your medications and maybe some of those additional benefits that you're, you're interested in. You can go onto our website@memorialcare.org/eventsor again, you can call me at (714) 698-4003. All of the Medicare meetings are free to the community. You can bring your prescriptions, you can bring your current plan. Pretty much any questions you may have about Medicare, the biggest changes for 2026, we're going to be there if you're still employed, and same thing. A lot of employers have open enrollment now. Bring your benefit highlights. We'll be able to go over those benefits and see maybe there's a better Medicare plan for your needs that covers you and your spouse.

Host: Wonderful. Well, thank you so much, Jose, for this information. It is so crucial to get as much education as possible so we can make the best insurance decisions for ourselves and our families. Once again, for even more information, you can call 714-698-4003, or email masupport@memorialcare.org. You can also visit memorialcare.org/choose-memorialcare. And if you enjoyed this podcast, please share it on your social channels and check out the entire podcast library for topics of interest to you. I'm your host, Caitlin Whyte, and this is Weekly Dose of Wellness.

Thank you for listening.