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Find out why some Medicare Advantage plans are being discontinued, what it means if yours is affected, and how to protect yourself with a stable Medicare Supplement plan. Don't wait, know your options before it's too late!
“When you think about where we were as a country before Medicare and Medicaid were created and where we are now, it's an incredible story,” says Chiquita Brooks-LaSure, who until earlier this year was the administrator for the Centers for Medicare and Medicaid Services (CMS). In a recent essay for The Century Foundation, where she is now a senior fellow, Brooks-LaSure used the 60th anniversary of enactment of those foundational insurance programs to help put their impact on individual Americans, the healthcare system and society at large in perspective. One prominent example is the desegregation of hospitals, which was achieved in part by withholding reimbursements for care unless facilities served Blacks as well as whites. Another is making it possible for more people with disabilities to live at home instead of in institutional settings. But as you'll hear in this probing Raise the Line conversation with host Lindsey Smith, Brooks-LaSure worries that many gains in coverage and other progress made over the years through Medicare, Medicaid and the Child Health Insurance Program (CHIP) are at risk because of a new federal law that calls for a trillion dollar decrease in spending, resulting in potentially millions of people losing their coverage, cuts to clinical staff and medical services, and the closure of hospitals and clinics, especially in rural areas. “Most rural hospitals in this country are incredibly dependent on both Medicare and Medicaid to keep their doors open and there's an estimate that over 300 hospitals will close as a result of this legislation, so that, I think, is a place of incredible nervousness.” Whether you are a patient, provider, policymaker or health system leader, this is a great opportunity to learn from an expert source about the range of potential impacts that will flow from changes to critically important insurance programs that provide coverage to 40% of adults and nearly 50% of children in the U.S. Mentioned in this episode:The Century FoundationEssay on 60th Anniversary of Medicare & Medicaid If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/raisethelinepodcast
Are you turning 65 soon or starting to think seriously about healthcare in retirement? This week, I discuss the complicated world of Medicare—with a focus on the seven most costly mistakes people make when enrolling. From missing crucial deadlines and underestimating penalties, to overlooking the true costs Medicare doesn't cover and getting tripped up by income-related surcharges, I give practical advice to help you avoid expensive pitfalls and make confident choices for your health and your wallet. Whether you're working past 65, exploring Medicare Advantage and Medigap, or just want to sidestep penalties, this episode unpacks the essentials so you can enter retirement feeling prepared and protected. Let's get into the key rules, deadlines, and decisions every retiring listener needs to know! You will want to hear this episode if you are interested in... [04:17] Medicare enrollment guidelines & penalties. [09:35] Understanding Medicare coverage gaps. [11:55] Medicare enrollment and switching plans. [17:15] Medicare premiums based on income. [19:50] Avoid high medicare costs. [23:16] How you can use HSA funds. [24:56] Medicare costs and supplemental plans. 7 Medicare Mistakes that Could Cost You Making the transition to Medicare at 65 is a big step for retirees. While the program does have plenty of benefits, it also comes with a few key complexities and deadlines that can trip up the unprepared. 1. Not Enrolling on Time Despite common belief, Medicare enrollment isn't always automatic when you turn 65. You're only auto-enrolled if you've begun collecting Social Security at least four months before your 65th birthday. Otherwise, you must actively sign up to avoid lifelong late enrollment penalties—10% annually for Medicare Part B and 1% per month for Part D, the prescription drug plan. Remember, if you're not covered by qualifying employer insurance (typically from a company with 20 or more employees), you must enroll during your Initial Enrollment Period (IEP), which starts three months before and ends three months after your 65th birthday month. 2. Misunderstanding Late Enrollment Penalties Enrollment deadlines carry not just inconvenience, but long-term financial consequences. For every year you delay Part B, a 10% penalty is added to your premium—for life. For Part D, missing timely enrollment adds a 1% penalty per month delayed. Even if you don't currently take prescription drugs, failing to enroll in Part D or lacking “creditable” drug coverage will trigger this penalty. Many people only find out about these charges after it's too late, so mark your calendar and stay ahead of these key windows. 3. Not Comparing Original Medicare and Medicare Advantage Original Medicare doesn't cover everything, leaving you responsible for 20% of costs and lacking extras like dental or vision. Medicare Advantage, on the other hand, often bundles additional services and may come with lower or even zero premiums, thanks to how the government pays private insurers. However, these plans have different provider networks and coverage rules, so compare carefully based on your health needs, preferred providers, and annual costs. 4. Waiting to Enroll in a Medigap Policy Failing to evaluate supplemental Medigap coverage during your initial eligibility window could lead to denial or much higher premiums later, especially if you develop health conditions. During the first six months after enrolling in Part B, you're guaranteed acceptance into any Medigap plan regardless of health. Afterward, insurers can impose restrictions or deny coverage. States like Connecticut, New York, and Massachusetts offer more flexibility, but most don't—making early action essential. 5. Ignoring IRMAA: Higher Premiums for Higher Incomes Many retirees are surprised by IRMAA—the Income-Related Monthly Adjustment Amount—which increases Part B and D premiums if your income exceeds certain thresholds. These adjustments are based on your tax returns from two years prior. Even a minor one-time income bump (like a large IRA withdrawal) could propel you into a higher bracket, doubling your premiums. Be proactive: monitor your adjusted gross income and consider strategies like Roth conversions, careful withdrawal timing, or appealing based on life-changing events like retirement. 6. Making HSA Contributions After Enrolling in Medicare Once you sign up for Medicare Part A or B, both you and your employer must stop making contributions to a Health Savings Account (HSA) six months before enrollment. Over-contributing subjects you to a 6% excise tax for every year the excess remains. However, you can continue to use existing HSA funds for eligible medical expenses tax-free throughout retirement. 7. Underestimating Out-of-Pocket Costs Even with Medicare, you'll face deductibles, co-pays, and services not covered (like long-term care, dental, and vision). Part A hospital stays have significant deductibles per benefit period, and Part B leaves you covering 20% of outpatient expenses. Medicare Advantage and Medigap plans can help limit these expenses, but each comes with specific limits, provider restrictions, and rules. Without a supplemental plan, your maximum out-of-pocket exposure could reach $9,350 (in-network) or higher, depending on your plan. Resources Mentioned Retirement Readiness Review Subscribe to the Retire with Ryan YouTube Channel Download my entire book for FREE Connect With Morrissey Wealth Management www.MorrisseyWealthManagement.com/contact Subscribe to Retire With Ryan
Charisse dives into the upcoming Medicare window, opening October 15, discussing the potential rise in premiums and the importance of evaluating your current plans. Learn about the differences between Medicare Advantage and Medicare Supplement plans, and get practical advice on how to make the best choices for your health and finances. Like this episode? Hit that Follow button and never miss an episode!
Welcome to another insightful episode of the Agent Boost Marketing Podcast! This week, Rich steps in for Dan to discuss significant events affecting the insurance industry and the community in Lehigh, Utah, including the tragic incident involving Charlie Kirk. The episode dives into Agent Boost's national kickoff event, major industry shifts, non-commissionable plans for 2026, and strategies for succeeding during AEP. Listen in for essential tips on defending your book, diversifying your portfolio, and preparing for industry disruptions. Whether you're a seasoned pro or new to the game, this episode is packed with vital information to help you navigate these challenging times. Need to take your AHIP certification to sell Medicare Advantage plans? Use our official Agent Boost link to get started today. It's accepted by all major carriers and includes the $50 discount—bringing your cost down to just $125.
Healthcare compliance just shifted fundamentally.Traditional whistleblowers who needed inside access are being replaced by artificial intelligence (AI)-powered relators who mine public datasets and flag statistical anomalies that could signal fraud.The U.S. Department of Justice (DOJ) logged 979 qui tam cases in 2024, many of which were reportedly triggered by mathematical outliers, rather than insider tips. Government agencies, such as the Centers for Medicare & Medicaid Services (CMS), have already recovered $820 million using algorithmic detection.During the next live edition of Monitor Mondays, senior healthcare analyst Frank Cohen will reveal a possible solution for hospitals, health systems, and physician practices.The weekly broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Adam Brenman, senior government affairs analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action.
En la edición de hoy de Radar Empresarial, analizamos un reporte reciente del Wall Street Journal que revela que UnitedHealth ha intentado sin éxito establecer contacto directo con Donald Trump. La compañía busca discutir el programa Medicare, que en los últimos meses le ha generado importantes desafíos. Según el medio, el CEO de UnitedHealth, Stephen Hemsley, sostuvo una reunión con Susie Wiles, jefa de campaña del expresidente, con el objetivo de abordar cuestiones clave relacionadas con dicho programa gubernamental de salud. La situación se ha complicado por una investigación del Departamento de Justicia que examina posibles irregularidades en la facturación de Medicare por parte de la aseguradora. Aunque en julio la empresa accedió a colaborar con las autoridades, las indagaciones apuntan a prácticas engañosas, incluyendo cobros inflados y pagos encubiertos a residencias geriátricas para minimizar ingresos hospitalarios. Esta incertidumbre ha afectado directamente el rendimiento financiero de la empresa. A pesar de haber registrado ingresos por 111.620 millones de dólares en el segundo trimestre, su beneficio por acción fue de 4,08 dólares, quedando por debajo de las expectativas de los analistas. No obstante, hay señales de recuperación. La aseguradora anunció recientemente que estima que el 78% de sus usuarios en el plan Medicare Advantage estarán inscritos en opciones calificadas con cuatro estrellas o más el próximo año. Este logro le permitiría recibir bonificaciones adicionales del Gobierno, lo que se traduciría en mayores ingresos y un alivio para sus cuentas. Esta mejora llega en un momento clave, ya que las reformas en Medicare y Medicaid se han convertido en una de las prioridades del secretario de Salud, Robert F. Kennedy Jr. Kennedy ha sido crítico del sistema actual, señalando en febrero que Medicaid no está ofreciendo buenos resultados para los beneficiarios. Además, la reciente aprobación de la ley conocida como Big Beautiful Bill ha provocado controversia, ya que la Oficina Presupuestaria del Congreso advirtió que podría implicar recortes automáticos de hasta 490.000 millones de dólares en Medicare entre 2027 y 2034, pese a las promesas de Trump de no afectar estos programas. Cabe recordar que Medicare fue creado en 1965 bajo la presidencia de Lyndon Johnson y siempre ha generado debate. La situación de UnitedHealth se volvió aún más compleja tras el trágico asesinato de su anterior CEO, Brian Thompson, a manos de Luigi Mangione.
If you'd like to work with us on your Medicare health plan, we're licensed in 45 states and actively helping clients across the country. Christian and the team at Everything Senior Insurance represent many of the top insurance companies in the Medicare space. We're happy to help—just reach out! ➡️ Visit our site: https://www.eseniorinsurance.com✅ Call us: (801) 255-5340
On this episode of the Newcomer podcast, host Eric Newcomer is joined by co-host Nayeema Raza for conversations with some of the most influential voices in healthcare and venture capital. Bob Kocher, Partner at Venrock, and Annie Lamont, Founder and Managing Partner of Oak HC/FT, share their perspectives on business models in healthcare, the rise of AI applications, the promise and pitfalls of longevity drugs like GLP-1s, and the future of Medicare Advantage. Later, Vinod Khosla, Founder of Khosla Ventures, brings his trademark candor to a wide-ranging discussion about AI's role in healthcare, regulatory challenges, global competition, and how startups can reimagine the system from the ground up
Still managing to add value for patients and payor While US markets make new highs, the S&P managed care index is half the level it was a year ago. We talk to Kevin Fischbeck about what's driven the substantial weakness and whether deterioration in medical loss ratios (MLR) is temporary or something that will last and prevent these companies from recapturing past margins. Kevin also discusses the different markets served by managed care, from commercial to Medicare Advantage to Medicaid and how profitability challenges are likely to last longer for some of these markets than for others. But he also addresses how managed care adds value to each of these settings, delivering care more effectively and cheaply than the alternatives. He notes that vertical integration is still part of the strategy at some managed care companies, and something that can still help to better align incentives, but that it's been overshadowed by challenges faced elsewhere in the business. You may also enjoy listening to the Merrill Perspectives podcast, featuring conversations on the big stories, news and trends affecting your everyday financial life. "Bank of America" and “BofA Securities” are the marketing names for the global banking businesses and global markets businesses (which includes BofA Global Research) of Bank of America Corporation. Lending, derivatives, and other commercial banking activities are performed globally by banking affiliates of Bank of America Corporation, including Bank of America, N.A., Member FDIC. Securities, trading, research, strategic advisory, and other investment banking and markets activities are performed globally by affiliates of Bank of America Corporation, including, in the United States, BofA Securities, Inc. a registered broker-dealer and Member of FINRA and SIPC, and, in other jurisdictions, by locally registered entities. ©2025 Bank of America Corporation. All rights reserved.
On this episode of the Newcomer podcast, host Eric Newcomer is joined by co-host Nayeema Raza for conversations with some of the most influential voices in healthcare and venture capital. Bob Kocher, Partner at Venrock, and Annie Lamont, Founder and Managing Partner of Oak HC/FT, share their perspectives on business models in healthcare, the rise of AI applications, the promise and pitfalls of longevity drugs like GLP-1s, and the future of Medicare Advantage. Later, Vinod Khosla, Founder of Khosla Ventures, brings his trademark candor to a wide-ranging discussion about AI's role in healthcare, regulatory challenges, global competition, and how startups can reimagine the system from the ground up
It seems there are news stories every week about the accelerating pace of innovation in gene therapy, but only about 50 therapies have been approved so far by the US Food and Drug Administration. Our guest today, Dr. Bobby Gaspar, leads a UK-based biotech company, Orchard Therapeutics, that developed one of those treatments using gene-modified stem cells in your blood that self-renew, so a single administration can give you potentially a lifelong effect. “Our approach is about correcting those hematopoietic stem cells and allowing them to give rise to cells that can then correct the disease,” explains Dr. Gaspar. The therapy in focus is lenmeldy, the first approved treatment for metachromatic leukodystrophy, also known as MLD, a devastating inherited disorder that affects roughly 600 children worldwide. But Dr. Gaspar is optimistic that learnings from Orchard's work on MLD could be useful in treating much more common disorders including frontotemporal dementia, Crohn's disease and others. This highly informative conversation with host Lindsey Smith also explores the importance of newborn screening, community collaboration in advancing clinical trials for rare diseases, and a future in which each gene therapy will be used as a tool for specific applications. “There will be many gene therapies available, some of which will become the standard of care for certain diseases, but it won't be for every disease.”Mentioned in this episode:Orchard Therapeutics If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/raisethelinepodcast
Learn how to sponsor the Seven Figure Medicare Agent Summit:https://sevenfiguremedicareagentsummit.com/On this episode of the Seven Figures or Bust podcast, we break down how agents can dominate AEP without relying on Medicare Advantage sales.
This week's Product Call is one you don't want to miss!
AEP 2026 will be here before you know it. We've broken down the path to a successful Annual Enrollment Period in 5 steps, tap that play button to find out what they are! Read the text version Contact the Agent Survival Guide Podcast! Email us ASGPodcast@Ritterim.com or call 1-717-562-7211 and leave a voicemail. Resources: Certification Center on Ritter Docs Compliance Posts on the Ritter Blog Compliance Tab in Ritter Docs Get Registered with Ritter Insurance Marketing Integrity Technology Training Schedule Meet Your Sales Team at Ritter Insurance Marketing Miramar:Agent Pinpoint Global Ritter Events Calendar The Complete Guide on How to Sell Medicare Advantage Plans The Complete Guide on How to Sell Prescription Drug Plans The Ritter Agent Compliance Handbook References: “CMS 2025 Medicare Advantage and Part D Final Rule.” Federalregister.Gov, Centers for Medicare & Medicaid Services, www.federalregister.gov/documents/2024/04/23/2024-07105/medicare-program-changes-to-the-medicare-advantage-and-the-medicare-prescription-drug-benefit. Accessed 28 Aug. 2025. “Medicare Advantage Communication Requirements.” Federalregister.Gov, Centers for Medicare & Medicaid Services, www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-422/subpart-V. Accessed 28 Aug. 2025. “Medicare Marketing Guidelines.” CMS.Gov, Centers for Medicare & Medicaid Services, www.cms.gov/medicare/health-drug-plans/managed-care-marketing/medicare-guidelines. Accessed 28 Aug. 2025. “Part D Communication Requirements.” Federalregister.Gov, Centers for Medicare & Medicaid Services, www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-423/subpart-V. Accessed 28 Aug. 2025. Follow Us on Social! Ritter on Facebook, https://www.facebook.com/RitterIM Instagram, https://www.instagram.com/ritter.insurance.marketing/ LinkedIn, https://www.linkedin.com/company/ritter-insurance-marketing TikTok, https://www.tiktok.com/@ritterim X, https://x.com/RitterIM and YouTube, https://www.youtube.com/user/RitterInsurance Sarah on LinkedIn, https://www.linkedin.com/in/sjrueppel/ Instagram, https://www.instagram.com/thesarahjrueppel/ and Threads, https://www.threads.net/@thesarahjrueppel Tina on LinkedIn, https://www.linkedin.com/in/tina-lamoreux-6384b7199/ Not affiliated with or endorsed by Medicare or any government agency.
Discover how you can join the course today!:https://sevenfigurecrm.com/how-to-find-and-purchase-books-of-businessesOn this episode of the Seven Figures or Bust podcast, we dive into shocking news—a Medicare Advantage carrier has announced that all commissions are gone.
Medicare Advantage plans are about to face unprecedented scrutiny as the Centers for Medicare & Medicaid Services (CMS) implements a dramatically expanded approach to RADV audits. Starting in 2025, every Medicare Advantage plan will be subject to contract-level RADV audits—a significant departure from the historical approach of randomly selecting 60 plans annually. During this 17-minute podcast, Deborah Curry, risk adjustment programs director at Medical Mutual. breaks down the critical changes that compliance teams need to prepare for immediately. She offers practical strategies for surviving this new audit environment, emphasizing the importance of designated backup personnel, weekly progress huddles, and careful oversight of vendors retrieving medical records. Whether you're already facing a RADV audit or preparing for the inevitable, this episode provides essential guidance for navigating CMS' aggressive new approach. For deeper insights, join RISE in Tampa, Fla. on October 21-23 for the 26th Risk Adjustment Forum, where Curry will be sharing additional strategies for RADV readiness.About Deborah CurryDeborah Curry, risk adjustment programs director, Medical Mutual, joined Paramount Healthcare in May 2013 and oversees the Risk Adjustment, Coordination of Benefits, and Subrogation departments. Prior to her position with Paramount, she had 21 years' experience working with the State of Ohio workers' compensation program, both for the government and a contracted managed care organization. She came to Paramount with extensive knowledge in medical coding, provider billing and education, Medicare payment methodologies, quality assurance, and regulatory compliance.Curry attended The University of Toledo for both her undergraduate and graduate degrees and currently holds a Master of Business Administration with major in Healthcare Systems Management. She is an active member of the American Health Information Management Association (AHIMA) and is a Registered Health Information Administrator (RHIA) and Certified Coding Specialist, physician based (CCS-P).Curry is also an active member of the America Academy of Professional Coders (AAPC) and is a Certified Risk Adjustment Coder (CRC). She holds certificates as a Risk Adjustment Practitioner (RAP) and Advanced HCC Auditor (AHCCA and serves as a Board Member of the University of Toledo Health Information Administration Advisory Board, Health and Human Services Alumni Affiliate at The University of Toledo, and Health Information Technology Advisory Committee at Owens Community College.About the Risk Adjustment ForumRISE's Risk Adjustment Forum is designed for leaders in risk adjustment, coding, compliance, finance, and analytics across Medicare Advantage, Medicaid, Affordable Care Act, and commercial plans. The three-day event, which will take place Oct. 21-23 at the Grand Hyatt Tampa Bay, will tackle RADV audit ramp‑up and extrapolation, the Big Beautiful Bill Act, V28/RxHCC shifts, internal audit design, and CDI.
In this episode of the Secure Your Retirement Podcast, Radon Stancil and Murs Tariq sit down with Medicare specialist Shawn Southard to unpack the recent developments around Medicare Advantage brokers, broker compensation, and the impact of a federal court ruling on CMS Medicare rules. With Medicare open enrollment and aggressive Medicare marketing campaigns happening every year, understanding how brokers get paid and how it may influence the advice you receive has never been more important. Shawn explains how the recent court decision effects Medicare plan comparison, Medicare star ratings, and the role of brokers in guiding retirees. If you're planning retirement or reviewing your options during Medicare open enrollment, this episode provides practical insights and unbiased Medicare advice to help you make informed choices. Listen in to learn about: How Medicare broker compensation structures may impact your coverage decisions and what questions you need to ask to protect yourself from Medicare scams. Whether you're seeking SHIP counseling, comparing plans, or building your retirement checklist, this discussion will help you confidently navigate your Medicare options and secure your retirement. In this episode, find out: The details behind the CMS rule, the court ruling, and what it means for Medicare Advantage beneficiaries. How broker compensation can influence recommendations and why questions to ask brokers are critical. Why aggressive Medicare marketing and commercials may increase — and how to stay vigilant. How to leverage Medicare plan comparison tools and SHIP counseling for unbiased Medicare advice. Steps you can take today to make smart, confident decisions for retiring comfortably. Tweetable Quotes: “Understanding how Medicare brokers are compensated empowers you to make better decisions and avoid being swayed by marketing tactics.” — Radon Stancil “Medicare open enrollment is your opportunity to make informed choices — but only if you ask the right questions and focus on what's best for you, not the broker.” — Murs Tariq Resources: If you are in or nearing retirement and you want to gain clarity on what questions you should be asking, learn what the biggest retirement myths are, and identify what you can do to achieve peace of mind for your retirement, get started today by requesting our complimentary video course, Four Steps to Secure Your Retirement! To access the course, simply visit POMWealth.net/podcast.
If you'd like to work with us on your Medicare health plan, we're licensed in 45 states and actively helping clients across the country. Christian and the team at Everything Senior Insurance represent many of the top insurance companies in the Medicare space. We're happy to help—just reach out! ➡️ Visit our site: https://www.eseniorinsurance.com✅ Call us: (801) 255-5340
WATCH OUR LIVE KICKOFF EVENT 9-9-25 @ 8am MST:https://youtube.com/live/5Gjbi9UXZ5YWelcome to the newest episode of the Agent Boost Podcast!
Consider this a wake-up call.As artificial intelligence (AI) quietly becomes part of the audit trail, healthcare leaders must ask a new question: who's reviewing the reviewers?During the next live edition of the venerable Monitor Mondays broadcast, contributing editor Sharon Easterling will break down why auditing AI tools are no longer a tech issue – they're a documentation integrity and compliance priority.Although this is an important topic for all healthcare professionals, register now to learn why it's particularly relevant for those in compliance and revenue integrity.The weekly broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Cate Brantley, senior government affairs analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action.
Medicare Advantage Minute: A reliable new study indicates that there is a growing level of dissatisfaction with MA plans. Your Medicare Benefits 2025: Pain Management is the subject for this episode. Finally, we present a list of sources of assistance with Medicare information and enrollment. Contact me at: DBJ@MLMMailbag.com (Most severe critic: A+) Visit us on: BabyBoomer.ORG Inspired by: "MEDICARE FOR THE LAZY MAN 2025; SIMPLEST & EASIEST GUIDE EVER!" "MEDICARE DRUG PLANS: A SIMPLE D-I-Y GUIDE" "MEDICARE FOR THE LAZY MAN: BARE BONES!" For sale on Amazon.com. After enjoying the books, please consider returning to leave a short customer review to help future readers. Official website: https://www.MedicareForTheLazyMan.com.
Health insurance in retirement does not have to be confusing. In this episode, Nick talks with Justine Bell of BeneGuides about marketplace coverage before 65, Medicare at 65, and how to compare real-world costs based on your doctors, prescriptions, and budget. We cover timing, penalties, and why an annual re-enrollment check can keep you from paying more than you need to. https://youtu.be/z-SnGX-qR88 What we cover Why working with a health insurance specialist costs you nothing and often saves time and trouble The five questions BeneGuides asks for marketplace plans: county and ZIP, ages, who is on the tax return, doctors and prescriptions, and expected MAGI How to think about “average year” costs vs “worst-case” out-of-pocket risk When bronze plans make sense and when to step up for drug coverage Medicare 101: Original Medicare, Medicare Advantage, and Medigap basics How to time your Medicare enrollment, including the first-of-the-month birthday quirk Why BeneGuides re-enrolls every client each year and stays on top of formularies and plan changes What may change in 2026 and why this open enrollment deserves a careful review Key open enrollment windows to mark on your calendar Dates to know Medicare plan review starts October 1 Medicare enrollment runs October 15 through December 7 Marketplace open enrollment runs November 1 through December 15 Contact BeneGuides Email: health@beneguides.com Phone: 517-939-1981 Team: Lauren and Kylie (Medicare), Liz and Andrea (Marketplace), Daniel (Group coverage) Resources mentioned Medicare 101 webinar from BeneGuides Listen to the full episode for the complete conversation and practical next steps. About Shotwell Rutter Baer At Shotwell Rutter Baer, we believe retirement planning should feel simple and personal. As independent, fee-only financial advisors, our priority is you. We are not paid by commissions or product sales. Instead, our advice is focused on helping you make clear decisions about your money, your retirement, and your future. We are proud to serve individuals and families who want practical guidance, a reliable strategy, and a trusted partner for every stage of life. Whether you are just beginning to think about retirement or you want to fine tune your income plan, we are here with straightforward advice and a plan that reflects your goals. Resources Email us at SRBadvisors.com to connect with our team. Learn about the Strategic Reliable Blueprint which is our process for building a financial plan that works for your future. Subscribe to our YouTube channel for helpful conversations and practical retirement planning tips.
TikTok and TV ads push seniors into Medicare Advantage scams while MAGA voters lose jobs, Trump's allies discourage college, billionaires back fascism, and airline rules are gutted.Subscribe to our Newsletter:https://politicsdoneright.com/newsletterPurchase our Books: As I See It: https://amzn.to/3XpvW5o How To Make AmericaUtopia: https://amzn.to/3VKVFnG It's Worth It: https://amzn.to/3VFByXP Lose Weight And BeFit Now: https://amzn.to/3xiQK3K Tribulations of anAfro-Latino Caribbean man: https://amzn.to/4c09rbE
Here is why you should disregard the TikTok, Instagram, YouTube, and TV ads purporting to educate you on all things Medicare. They will try to coerce you into enrolling in a Medicare Advantage plan.Subscribe to our Newsletter:https://politicsdoneright.com/newsletterPurchase our Books: As I See It: https://amzn.to/3XpvW5o How To Make AmericaUtopia: https://amzn.to/3VKVFnG It's Worth It: https://amzn.to/3VFByXP Lose Weight And BeFit Now: https://amzn.to/3xiQK3K Tribulations of anAfro-Latino Caribbean man: https://amzn.to/4c09rbE
Gain access to Everything Senior Insurance: https://eseniorinsurance.com/On this episode of the Seven Figures or Bust podcast, we cover the shocking news of a carrier dropping all Medicare Advantage members in 2026.
You are in for a dose of inspiration in this episode of Raise the Line as we introduce you to a rare disease patient who was a leading force in establishing the diagnosis for her own condition, who played a key role in launching the first phase three clinical trials for it, and who is now coordinating research into the disease and related disorders at one of the nation's top hospitals. Rebecca Salky, RN, was first afflicted at the age of four with MOGAD, an autoimmune disorder of the central nervous system that can cause paralysis, vision loss and seizures. In this fascinating conversation with host Lindsey Smith, Rebecca describes her long and challenging journey with MOGAD, her work at the Neuroimmunology Clinic and Research Lab at Massachusetts General Hospital, and the importance of finding a MOGAD community in her early twenties. “There's a sense of power and security when you have others on your side. You're not alone in this journey of the rare disease,” she explains. Be sure to stay tuned to learn about Rebecca's work in patient advocacy, her experience as a nurse, and the three things she thinks are missing in the care of rare disease patients as our Year of the Zebra series continues.Mentioned in this episode:The MOG ProjectNeuroimmunology Clinic & Research Lab at Mass General If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/raisethelinepodcast
oni solves a Medicare Advantage problem using the Medicare Special Enrollment Period! Need more information? Take advantage of Toni's brand new video series now a available at www.tonisays.com Remember - with Medicare it's what you don't know that will hurt you! There's so much good information in this podcast, please be sure to share this podcast with your friends! Recognized by feedspot.com as one of the best Medicare Podcasts in the nation! Write Toni - info@tonisays.com. Toni's book is available at www.seniorresource.com and www.tonisays.com You can call Toni at 832-519-8664 Toni welcomes all Medicare questions. Toni ow offers informative Medicare Webinars for all of your Medicare needs at www.Tonisays.com You can find Medicare Moments wherever you find your favorite podcasts, such as: Apple: https://apple.co/44MoguG Spotify: https://open.spotify.com/show/7c82BS4hb145GiVYfnIRsoAmazon Music: https://music.amazon.com/podcasts/884c1f46-9905-4b29-a97a-1a164c97546b/medicare-moments?refMarker=null Toni's new book: Maze of Medicare is now available at www.tonisays.com Combining Scripture with Medicare, it is the only book of its kind. Toni's columns appear weekly in about 100 newspapers across America. If you would like Toni's column to appear in your local paper, or if you would like Toni to speak at an event - contact Toni King at 832-519-8664 Thank you for listening and be sure to tell your friends about Medicare Moments! Blessings!See omnystudio.com/listener for privacy information.
Telehealth for speech therapy is under threat, and if Medicare pulls access, the consequences could ripple far beyond one program. Adults, families, and care partners lose critical care options, but that's just the start. A Medicare rollback could trigger private insurance and Medicaid to follow suit, resulting in reduced access across the board. In this episode, we explore why telehealth is crucial for patients who can't drive, for care partners balancing demanding schedules, and for clinicians serving rural and underserved communities. You'll also get advocacy tools, ready-to-use letter templates, and simple ways to mobilize your practice and patients to keep telehealth accessible.Find all of the advocacy tools you need here to participate in the telehealth call to action, or check out Katie's SLPs Blueprint to Medicare Success and get $100 off with the code FixSLP.Stop paying to track ASHA-approved CEUs. Save your money and set up for a FREE CEU/PDH tracker with Speech Therapy PD. While you are there, get $10 off a professional subscription with the code FixSLP10! Thank you to our sponsor, ⭐️ Befitting You Medical Supply ⭐️, offering AAC devices with hands-on assessments, education, and support for patients and families. Check them out!New here? Subscribe, share with a colleague, and call the Minivan Meltdown line at fixslp.com to add your voice.
Insurance Dudes: Helping Insurance Agency Owners Gain Business Leverage
Welcome back to another episode of The Insurance Dudes! Craig and Jason sit down with the energetic and insightful Julian Chambers. From his early days dabbling in network marketing straight out of high school, to finding his stride in life insurance and then crushing it in Medicare sales, Julian shares his journey as a young entrepreneur in the insurance world.You'll hear firsthand about the mindset shifts, personal development rituals inspired by Tony Robbins and Grant Cardone, and the actionable strategies that helped Julian go from rookie uncertainty to writing ten Medicare Advantage policies a week.If you're an agent looking to up your game or just need a dose of motivation, you won't want to miss this episode packed with real talk, practical tips, and a whole lot of inspiration. Let's dive in!Join the elite ranks of P&C agents. Sign up for Agent Elite today and get exclusive resources to grow your agency!
Personalization, engagement, and “food as medicine” programs are shaping the future of preventive care. This episode features a conversation with Jared Childs and Julie Fleisher from Soda Health; a company focused on improving access to preventive healthcare through benefits platforms. Barry Thomas and Rachel Dalton sat down with Jarden and Julie to explore how their innovative platform is transforming healthcare access for millions of Medicare Advantage members. Discover how Soda Health connects brands, retailers, and health plans to empower older consumers with easy-to-use benefits cards for OTC products, healthy food, and more. Tune in to learn how Soda Health is driving collaboration, closed-loop analytics, and meaningful outcomes for consumers and partners alike! Have a topic you'd like us to cover? Contact us at Kantar's Retail Sound Bites Podcast. Contact Barry: Email | LinkedIn Contact Rachel: Email | LinkedIn Smoothie King launches a food menu nationwide, a first for the brand As Publishers Face Search Headwinds, Creators Gain Affiliate Spend The most powerful retail media screen is already in stores https://www.retaildive.com/news/macys-partners-amazon-retail-ads-holidays/758719/ https://www.modernretail.co/operations/many-target-stores-will-stop-fulfilling-online-orders/ https://fortune.com/2025/08/25/keurig-dr-pepper-peets-coffee-18-billion/
SPECIAL EPISODE: Prior authorization causes misery in Medicare Advantage plans. How concerned should freedom lovers be when the government delivers that same troublesome process to Original Medicare? Contact me at: DBJ@MLMMailbag.com (Most severe critic: A+) Visit us on: BabyBoomer.ORG Inspired by: "MEDICARE FOR THE LAZY MAN 2025; SIMPLEST & EASIEST GUIDE EVER!" "MEDICARE DRUG PLANS: A SIMPLE D-I-Y GUIDE" "MEDICARE FOR THE LAZY MAN: BARE BONES!" For sale on Amazon.com. After enjoying the books, please consider returning to leave a short customer review to help future readers. Official website: https://www.MedicareForTheLazyMan.com.
Right up front here, let me just state loudly that there are some amazing independent TPAs (third-party administrators) out there who have the expertise, the scrappy willfulness, and the deep desire to do right by their clients, their self-insured employer clients. For a full transcript of this episode, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. And look, they may be facing some of the same headwinds that plan sponsors themselves face, like anticompetitive contracts, brokers who are up to no good, etc. So, just keep that in mind as you listen. And the main point of all of this if you are a plan sponsor is, find a good TPA partner, which, as Bryce Platt has said about consultants but same rules apply about TPAs here, the difficulty is being informed enough to tell the difference. So, the goal of this show is to help with that, the “be informed enough to tell the difference.” All of this being said, this is technically a Take Two; but we trimmed it down and welcome to a whole new intro. So, call this a refresher and an update about a really, really important topic from last year that is becoming extremely (maybe even more) relevant this year. Really relevant. Consider, for example, the show with Claire Brockbank (EP453) about carrier/TPA RFPs (requests for proposal) and all of the landmines that are really expensive, that are buried in some of these contracts. Then there was the Cynthia Fisher show (EP457) from last year about the millions, maybe billions of dollars in aggregate going missing in medical (ie, TPA or ASO [administrative services only]) spread pricing. We had “The Mystery of the Weekly Claims Wire” show with Justin Leader (EP433), again, revealing money that's being disappeared when the TPA is withdrawing dollars from plan sponsor checking accounts. And then there's the payment integrity episode with Kimberly Carleson (EP480) from a few weeks ago with just another wrinkle on this, namely TPAs or ASOs who insist on auditing themselves and how that turns out for members and plan sponsors. Oh, and last, but certainly not least, is the whistleblower show with Ann Lewandowski (EP476) on how a TPA arm of an EBC (employee benefit consultant) allegedly pocketed $20 million—$20 million of their client's pharma rebates—and used that $20 million to fund their executive bonus pool. What a time to be alive! All of this just highlights the huge stakes for plan sponsors to really understand what their TPA is all about. And when I say high stakes, I mean from both a legal standpoint and also just vast dollars in play here. But this episode with Elizabeth Mitchell is also, I'm gonna say, extremely relevant given just a few ripped from the headlines and news articles such as these. I'm gonna start actually with a post from Kimberly Carleson, and I like the comment by Jeff Evans, who wrote, “How does $8,710 equal $104,266?” Spoiler alert, it doesn't. Lots of missing dollars there. Someone's hands are in the cookie jar. Oh, look, the TPA has entered the chat. In a nutshell, and I'm quoting something Peter Hayes wrote, he wrote, “TPAs have received relatively little public attention. [There's an article in Health Affairs] that describes how TPAs impose hidden fees, benefit from their own form of spread pricing, and otherwise prioritize their own financial interests over those of their plan clients.” Also, here's a totally other issue. Let me quote Luke Prettol highlighting something Jason Shafrin had written about a paper by Jeff Marr, Daniel Polsky, and Mark Meiselbach. Let me slightly rephrase what Luke said. He wrote, “Employers pay, on average, a 4.7% [so almost 5%] price markup when hospitals are in their TPA's [Medicare Advantage] network.” Right? Dr. Eric Bricker talked about this in that episode (EP472) just how TPAs with MA (Medicare Advantage) business negotiate their commercial clients to pay higher rates so that then they can pay lower rates for their own MA members. As Luke wrote, “On its face, this overpayment does not appear to be solely in the interest of participants.” No kidding. Now, let's spin the wheel here. There are barriers for TPAs themselves, even the ones who have a deep desire to do the right thing. As Patrick Moore wrote, “Most TPAs still can't do [many of the things that employers might want because there are] PPO contracts.” So, is it a rock in a hard place situation? I mean, if the TPA has no other options than using a carrier's PPO (preferred provider organization) network with all its attendant contractual issues, then yeah, that is one definite challenge. Along these lines, let me read a post by Rina Tikia, because I think she sums up this really well. “When independent TPAs … push for transparency, they're blocked under the banner of ‘fiduciary risk.' “Meanwhile, the largest carriers and PBMs, with Cayman shell subsidiaries, DOJ kickback probes, [huge] hedge fund ties, [$10 million-plus] lobbying budgets, and antitrust violations continue unchecked. They are not only allowed to operate but celebrated as mainstream options. “Why the double standard? Political donations? Foundation smokescreens? Nonprofit status as a PR shield?” These are excellent questions. And here's another challenge: brokers. Ramesh Kumar Budhani wrote about this one, just how hard it is sometimes to find—for TPA, an independent TPA, trying to do the right thing—to find brokers who prioritize doing the right thing for employers and helping their clients save money. The summary of all of this: There are TPAs and there are ASOs who aren't even trying. They are going to ride the flywheel, the gravy train, and catch all of the dollars flying off of it for as long as they can manage to cling to it with all 10 of their fingers. Then there are TPAs, mostly indies, trying super hard to do the right thing. But how successful they are is going to depend on how boxed in they are by the PPO networks or the carriers that the brokers or even plan sponsors may insist on. Just how courageous they are and just how smart they are and experienced they are about the market and how it actually operates. So, the show that follows is about all of this, including how we can inspire TPAs, which, in the show that follows, subsumes ASOs kind of into it. But in the show that follows, I hope it's inspiring to create an environment so that the market demands TPAs that do all of the things, and we make inertia not a viable business strategy. Elizabeth Mitchell, my guest today, currently serves as the president and CEO of the Purchaser Business Group on Health. Also mentioned in this episode are Purchaser Business Group on Health; Bryce Platt; Claire Brockbank; Cynthia Fisher; Justin Leader; Kimberly Carleson; Ann Lewandowski; Jeff Evans; Peter Hayes; Luke Prettol; Jason Shafrin; Jeff Marr; Daniel Polsky; Mark Meiselbach; Eric Bricker, MD; Tom Nash; Patrick Moore; Rina Tikia; Ramesh Kumar Budhani; Mark Cuban; Harold Miller; Chris Deacon; Moby Parsons, MD; Benjamin Schwartz, MD, MBA; Mishe Health; Rik Renard; and Cora Opsahl. You can learn more at PBGH and by connecting with Elizabeth on LinkedIn. Elizabeth Mitchell, president and CEO of the Purchaser Business Group on Health (PBGH), advances its strategic focus areas of advanced primary care, functional markets, and purchasing value. She leads PBGH in mobilizing health care purchasers, elevating the role and impact of primary care, and creating functional healthcare markets to support high-quality affordable care, achieving measurable impacts on outcomes and affordability. At PBGH, Elizabeth leverages her extensive experience in working with healthcare purchasers, providers, policymakers, and payers to improve healthcare quality and cost. She previously served as senior vice president for healthcare and community health transformation at Blue Shield of California, during which time she designed Blue Shield's strategy for transforming practice, payment, and community health. Elizabeth served as the president and CEO of the Network for Regional Healthcare Improvement (NRHI), a network of regional quality improvement and measurement organizations. She also served as CEO of Maine's business coalition on health (the Maine Health Management Coalition), worked within an integrated delivery system (MaineHealth), and was elected to the Maine State Legislature, serving as a State Representative. Elizabeth served as vice chairperson of the U.S. Department of Health and Human Services Physician-Focused Payment Model Technical Advisory Committee, board and executive committee member of the National Quality Forum (NQF), member of the National Academy of Medicine's “Vital Signs” Study Committee on core metrics, and a guiding committee member for the Health Care Payment Learning & Action Network. Elizabeth holds a degree in religion from Reed College and studied social policy at the London School of Economics. 08:06 What is the overarching context for health plans in healthcare purchasing? 11:31 Why is it important to reestablish a connection between the people paying for care and people providing care? 13:47 What are the needs of a self-insured employer when managing employee benefits? 19:00 Is it doable for employers to set their own contracts? 21:24 Is transparency presumed? 22:39 Will the new transparency upon us actually expose wasted expense? 24:23 EP408 with Chris Deacon. 25:58 “This is not about individual bad actors. … The systems … that is not aligned.” 27:39 Are there providers who want to work directly with employers? 30:53 Why is it important that incentives need to be aligned? 32:42 EP427 with Rik Renard. 33:51 What's missing from the conversation on changing health plans? You can learn more at PBGH and by connecting with Elizabeth on LinkedIn. @lizzymitch2 of @PBGHealth discusses #TPA and #healthplan vs. #jumboemployer inertia on our #healthcarepodcast. #healthcare #podcast #financialhealth #patientoutcomes #primarycare #digitalhealth #healthcareleadership #healthcaretransformation #healthcareinnovation Recent past interviews: Click a guest's name for their latest RHV episode! Dave Chase, Jonathan Baran (Part 2), Jonathan Baran (Part 1), Jonathan Baran (Bonus Episode), Dr Stan Schwartz (Summer Shorts), Preston Alexander, Dr Tom X Lee (Take Two: EP445), Dr Tom X Lee (Bonus Episode), Dr Benjamin Schwartz, Dr John Lee (Take Two: EP438), Kimberly Carleson, Ann Lewandowski (Summer Shorts)
“You have to love what you do, especially in healthcare, and the earlier you find that, the better. So that's why I love to see HOSA helping young people find what it is that they want to do,” says Dr. David Kelly, a fellow in oculofacial surgery at University of California San Francisco and HOSA's board chair. You can still hear the excitement in Dr. Kelly's voice describing his earliest experiences with HOSA -- a student led organization with 300,000 plus members that prepares future health professionals to become leaders in international health – even though they happened sixteen years ago when he was a sophomore in highschool. Through hundreds of competitive events and hands-on projects, HOSA creates a framework for developing skills in communication, professionalism and leadership starting in middle school. Programs are offered throughout highschool and college as well, which Dr. Kelly took advantage of before becoming an active alumnus and joining the HOSA board as a way of giving back to an organization that has given so much to him. Since taking the reins as board chair last year, one key focus has been preparing to mark HOSA's 50th anniversary in 2026. Dr. Kelly sees the occasion as not only an opportunity to celebrate what HOSA has accomplished, but to ensure it is positioned to continue helping the healthcare industry tackle important challenges in the future. Examples include chronic workforce shortages and improving how clinicians communicate with patients and team members. Join host Lindsey Smith on this uplifting Raise the Line episode for an optimistic look at the next generation of healthcare leaders.Mentioned in this episode:HOSAHOSA Alumni Registration If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/raisethelinepodcast
A federal judge has halted recent changes to the Affordable Care Act exchanges. More Medicare patients are leaving the hospital against medical advice, according to a new report. And satisfaction with Medicare Advantage plans is falling, fueled in part by declining trust. These stories and more are on today's episode of the Gist Healthcare Podcast. Hosted on Acast. See acast.com/privacy for more information.
Insurers pull Medicare Advantage plans as profit pressures mount: This from the "Medicare Advantage Minute" In the "Your Medicare Benefits 2025" we learn how Medicare is likely to cover Outpatient hospital services. Friend of the podcase, Steve sent an article addressing "Targeted Medicare Cuts" and how they can save money while reducing risk. How about a side trip to Social Security Land? Someone named Rusty has an advisory column and fielded a question from a reader about when the best time might be to start collecting Social Security benefits might be. Normally Democrats are on the opposite side of almost every possible subject from me but we now find ourselves connected like Siamese twins over support for the freedom from prior authorization in Original Medicare. I am dazed and confused by my unexpected alliance! Finally, we have a new member of the podcast audience who hangs her hat in South Dakota ...er Nebraska sometimes. I expect her to join the ranks of my happy clients as well! Contact me at: DBJ@MLMMailbag.com (Most severe critic: A+) Visit us on: BabyBoomer.ORG Inspired by: "MEDICARE FOR THE LAZY MAN 2025; SIMPLEST & EASIEST GUIDE EVER!" "MEDICARE DRUG PLANS: A SIMPLE D-I-Y GUIDE" "MEDICARE FOR THE LAZY MAN: BARE BONES!" For sale on Amazon.com. After enjoying the books, please consider returning to leave a short customer review to help future readers. Official website: https://www.MedicareForTheLazyMan.com.
In this episode of Healthcare Americana, host Christopher Habig sits down with Dr. Marion Mass, pediatrician and co-founder of Practicing Physicians of America, to uncover widespread fraud and abuse in the Medicare Advantage program. They break down how insurers use practices like upcoding, assigning patients exaggerated or false diagnoses, to collect billions in taxpayer dollars each year, with UnitedHealthcare highlighted as a major offender. Dr. Mass explains the systemic conflicts of interest, lack of accountability, and the urgent need for audits, penalties, and transparency to protect both patients and federal budgets. The conversation also highlights the importance of informed healthcare choices and explores how direct care models offer a more sustainable alternative. This episode is a must-listen for anyone concerned about Medicare, insurance oversight, and the integrity of America's healthcare system.More on Freedom Healthworks & FreedomDoc HealthSubscribe at https://healthcareamericana.com/More on Dr. Marion Mass & Practicing Physicians of AmericaFollow Healthcare Americana: Instagram & LinkedIN
The power of Health Savings Accounts (HSAs) as a tool for both managing health expenses and building your retirement savings is often overlooked. On this episode, I'm sharing the basics of HSAs, highlighting their triple tax-free advantage, and explaining why they might be one of the best ways to maximize your retirement savings, even compared to more familiar accounts like IRAs and 401(k)s. I also unpack some important upcoming changes to HSAs thanks to the One Big Beautiful Bill Act, set to take effect in 2026. These changes expand HSA eligibility, especially for those on healthcare exchange plans and direct primary care memberships. Whether you're new to HSAs or looking to fine-tune your retirement strategy, my practical tips—like how to track reimbursements, invest your HSA funds wisely, and ensure you're making the most of every retirement planning opportunity. You will want to hear this episode if you are interested in... [00:00] HSA contributions and eligible expenses. [03:33] HSA eligibility and individual plans. [07:27] HSA vs. 401(k) savings benefits. [12:10] HSAs and tax-free retirement reimbursements. [14:57] HSA contributions and Medicare Timing. [16:44] Top HSA provider tips. What is an HSA and Who Qualifies? Health Savings Accounts (HSAs) are often overlooked as powerful retirement planning vehicles. They are tax-advantaged accounts that allow individuals with high deductible health plans (HDHPs) to save and pay for qualified medical expenses. To be eligible, you must be enrolled in a qualifying HDHP; not all plans make the cut, so check with your insurer or employer to confirm eligibility. For 2025, annual contribution limits are $4,300 for individuals and $8,550 for families, with an additional $1,000 catch-up allowed for those age 55 and over. Both you and your employer can contribute, but the total combined contribution cannot exceed these limits. Triple Tax Advantage: The Unique HSA Benefit HSAs are the only accounts that offer a triple tax advantage: Pre-tax contributions: Contributions reduce your taxable income for the year, helping you save on federal and (in most cases) state income taxes. Tax-free growth: Money in your HSA can be invested, and all interest, dividends, and capital gains are tax-free while in the account. Tax-free withdrawals: Withdrawals used for qualified medical expenses remain tax-free, even in retirement. This makes HSAs one of the most tax-efficient savings vehicles available. HSAs as a Retirement Strategy While the primary purpose of an HSA is to cover medical expenses, its value extends far beyond that, especially for forward-thinking retirement planners. Many people cover their current medical out-of-pocket expenses with regular cash flow, allowing their HSA investments to grow tax-free for years, even decades. Upon reaching age 65, you are allowed to withdraw funds for non-medical expenses without penalty (although you will owe income tax, much like a traditional IRA). For medical expenses—including Medicare Part B, D, and Medicare Advantage premiums—withdrawals remain tax-free. However, Medigap policy premiums are not eligible for tax-free reimbursement from your HSA. A strategic approach can involve tracking your unreimbursed eligible medical expenses over the years. You can reimburse yourself in retirement with HSA funds for past qualified expenses, effectively turning your HSA into a tax-free retirement “bonus.” New HSA Legislation on the Horizon Looking ahead to 2026, recent legislative changes will further expand HSA eligibility and flexibility. Expanded Access for Health Care Exchange Plans: Before 2026, only certain HDHPs on the healthcare exchange allowed HSA contributions. The One Big Beautiful Bill Act will enable individuals enrolled in any Bronze-tier plan through the health care exchange to qualify for HSA contributions, potentially making over 7 million more people eligible. Direct Primary Care Compatibility: Membership in direct primary care plans—where patients pay a monthly fee for enhanced access to primary care services—will now be compatible with HSA eligibility, subject to fee limits ($150/month for individuals, $300/month for families, indexed to inflation). Previously, participating in such plans disqualified individuals from contributing to HSAs. Common HSA Mistakes and Best Practices Investing your HSA balance (beyond a buffer for immediate health costs) can help you harness the benefits of compound growth over time. Compare fees and investment options among HSA providers to maximize long-term gains. Be mindful when approaching Medicare eligibility. HSA contributions must stop six months before you enroll in Medicare Part A, due to retroactive coverage. Resources Mentioned Retirement Readiness Review Subscribe to the Retire with Ryan YouTube Channel Download my entire book for FREE IRS List of Covered HSA Expenses Connect With Morrissey Wealth Management www.MorrisseyWealthManagement.com/contact Subscribe to Retire With Ryan
Are you getting what you pay for with your Medicare plan? This eye-opening conversation between healthcare insiders Nathan Kaufman and Rich Helppie pulls back the curtain on what they provocatively call "Medicare Disadvantage" plans.When something sounds too good to be true, it usually is. Medicare Advantage plans tempt seniors with zero premiums, dental coverage, vision benefits, and even gym memberships. But these apparent perks mask a troubling reality: significantly restricted healthcare options when serious illness strikes. Our experts explain how insurance companies profit from delaying and denying care while creating increasingly narrow provider networks that limit access to specialists and top medical centers.The most alarming revelation? The trap many seniors find themselves in when they discover these limitations. Once enrolled in Medicare Advantage, leaving becomes nearly impossible if you develop a serious condition, as new supplemental plans can exclude pre-existing conditions. Meanwhile, those with Traditional Medicare maintain freedom to choose providers nationwide, including prestigious research hospitals like Mayo Clinic or MD Anderson, without administrative barriers or insurance company gatekeepers.For anyone approaching Medicare eligibility or reconsidering their current coverage, this episode provides crucial guidance. Our experts recommend a clear path: Medicare Parts A, B, and D, plus a comprehensive Medigap policy. While this combination involves upfront premiums, it offers something priceless: control over your healthcare decisions precisely when you need it most.Subscribe to Healthcare Bridge on your favorite podcast platforms or find us at the Common Bridge on Substack to continue exploring the vital connections shaping our healthcare landscape. Your health decisions matter—make them with complete information.Support the showEngage the conversation on Substack at The Common Bridge!
The Department of Health and Human Services announces plans to start an advisory committee to help reimagine federal health insurance programs. A federal court ruling strikes down a Medicare Advantage marketing rule introduced during the Biden administration. And, Johnson & Johnson commits to a major investment aimed at strengthening domestic pharmaceutical manufacturing. Those stories—and more—on today's episode of the Gist Healthcare Podcast. Hosted on Acast. See acast.com/privacy for more information.
In this episode of HIPcast, Lorie Mills focuses the episode to our patient community to discuss the differences in a traditional Medicare plan versus a Medicare Advantage plan. The goal of this presentation is to educate our seniors on their options and rights as a patient to make the most informed decision for their situation. If you are a community organization and would like to share this with your seniors, please feel free to do so. #HIPcast with Shannan and Seth.https://primeauconsultinggroup.com/lmills@primeauconsultinggroup.comHIPcast brought to you by Enterprise Social Record
The Evolution and Future of Medicare Call Centers
The Unified Program Integrity Contractors (UPICs) are household names in healthcare compliance.But their track record tells a troubling story, according to senior healthcare analyst Frank Cohen. These Medicare fraud enforcement contractors are using controversial extrapolation techniques that providers successfully challenge over 60 percent of the time on appeal.Cohen, who will be the special guest during the next live edition of Monitor Mondays, said he will examine how the 2016 consolidation created five regional enforcement powerhouses, along with why their statistical methodologies are devastating practices based on flawed assumptions. Cohen intends to show how misaligned incentives are creating systematic accuracy problems, while revealing why the current UPIC system might be fundamentally broken, despite everyone agreeing that fraud prevention matters.The weekly broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Matthew Albright, chief legislative affairs analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action.
The American Academy of Pediatrics releases a new childhood vaccination schedule and diverges from federal guidelines. Employers prepare for rising healthcare costs in the year ahead. And Elevance Health faces a legal setback in its Medicare Advantage star ratings dispute. Catch these stories on today's episode of the Gist Healthcare Podcast. Hosted on Acast. See acast.com/privacy for more information.
“We've been able to show that even by 30 days of age, we can predict with some accuracy if a child is going to have a diagnosis of autism,” says Dr. Geraldine Dawson, sharing one of the recent advancements in early diagnosis being aided by artificial intelligence. Dr. Dawson -- a leading scholar in the field and founding director of the Duke Center for Autism and Brain Development – explains that an AI examination of a child's pattern of visits to medical specialists in its very early life is an objective diagnostic tool that can supplement the current subjective reports from parents which vary in reliability. Another objective diagnostic tool in development uses a smartphone app developed at Duke that takes video of babies watching images and applies AI-aided Computer Vision Analysis to measure for signs of autism. This enlightening Raise the Line conversation with host Lindsey Smith is loaded with the latest understandings about Autism Spectrum Disorder including advancements in early therapeutic interventions, the interplay of genetic and environmental factors, and the role of the mother's health and exposures during pregnancy. You'll learn as well about what Dawson sees as necessary societal shifts in how autism is perceived, the numerous factors contributing to a near tripling of diagnoses over the past two decades, and how early intervention and informed advocacy can make a meaningful difference in the lives of countless families.Mentioned in this episode:Duke Center for Autism and Brain Development If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/raisethelinepodcast
By Adam Turteltaub There's a lot new going on in healthcare enforcement, and, at the same, there's a lot that hasn't changed, reports Greg Demske (LinkedIn), partner at Goodwin Proctor and, formerly, Chief Counsel to the Inspector General at HHS. While the US Department of Justice has changed its priorities in areas such as anticorruption, if you look at what they and the Office of Inspector General (OIG) at Health and Human Services have been doing, he observes, the long-time bipartisan effort to stop fraud in healthcare is continuing. Yet, there are some significant changes. At CMS a major shift has occurred when it comes to Medicare Advantage. In the past there were audits of fifty plans a year, but now the goal is to audit all six hundred or so annually. Backing that up is an expansion in the number of coders from 40 to 2000. This has huge implications both for the plans and providers. Meantime the Department of Justice and HHS have created a False Claims Act Working group to further their efforts. Then, of course, there are qui tam claims, which hit a record high in 2024, and we have dispositions in the courts as well. So what should compliance teams do? He recommends keeping a close eye on what the government is saying to ensure your program is staying ahead of the curve. And, of course, you should listen to this podcast to gain more of his insights from private practice and over 16 years at HHS.
More management and insurance knowledge in my newsletter: https://www.odysseymgmt.com/newsletter Did you know 80% of dental claim denials can be overturned with the right strategy? I love meeting fellow insurance nerds! My time with Dr. Christie Bateman was packed full! She shared how to master PPOs, Medicare Advantage plans, and complex prior authorization rules while protecting your bottom line. Dr. Christie breaks down the exact methods she uses to reverse denials, clear documentation, targeted patient photos, and short, persuasive appeals that insurance carriers can't ignore. Get the inside scoop on Liberty Medicare Advantage's extensive prior auth requirements and how direct advocacy led to changes that benefit dentists. We discussed the concept of “provider gold cards” that could dramatically reduce administrative workload. The conversation wraps up with real talk about how patient education can guide smarter insurance plan choices. It's not just about better coverage - it's about a smarter patient. Connect with Dr. Christie Website: Bateman & LaMond Milford Dentistry Instagram: milforddentist Facebook: Bateman & Lamond Milford Dental ------------- I created Dental Revenue Network to foster collaboration and networking amongst RCM professionals. Billing company owners and billing professionals will have access to skill building sessions, current carrier news and insurance discussions beyond “what's the code?" Check it out - I hope you'll join! https://dentalrevenuenetwork.mn.co/ ------------- Medical Billing Made Easy! Dental Classroom Online: https://www.dentalclassroomonline.com/ Use ODYSSEY for a 10% courtesy ------------- Synergy Dental Partners offers lower prices for your dental supplies and services https://www.odysseymgmt.com/synergy NTMT listeners receive a 2 Month Free Trial + a 3rd Month if you buy anything from any vendor during the trial period. Also, new Darby customers receive a $200 Darby statement credit with a purchase. ------------- My insurance course Dental Insurance Design and Management is geared toward those who want to understand the how and why of insurance. As a loyal podcast listener, please use "NTMT" for a $75 courtesy toward your investment. ------------- Visit odysseymgmt.com to check out my book, webinars and courses. ------------- Don't forget to check out my other podcast Chew on This - A Dental Podcast! **If you like the show then I'd appreciate a good rating. Tell your friends. Even podcasters ask for referrals!** YouTube: https://youtube.com/@odysseymgmt
CareOregon, the largest Medicaid provider in the state, will soon stop covering mental health and substance use treatment from out-of-network providers. Coverage will end on Oct. 1 for Medicaid members and on Jan. 1 for members of Medicare Advantage. The decision will disrupt care for an estimated 15,000 patients, or about 15% of the organization’s members who use behavioral health services. The organization says the changes will bring it back into alignment with industry best practices after making provisions to expand access to mental health care during the COVID-19 pandemic. Amit Shah is the chief medical officer at CareOregon. He joins us with more details about the decision.
"Burnout and trauma are not mental illnesses. They live in your physiology. They live in your biology. They live very specifically in your nervous system,” Dr. Rola Hallam says with a conviction rooted in her own successful journey to overcome the effects of chronic stress she accumulated during many years on the frontlines of humanitarian crises in Syria and other conflict zones. Out of concern for the multitudes of health professionals who, like herself, spend years carrying the weight of their traumatic experiences without seeking help, or who pursue ineffective remedies for relieving it, Dr. Rola -- as she's known – has shifted her focus to being a trauma and burnout coach. Among her offerings is Beyond Burnout, a twelve-week program that includes multimedia content as well as live coaching and teaching about developing nervous system awareness and regulation. “Most wellness initiatives fail because they're not rewiring the nervous system to come out of survival mode and back into what is called the ventral-vagal state, which is our state of social connection and of healing and repair.” She also stresses that healing is not an individual pursuit, especially for providers who work in a relational field, and teaches about the benefits of borrowing from a colleagues' state of calm and offering them the same. Don't miss this insightful and giving conversation with host Lindsey Smith that covers Dr. Rola's wrenching experiences providing care in desperate conditions, the critically important distinction between empathy and compassion, and how empowering frontline workers to heal their trauma can uplift individuals and empower entire communities. Mentioned in this episode:Dr. Rola CoachingBeyond Burnout AssessmentCanDo - Humanitarian Aid If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/raisethelinepodcast
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