Medicare Advantage Plans 2025 and possible changes in 2026

✅ Medicare Part C (Medicare Advantage) Explained

Serving Seniors in Augusta, GA
Helping you compare your Medicare Advantage options with confidence

🧍 Tab 1: Who Qualifies for Medicare Advantage (Part C)

To enroll in a Medicare Advantage Plan, you must meet all the following:

✅ Be enrolled in both Medicare Part A and Part B
✅ Live in the plan's service area (many plans are county-specific – Augusta and surrounding areas qualify for various plan options)
✅ Not have End-Stage Renal Disease (ESRD) (although as of 2021, most people with ESRD can now enroll in MA plans)
✅ Be a U.S. citizen or legal resident
✅ Apply during a valid enrollment period

Medicare Advantage is offered by private insurance companies approved by Medicare. Plans often include extra benefits like vision, dental, hearing, and prescription drug coverage (MAPD).

💲 Tab 2: What the Cost Is for Medicare Advantage

Unlike Original Medicare, costs for Medicare Advantage plans can vary by plan and location. Here's what you can expect:

🔹 Premiums:

Many plans have $0 monthly premiums
You must still pay the Part B premium ($174.70/month in 2025, unless income-based IRMAA applies)

🔹 Out-of-Pocket Costs:

Copays and coinsurance for doctor visits, hospital stays, etc.
Out-of-pocket maximum: Once you hit this annual limit, the plan covers 100% of covered services
- Average in 2025: ~$8,850 (in-network), varies by plan

🔹 Extra Benefits:

Some plans include:
- Vision, dental, hearing
- Gym memberships (like SilverSneakers)
- Over-the-counter (OTC) allowances
- Prescription drug coverage (Part D)

💡 Costs and coverage vary by plan — I can help you compare options available right here in Augusta.

📅 Tab 3: When Can One Sign Up for Medicare Advantage

Enrollment is limited to specific periods unless you qualify for a Special Enrollment Period (SEP).

🟢 Initial Enrollment Period (IEP)

7-month window around your 65th birthday
Must have Part A and B before enrolling in a Medicare Advantage plan

🔄 Annual Enrollment Period (AEP)

October 15 – December 7
Switch, enroll in, or drop a Medicare Advantage plan
Coverage begins January 1

🟡 Medicare Advantage Open Enrollment Period (MA-OEP)

January 1 – March 31
For people already in a Medicare Advantage plan
You can:
- Switch to a different Medicare Advantage plan
- Drop it and go back to Original Medicare (and join a Part D plan)

🔵 Special Enrollment Periods (SEPs)

Available for specific situations, such as:

Moving out of your plan’s service area
Losing other coverage (employer, Medicaid, etc.)
Plan changes or contract non-renewal

📅 I help clients in Augusta track these dates to avoid penalties and maximize benefits.

🔮 Tab 4: Possible Changes in 2026

Here’s what you might expect for Medicare Advantage in 2026:

📈 1. Premium and Benefit Adjustments

Some plans may raise or lower premiums and out-of-pocket limits
Additional benefits (OTC, dental, etc.) may expand or shift by carrier

🧾 2. CMS Oversight & Star Ratings

The federal government may update how plans are scored
Star ratings can impact plan quality, benefits, and marketing

💊 3. Integration of Drug Cost Reforms

Drug cost caps and negotiated pricing under Medicare drug reform laws may affect MAPD plans (those with drug coverage)

📲 4. More Digital and Telehealth Services

Continued focus on expanding telehealth, remote monitoring, and digital benefits

🛑 I’ll keep clients up to date on plan-specific changes as 2026 plans are released (usually by October 1).

Contact LIsa

Lisa MatfesS
HLM INSURANCE
Medicare Specialists

2918 PRofessional Parkway, Augusta, GA 30907

Medicare Advantage Plans 2025 and possible changes in 2026

✅ Medicare Part C (Medicare Advantage) Explained

🧍 Tab 1: Who Qualifies for Medicare Advantage (Part C)

💲 Tab 2: What the Cost Is for Medicare Advantage

🔹 Premiums:

🔹 Out-of-Pocket Costs:

🔹 Extra Benefits:

📅 Tab 3: When Can One Sign Up for Medicare Advantage

🟢 Initial Enrollment Period (IEP)

🔄 Annual Enrollment Period (AEP)

🟡 Medicare Advantage Open Enrollment Period (MA-OEP)

🔵 Special Enrollment Periods (SEPs)

🔮 Tab 4: Possible Changes in 2026

📈 1. Premium and Benefit Adjustments

🧾 2. CMS Oversight & Star Ratings

💊 3. Integration of Drug Cost Reforms

📲 4. More Digital and Telehealth Services

Lisa MatfesS HLM INSURANCE Medicare Specialists

2918 PRofessional Parkway, Augusta, GA 30907

Medicare Advantage Plans 2025 and possible changes in 2026

✅ Medicare Part C (Medicare Advantage) Explained

🧍 Tab 1: Who Qualifies for Medicare Advantage (Part C)

💲 Tab 2: What the Cost Is for Medicare Advantage

🔹 Premiums:

🔹 Out-of-Pocket Costs:

🔹 Extra Benefits:

📅 Tab 3: When Can One Sign Up for Medicare Advantage

🟢 Initial Enrollment Period (IEP)

🔄 Annual Enrollment Period (AEP)

🟡 Medicare Advantage Open Enrollment Period (MA-OEP)

🔵 Special Enrollment Periods (SEPs)

🔮 Tab 4: Possible Changes in 2026

📈 1. Premium and Benefit Adjustments

🧾 2. CMS Oversight & Star Ratings

💊 3. Integration of Drug Cost Reforms

📲 4. More Digital and Telehealth Services

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Lisa MatfesS
HLM INSURANCE
Medicare Specialists