Insurance Archives - Health Directions

GLP-1 NEWS: Bridge Program Expands Coverage to Treat Obesity

October 19, 2026

Examining the overall health and financial system benefits of managing obesity at all ages, beginning July 1, 2026, eligible Medicare beneficiaries will have a new, lower-cost option for FDA-approved GLP-1 medications used to treat obesity. This is big news!

The new Medicare GLP-1 Bridge Program is a temporary pilot that gives qualified plan participants access to medications such as Wegovy® and Zepbound® for a $50 monthly copay through December 31, 2027. Until now, Medicare covered only GLP-1 medications prescribed for conditions such as type 2 diabetes or cardiovascular disease — not obesity alone.

Beneficiaries must be:

Enrolled in Medicare Part D or a Medicare Advantage plan with drug coverage
Meet specific medical criteria for obesity
Receive prior authorization from their healthcare provider

Right now, this program operates outside of Part D formularies. However, if successful, it could help shape future Medicare policy regarding currently excluded anti-obesity medications. If you think you would benefit from a GLP-1 and might qualify for coverage, speak with your physician and a Medicare adviser like Health Directions to learn whether the program is appropriate for you.

Resources: cms.gov; kff.org; medpac.gov

MEDICARE SPECIAL NEEDS PROGRAMS: Features, Benefits Qualifications

September 9, 2026

Special Needs Plans (SNPs) are a type of Medicare Advantage plan offered by private insurance companies. SNPs are either HMOs or PPOs within defined coverage areas, designed to provide specialized care and benefits to individuals with specific health needs or financial constraints.

For example, an SNP for diabetes offers $0 co-pays for insulin, free continuous glucose monitors, tailored diabetic diet meal delivery and routine vision care to prevent eye complications.

Types of SNPs

Institutional SNP: People who live in certain institutions (like skilled nursing homes) or who require nursing care at home
Dual Eligible SNP: People who qualify for both Medicare and Medicaid
Chronic Condition SNP: People who have specific chronic or disabling conditions (like diabetes, End-Stage Renal Disease, HIV/AIDS, chronic heart failure, or dementia)

As with all Medicare programs, there are benefits and limits to enrollment. Mark and Curtis can help you determine your eligibility and assess the benefits of the available SNPs in our area.

Resources: cms.gov; medicare.gov; ncoa.org

ENROLLMENT TRENDS INSIGHT: Original Medicare vs. Medicare Advantage

August 11, 2026

Over the years, we’ve covered the distinctions between federally managed Original Medicare (Parts A, B, and D) and privately managed Medicare Advantage (Part C) plans. Refresh your knowledge here.

What Are Your Fellow Americans Over Age 65 Choosing?

As of 2025, 54 percent of those eligible were enrolled in Medicare Advantage (MA) vs. just 33 percent a decade ago. The rate of increase, however, has started to decline over the past couple of years.

Who Is Opting for Medicare Advantage?

Almost 25 percent of all MA program participants are in Special Needs Plans (SNPs), and SNPs account for a whopping 85 percent of Medicare Advantage increases since last year. This is likely a result of reduced cost-sharing and additional benefits offered, especially for enrollees who also qualify for Medicaid. See below for further details on SNPs.

What Drives Original Medicare Enrollment?

Provider choice is cited as the biggest benefit of Original Medicare. While Medicare Advantage may offer lower premiums and extra coverage areas, its provider network is significantly narrower and its plans require more prior authorizations.

Determining the right Medicare options for you is an important and complex process. We’ve weighed the costs and benefits and can help align the best plans with your healthcare needs, financial outlook and lifestyle. Contact us to set up a complimentary consultation at your convenience.

Resources: kff.org; medpac.gov

EASING THE Rx BURDEN: Medicare Prescription Payment Plan

June 4, 2026

If you signed up for the Medicare Prescription Payment Plan, you don’t need to reapply each year. As a refresher, this option lets you spread your out-of-pocket drug costs into manageable monthly bills instead of paying as you go at the pharmacy.

This voluntary option is available whether you have Traditional Medicare Part D or a Medicare Advantage plan with drug coverage. While the Medicare Prescription Payment Plan doesn’t lower your overall annual drug costs, it does help you budget them more smoothly throughout the year!

In 2026, Medicare plans automatically re-enroll you in the payment plan you’re already using as long as you stay in the same Part D or Medicare Advantage plan. However, if you’d prefer to opt out and pay at the pharmacy again, you can request that through your plan.

Sources: cms.gov; medicare.gov

WORKING IT OUT: Medicare Decision Making When You’re Employed

May 5, 2026

Approaching age 65 is an important milestone — in your life and in healthcare coverage. If, like millions of older Americans, you, your spouse, or both are still working and enrolled in an employer (group) medical insurance plan, there are critical decisions to weigh now to avoid financial penalties or gaps in coverage later.

Part A

Many people enroll in Medicare Part A (hospital insurance) at 65 because it’s usually premium-free. However, if you’re contributing to a Health Savings Account (HSA), enrolling in any part of Medicare means you can no longer contribute to your HSA. That’s an important planning detail to review.

Part B

If you’re covered by an employer plan (yours or your spouse’s), you may be able to delay Medicare Part B without penalty if the employer has 20 or more employees. However, if you do enroll and stay on the employer plan, the employer plan usually pays first, and Medicare would pay second. If the employer has fewer than 20 employees, Medicare generally becomes primary at age 65, and delaying Part B enrollment could lead to coverage gaps or penalties.

When You Retire

If one spouse over age 65 retires and loses employer coverage, that spouse may qualify for an 8-month Special Enrollment Period (SEP) to sign up for Medicare Part A or B without penalty. The SEP starts the month after employment ends or employer coverage ceases, whichever comes first. There is also a 2-month (63-day) window to join Part D or Medicare Advantage drug plan. Critical factors:

You must enroll during this time to avoid steep penalties
COBRA and Retiree Coverage do not count as current coverage. The SEP clock starts counting down when you stop working or regular employee coverage ceases.

How an Expert Can Help

While working and planning your transition to retirement, there are numerous complex questions to consider:

How much does the employer plan cost compared to Medicare?
Are your doctors and prescriptions covered the same way?
Do you travel often or live in more than one state?
Are you coordinating coverage for a spouse?
What is your projected financial situation and healthcare usage over the coming years?

Everyone’s needs and goals are a little different. Addressing these questions now can make the transition smooth and stress-free. Let us guide you into the next phase with a strong plan for Medicare enrollment.

Resources: cms.gov; medicare.gov; ssa.gov