my-silver-benefits

Move Your Body to Lift Your Mood

Wed, 20 May 2026 06:00:19 GMT

The Benefits of Exercise for Mental Health

The physical benefits of exercise are no secret, but its impact goes far beyond stronger muscles, weight loss, or improved endurance. Regular movement can play a meaningful role in supporting mental health as well—helping to ease symptoms of depression, improve mood, and build resilience over time.

While exercise is not a replacement for therapy or medication, research continues to show it can be a powerful complementary tool. In fact, a large review published in the Cochrane Database of Systematic Reviews found that exercise can reduce depressive symptoms at levels comparable to certain psychological therapies. In some cases, its benefits are comparable even to medication. Though results vary for individual bodies and circumstances, the takeaway is clear: movement matters .

How Exercise Supports Mental Health

Physical activity affects both the body and the brain in ways that can improve emotional well-being. Specifically:

Boosts feel-good chemicals: Exercise triggers the release of endorphins, which can help reduce stress and promote a sense of well-being.

Interrupts negative thought patterns: Exercising helps you refocus your attention on balance, sensation, and movement, rather than rumination and worry

Improves sleep and energy levels: Regular activity is closely tied to better rest and increased energy, which in turn leads to improved mood.

Builds confidence: Achieving even small fitness goals can create a sense of accomplishment that can extend into other areas of your life.

Encourages social connection: Group fitness classes or walking/jogging with a buddy can motivate you and build a sense of community. Even working out to the guidance of a favorite YouTuber can help you feel less isolated.

Even brief, positive interactions with others—like a smile during a walk or a few words exchanged at the gym—can have a meaningful impact on your sense that you’re not in this alone.

Finding What Works for You

Exercise doesn’t have to mean intense workouts or long hours at the gym. In fact, research suggests that light- to moderate-intensity activity may be especially beneficial for mental health.

This includes simple activities like:

Walking
Gardening
Stretching
Household chores

Is there something that’s especially fun for you, like roller skating, cycling, dancing, or swimming? Do that! Any kind of movement you like to do is the right kind.

Current guidelines recommend about 150 minutes of moderate activity per week, but don’t let that number feel overwhelming. Even 10 minutes is a great beginning. Consistency is more important than intensity, but also remember that every minute counts, and doing anything at all is better than nothing.

Getting Started When You Don’t Know Where to Start

Starting an exercise routine during a period of depression can feel challenging. A few strategies can help:

Start small
Choose activities you enjoy
Set realistic, flexible goals

Don’t expect perfection, and keep going even if you fall off for a week or two. The key is to keep going and do what you can. Talking with a healthcare provider can also help you safely incorporate exercise into your overall care plan.

A Helpful Tool, Not a Replacement

Exercise can be an effective way to support mental health, but it’s not a substitute for professional care. If depression is interfering with your daily life, therapy, medication, or a combination of treatments may still be necessary.

That said, adding movement into your routine is a must for your mental well-being. Over time, it can help stabilize your mood, reduce stress, and improve your overall quality of life.

How VA Benefits and Medicare Can Work Together

Wed, 13 May 2026 06:00:13 GMT

How VA health coverage and Medicare differ—and when having both may make sense

If you’re a Veteran, you may have access to both VA health benefits and Medicare. Understanding how these two programs can work together can help you make more informed decisions about your healthcare coverage—both now and in the future.

Do You Need Both VA Benefits and Medicare?

VA benefits and Medicare are separate programs, and each has its own rules, provider networks, and coverage guidelines.

VA benefits typically cover care received at VA facilities or through VA-approved providers. The VA may also authorize service provided at non-VA facilities in limited circumstances.
Medicare (Part A and Part B) helps cover care from providers who accept Medicare nationwide.

Because Medicare covers care provided by a wider range of providers than the VA, many Veterans choose to enroll in Medicare when they become eligible, even if they already use VA benefits.

How Coverage Works

In most cases, VA benefits and Medicare do not coordinate benefits for the same service. This means:

The VA generally pays for care at VA facilities or non-VA facilities in limited circumstances when authorized by the VA.

Medicare generally pays for care received outside the VA system (from Medicare-approved providers).

Why Some Veterans Enroll in Medicare

While every situation is unique, there are a few common reasons Veterans consider enrolling in Medicare:

1. Greater Flexibility
Medicare allows you to receive care outside of the VA system, which may be helpful if you travel frequently or want additional provider options.

2. Avoiding Late Enrollment Penalties
If you delay enrolling in Medicare Part B and later decide to sign up, you may incur a late enrollment penalty that can increase your premium. The Part B late enrollment penalty increases each year and is applied for as long as you are enrolled in Part B.

3. Having other Healthcare Options . If funding for VA health benefits is reduced in future years, it is helpful to have other healthcare options to rely on.

Prescription Drug Coverage Considerations

Veterans who receive prescription drug coverage through the VA may already have creditable coverage, per the Medicare standards. However, Medicare Part D may still be a logical thing for you to add to your prescription coverage, depending on individual needs, pharmacy preferences, and access to medications.

Important Considerations

You are not required to enroll in Medicare to keep VA benefits.
Costs, coverage, and provider access can vary depending on the program and services used.
Decisions about enrolling in Medicare should take into account your healthcare needs, budget, and preferred providers.

Final Thoughts

Having both VA benefits and Medicare can provide added flexibility and peace of mind, but it’s important to understand how each program works independently. Reviewing your options annually can help ensure your coverage continues to meet your needs.

For personalized guidance, consider contacting Medicare directly at 1-800-MEDICARE or speaking with a licensed insurance professional. We are here to help.

Mental Health and Medicare

Wed, 06 May 2026 06:00:02 GMT

Understanding Your Coverage and Resources

May is Mental Health Awareness Month, and this is a crucial time to recognize that mental health is just as important as physical health, especially as we age. You may not be aware that Medicare provides coverage for a wide range of mental health services, helping you or your loved ones access the care and support they need.

Mental Health Coverage Under Medicare

Medicare covers both inpatient and outpatient mental health and substance recovery services, depending on your needs.

Medicare Part A (Hospital Insurance) covers mental health care if you are admitted to a hospital, including psychiatric hospitals. This includes room, meals, nursing care, and medications during your stay.
Medicare Part B (Medical Insurance) covers outpatient services such as therapy, counseling, and visits with mental health professionals. This includes services provided in a doctor’s office, clinic, or hospital outpatient setting.
Medicare Part D (Prescription Drug Insurance) covers prescription drugs, including many that are prescribed for mental health purposes.

Together, these parts help ensure access to care across different levels of need, from routine counseling to prescription medications for mental health to more intensive treatment.

What Services Are Covered?

Medicare beneficiaries have access to a variety of mental health resources, including:

Individual and group therapy
Psychiatric evaluations and diagnostic testing
Annual depression screenings
Substance use disorder treatment and counseling
Prescription medications and medication management
Partial hospitalization and intensive outpatient programs

Medicare also covers telehealth services, in many cases, making it easier to connect with providers from the privacy of your home.

Who Can Provide Care?

Medicare covers services from a range of licensed professionals, including:

Psychiatrists and psychologists
Clinical social workers
Primary care physicians, nurse practitioners, and physician assistants
(More recently) Licensed mental health counselors and marriage/family therapists

It’s important to confirm that your provider accepts Medicare to help keep costs manageable.

What Will You Pay?

While Medicare helps cover many mental health services, there are still some out-of-pocket costs:

For most outpatient services, you typically pay 20% of the Medicare-approved amount after meeting your Part B deductible.
Inpatient costs vary depending on the length of stay and facility type.

If you have a Medigap plan or Medicare Advantage plan, these costs may be less.

Why Mental Health Care Matters

Mental health challenges such as depression, anxiety, and loneliness can profoundly affect older adults, sometimes going unnoticed or untreated. Access to counseling, therapy, support services, and medication management can make a meaningful difference in overall well-being, quality of life, and even physical health.

How to Take the First Step

If you or a loved one may benefit from mental health support, consider starting with:

A conversation with your primary care provider
Your annual Medicare wellness visit
A covered depression screening

It’s most important to understand that mental health support is not a sign of weakness; It’s another important aspect of staying healthy and taking good care of yourself.

During Mental Health Awareness Month, check in on your emotional well-being. Help is available, and Medicare can be an important part of accessing it.

The Power of Routine: Why Your Body Loves Consistency

Fri, 30 Jan 2026 13:15:00 GMT

In a world full of constant change, your body craves one thing more than anything else: consistency . A daily routine may sound simple, but it has a powerful impact on both your physical and emotional well-being. When your days follow a steady rhythm, your body knows what to expect—and that’s where the magic happens.

Our internal systems thrive on predictability. Consistent sleep and wake times help regulate your circadian rhythm, making it easier to fall asleep, wake up refreshed, and maintain steady energy throughout the day. Even your hormones operate more smoothly when your body isn’t forced to adapt to irregular patterns. That’s why people who follow regular schedules often experience better mood stability, sharper focus, and fewer feelings of stress or overwhelm.

Routine also supports healthier choices. When healthy habits—like drinking water, taking medications, exercising, or preparing balanced meals—are part of your daily rhythm, they become easier to maintain. You’re less likely to skip activities that support your health because they no longer require extra motivation or decision-making. Your routine does the heavy lifting for you.

One of the easiest ways to build consistency is to adopt micro-habits —small actions that require little effort but deliver meaningful impact over time. Some lesser-known tips include pairing habits together (like stretching while the coffee brews), setting “anchor moments” throughout your day to trigger healthy actions, or creating a five-minute “reset” in the afternoon to realign your energy. You can also choose a “signature routine”—a simple, repeatable practice you do every single day, such as a short walk after lunch or journaling one sentence before bed. These small, strategic habits help train your brain to stick with routines naturally and reduce the mental load of staying consistent.

Emotionally, structure brings a sense of calm. A reliable routine grounds you, especially during stressful or uncertain times. It creates touchpoints throughout the day that remind your mind and body, “You’re safe. You’re supported. You’re in control.” That stability can be especially meaningful for adults managing chronic conditions or navigating life transitions like retirement or caregiving.

Of course, life isn’t always predictable—and that’s okay. Routines aren’t about perfection; they’re about creating a strong foundation. Even small consistencies, like starting your morning with a glass of water or taking a daily walk, send powerful signals to your body that promote balance and well-being.

The bottom line: Your body loves routine because routine loves your body right back. Building steady, supportive habits may be one of the simplest—and most effective—ways to improve your health, boost your energy, and feel your best every day.

Fall Monitors Save Lives: What You Should Know—And How Medicare Helps

Fri, 23 Jan 2026 16:30:11 GMT

Falls are one of the most serious health risks facing older adults, yet they are also one of the most preventable. Each year, millions of seniors experience a fall, and many of these incidents occur when no one else is around to help. This is where fall monitors—also known as personal emergency response systems (PERS)—can make a life-saving difference. These devices provide 24/7 monitoring and instant access to help at the push of a button or even automatically through built-in sensors. Fall monitors aren’t just helpful technology; they are powerful tools that support independence, safety, and peace of mind for older adults and their families.

Fall monitors come in several varieties, including wearable pendants, wristbands, and smart sensors placed around the home. Many modern devices use advanced fall-detection technology that can automatically alert emergency services if a fall is detected, even if the user is unable to press a button. For aging adults who want to remain in their homes longer, these monitors act as a safety net, ensuring that help is always available. This rapid response is crucial because timely medical attention dramatically improves outcomes after a fall.

Medicare plays an important role in helping seniors access fall-prevention resources, but coverage can vary. Original Medicare (Parts A and B) does not typically cover the cost of personal emergency response systems, including fall monitors. However, many Medicare Advantage (Part C) plans now include supplemental benefits that may help pay for these devices—especially plans focused on chronic care management, safety benefits, or in-home support services. Because each Medicare Advantage plan may choose whether to offer benefits beyond those covered by Medicare, it's important for beneficiaries to review their plan’s details or speak with a licensed Medicare agent to understand what is available in their area.

In addition to device coverage, Medicare offers preventive services aimed at reducing fall risk. This includes an annual wellness visit, during which a healthcare provider assesses fall risk, reviews medications, and recommends balance or mobility screenings. Medicare Part B may also cover physical therapy to improve strength and stability when medically necessary. Combining these preventive services with a fall monitor creates a strong safety strategy that can significantly reduce the chances of serious injury.

Fall monitors also provide emotional peace of mind. Many older adults fear falling more than they fear other health events, and that fear can limit activity and independence. Knowing that help is only a button-press away—or automatically detected—can restore confidence and encourage healthy, active living. Families also feel reassured knowing their loved one has reliable support around the clock, especially if they live alone or have a history of falls.

As technology continues to advance, fall monitors are becoming smarter, more affordable, and easier to use. For many seniors, they are no longer optional but essential. They offer immediate life-saving assistance, support safe aging at home, and complement Medicare’s preventive care benefits. For anyone looking to protect themselves or a loved one, exploring fall-monitor options and reviewing Medicare coverage is a meaningful step toward safer, more independent living.

Tips for Transitioning to a New Medicare Plan

Fri, 16 Jan 2026 14:30:00 GMT

If you recently enrolled in a new Medicare plan during the Annual Enrollment Period (AEP), your coverage likely started on January 1st. Whether you switched Medicare Advantage plans, changed Part D drug coverage, or moved between Original Medicare and a Medicare Advantage plan, it’s important to make a smooth transition.

Here are some tips to help you get started with your new plan:

1. Watch for Your New Plan Materials

You should receive a welcome packet and a new member ID card from your plan. Be sure to review these materials carefully. They’ll include important details about your coverage, provider networks, drug formularies, and how to get care.

2. Share Your New Card with Providers

Give your new Medicare Advantage or Part D card to your doctor, pharmacy, and any specialists you see. This ensures your care is billed correctly from day one.

3. Double-Check Your Coverage

Even if you already reviewed your benefits before enrolling, it’s smart to confirm:

Your doctors and pharmacies are in-network (if applicable)
Your medications are covered and fall within the plan’s formulary
You understand copays and other out-of-pocket costs

4. Prepare Your Prescriptions for the First 30 Days

If your medications or providers have changed, plan ahead to avoid any disruptions. Refill prescriptions early if possible, and call your plan’s customer service if you have any trouble getting your medications or setting up care.

5. Keep an Eye on Your Mail

You may receive additional documents throughout the year, like Explanations of Benefits (EOB) when you receive plan services, or plan updates. Don’t ignore them—these may contain information about your costs or changes to provider networks.

Have Questions or Concerns?

If something about your new plan isn’t working the way you expected, or you’re unsure about what to do next, we’re here to help you understand your coverage and explore any options you may still have.

Medicare Scams: Protect Your Benefits and Assets

Fri, 09 Jan 2026 14:00:01 GMT

Because of the massive scale and complexity of Medicare, this essential program is sadly a frequent target of fraud and abuse. Scammers may try to steal your personal information, bill for services never rendered, or trick you into bogus plan offers. Not only can these scams cost taxpayers millions of dollars annually, but they may also compromise your identity, coverage, and peace of mind.

That’s why awareness and vigilance are key. Knowing how scams operate and what red flags to watch for is crucial for every Medicare beneficiary and their family members. You are the first line of defense to protect yourself and the broader Medicare program from scammers.

Learn more from Medicare.gov

Common Scams and Tactics to Watch Out For

Scams targeting Medicare beneficiaries come in many forms, but several commonly recur. Here are some of the most frequent:

Fake “Medicare” Calls or Visits
Scammers often impersonate Medicare officials or agents, calling or sometimes even showing up in person. They may claim they need to “update your Medicare information,” issue a “new card,” or warn that your coverage is at risk unless you provide personal details. These communications can involve requests for your Medicare number, Social Security number, or even banking information. Legitimate Medicare or affiliated official programs will never cold‑call you for that kind of sensitive data.
Phantom Billing or False Claims
In what’s sometimes called “phantom billing,” unscrupulous providers may bill Medicare for services, tests, or equipment that were never provided. This can include duplicative billing, billing for more expensive services than were rendered (known as “upcoding”), or submitting claims for unnecessary procedures.
Free Medical Equipment or Services Offers
Scammers might contact you offering “free” medical supplies, equipment (like braces, wheelchairs, or test kits), or free tests — claiming Medicare will cover them. Their goal is often to get your Medicare or personal information upfront, then bill Medicare fraudulently, or even bill you for equipment you never requested or don’t need.
Fake Plan Offers, Cancelling Threats, or Refund Schemes
Around open enrollment periods — when many beneficiaries are shopping or switching plans — scammers may offer “exclusive” Medicare Advantage or Part D plans that promise better benefits, lower costs, or free extras. Some may even claim you’re entitled to a refund or rebate. These offers usually require giving up personal or financial information. Similarly, fraudsters may threaten that your benefits will be canceled unless you provide information or pay a “processing fee.”

Smart Habits for Medicare Beneficiaries

Staying safe from Medicare scams largely comes down to cautious behavior, record‑keeping, and verifying all suspicious contact or billing. Below are recommended best practices:

Guard Your Medicare Number Like Your Social Security Number
Never give your Medicare number or Social Security number to anyone over the phone or via email, unless you initiated the contact and are sure of the recipient’s identity.
Be Skeptical of Unsolicited Contact
If you receive an unexpected call, letter, email, or visit claiming to be from Medicare, do not provide any personal or financial information. Instead, hang up or close the communication and verify by calling Medicare directly at 1‑800‑MEDICARE (1‑800‑633‑4227) .
Keep Track of Your Medical Services and Bills
Maintain a personal record of all medical visits, procedures, equipment, and services you receive. Keep receipts, statements, and calendars of dates for services — especially if you didn’t receive bills yourself. Then compare that with the official notices from Medicare.
Review Your Medicare Notices Closely
Medicare sends out a notice (often called an MSN or Explanation of Benefits) when a claim is made. Review these carefully. If you see something you don’t recognize — services you didn’t receive, providers you never visited, or equipment you didn’t order — treat it as suspicious.
Shred Old Documents and Cards
Dispose of any retired Medicare or Social Security cards securely. Old documents can still be used by fraudsters for identity theft.
Avoid High‑Pressure Offers and “Free” Promises
Offers of “free” equipment or limited-time plan deals are often scams. If it sounds too good to be true — very likely it is. Always verify through official Medicare channels.

What to Do If You Suspect Fraud or a Scam

If you suspect something isn’t right — whether you got a suspicious call, received unexpected equipment, or saw incorrect billing — take action as soon as possible. Here are the main steps:

Do not ignore it. Even small discrepancies can signal scam activity. Early detection is usually easier to resolve than problems discovered months later.
Gather documentation. Include your Medicare number, provider information (name, address), dates and descriptions of the service in question, bills, explanation-of-benefits forms, and any other supporting statements.
Report the fraud. You can:

Call 1‑800‑MEDICARE (1‑800‑633‑4227) to report suspicious calls, billing, or unauthorized claims.
Call the federal fraud hotline at 1‑800‑HHS‑TIPS (1‑800‑447‑8477) .
If you have a Medicare Advantage plan or a Part D drug plan, you can call the customer service or claims integrity line for those plans — or use the private contractor line, e.g., 1‑877‑7SAFERX (1‑877‑772‑3379) .
Contact your local Senior Medicare Patrol (SMP), which can help you investigate and report suspected fraud, and advise on next steps. See https://smpresource.org to find the phone number in your state.

Stay vigilant. Continue reviewing your Medicare statements, and consider setting up safeguards such as appointment of a trusted relative to help monitor bills if memory or health becomes a concern.

Reporting Matters For the Good of All

While preventing scams protects your personal identity and coverage, it also serves a larger purpose. Fraud, waste, and abuse in Medicare divert funds away from legitimate patient care — draining taxpayer dollars and undermining trust in the system.

Programs like the Senior Medicare Patrol rely on tips from beneficiaries to investigate suspicious activity. Over the years, SMP volunteers have helped recover millions of dollars and prevented future fraud.

By staying alert and reporting what seems wrong, you’re helping preserve Medicare’s integrity — for yourself, your peers, and future generations.

Turning 65? Here’s What You Need to Know About Medicare

Thu, 27 Nov 2025 18:00:00 GMT

If your 65th birthday is approaching, congratulations! It’s a big milestone—and not just personally. Age 65 is when most Americans become eligible for Medicare, and there are important steps you need to take to avoid coverage gaps or financial penalties.

Whether you’re retiring, still working, or somewhere in between, understanding your Medicare enrollment options will help ensure you make confident, informed choices.

1. Do I Need to Sign Up for Medicare or Will It Happen Automatically?

That depends on your situation:

If you’re already receiving Social Security or Railroad Retirement Board (RRB) benefits, you’ll be automatically enrolled in Medicare Parts A and B. Your coverage will begin the first day of the month you turn 65—or the month before if your birthday falls on the 1st.
If you’re not receiving Social Security yet, you’ll need to actively enroll in Medicare. You can do so by visiting SSA.gov/medicare , calling Social Security, or applying in person.

Tip: You can apply up to three months before your 65th birthday month to ensure coverage begins on time.

2. Should I Sign Up for Part A and Part B?

Part A (Hospital Insurance) is usually premium-free if you or your spouse worked and paid Medicare taxes for at least 10 years. Most people enroll in Part A when they turn 65, even if they are still working.
Part B (Medical Insurance) has a standard monthly premium, which is set annually. For 2025, it is $185, though it may be higher depending on your income. If you’re still working and you have health insurance through your employer, you can often delay Part B enrollment without penalty.

3. What’s My Medicare Enrollment Timeline?

Here are the key timeframes:

Initial Enrollment Period (IEP): This 7-month window starts 3 months before your 65th birthday month and ends 3 months after. Enrolling early ensures your coverage starts on time.
Special Enrollment Period (SEP): Available if you’re working and covered by group health insurance. You can enroll anytime while covered, or within 8 months of the coverage ending, without penalty.
General Enrollment Period (GEP): Runs January 1 – March 31 each year, but this can result in delayed coverage and late penalties if you missed your IEP or SEP.

4. Do I Need to Take Social Security at 65 to Get Medicare?

You don’t need to claim Social Security to enroll in Medicare - the two are independent decisions.

5. Still Working at 65? Here’s How Medicare Works With Employer Coverage

Many people are still working at 65 and beyond, and have health insurance through their employer—or through a spouse’s employer. If that’s you, here’s what you need to know:

If Your Employer Has 20 or More Employees

You can often delay Medicare Part B (which has a monthly premium) without a penalty. Rules can vary depending on your specific employer coverage. Your employer plan pays first , and Medicare acts as a secondary payer. This allows you to postpone enrolling in Part B until your employer coverage ends. Always confirm with your HR department or Social Security before delaying Part B.

If Your Employer Has Fewer Than 20 Employees

In this case, Medicare pays first , and your employer plan is secondary. You’ll likely want to enroll in both Part A and Part B when you turn 65 to avoid any gaps in coverage.

COBRA, Retiree Plans, and Marketplace Coverage Don’t Count

If you're covered by COBRA, a retiree health plan, or an Affordable Care Act (ACA) Marketplace plan, be aware that these are not considered active employer coverage. They do not qualify you for a Special Enrollment Period (SEP), and delaying Part B could result in permanent late penalties.

How to Transition From Employer Coverage to Medicare

When you or your spouse stops working and your group health coverage ends, you’ll have an 8-month Special Enrollment Period to sign up for Part B without a penalty. To avoid any break in coverage, it’s smart to start the transition about 1–2 months before your employer coverage ends.

Here’s what to do:

Enroll in Part B through Social Security at SSA.gov/medicare .
Submit two important forms:
CMS-40B (Application for Part B)
CMS-L564 (Request for Employment Information)—your employer must fill this out to verify coverage.
Coordinate your effective dates to ensure continuous coverage as you switch from employer insurance to Medicare.

Tip: If you have a Health Savings Account (HSA), stop contributing to it at least 6 months before you apply for Medicare to avoid IRS tax penalties.

6. What If I’m a Veteran or Have TRICARE?

If you have VA benefits , Medicare works alongside them. You can use Medicare for care outside the VA system.
If you have TRICARE , you’ll generally need to enroll in both Part A and Part B to maintain your TRICARE coverage.

7. Where to Get Help

Apply or learn more: SSA.gov/medicare
Compare plans: Medicare.gov/plan-compare
Find local help: SHIPhelp.org
Give us a call. We are here to help.

Final Thoughts

Whether you’re retiring at 65 or planning to work a few more years, it’s important to review your options early to avoid late penalties or gaps in coverage. Knowing your options and deadlines will help protect both your health and your finances.

Need guidance on transitioning from employer coverage? Want to compare Medicare Advantage and Medigap options? Our team is here to help—reach out today.

What Medicare Part D Users Can Expect in 2026

Sat, 22 Nov 2025 15:45:00 GMT

In 2026, Medicare beneficiaries with Part D prescription drug coverage will see major changes—thanks to the continued rollout of the Inflation Reduction Act (IRA). These changes are designed to lower out-of-pocket drug costs, improve predictability, and increase access to lifesaving medications.

Here’s what Part D users can expect in 2026:

1. Out-of-Pocket Costs Capped at $2,100 (Adjusted for Inflation)

In 2025, the annual cap on out-of-pocket drug costs is set at $2,000. In 2026, that cap will increase slightly to $2,100 , as indexed for inflation.

Once you reach this threshold, you will pay $0 for covered Part D prescription drugs for the rest of the year—no coinsurance or copays.

What this means for you:

Predictable yearly drug costs
No more catastrophic phase or the so-called “donut hole”
Major savings for those with expensive medications

2. Medicare Will Start Negotiating Drug Prices

Starting in 2026, Medicare will implement its first negotiated drug prices for certain high-cost medications covered under Part D.

These will initially include 10 brand-name drugs with the highest total spending in the Medicare program.

The first 10 drugs selected for Medicare negotiation are: Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, Fiasp / NovoLog.

These drugs were selected because they account for billions in Medicare spending each year, and do not yet have generic alternatives.

What this means for you:

Lower out-of-pocket costs if you take one of these drugs
Improved transparency around drug pricing

The negotiated prices will take effect January 1, 2026 . Additional drugs will be added to this list in the years to follow.

3. Monthly Payment Option for Out-of-Pocket Costs

If paying up to $2,100 all at once sounds daunting, you’ll have another option.

In 2025, Medicare introduced the Prescription Payment Plan (PPP) , which allows you to spread out your Part D out-of-pocket costs across the calendar year .

What this means for you:

You can choose to make monthly payments instead of large up-front costs
Easier to budget and manage finances throughout the year
Enrollment is optional—you can opt in or out as needed
Starting in 2026, if you are enrolled in the PPP, you will automatically be enrolled in the PPP the following year.

4. Insulin and Vaccine Cost Caps Continue

Even as the broader cap changes with inflation, these key protections remain in place:

The insulin cap in 2026 will be the lowest of $35, 25% of negotiated price, or 25% of maximum fair price
CDC-recommended adult vaccines (like shingles and Tdap) stay free with no copay or deductible.

5. Stricter Limits on Price Increases

Drug manufacturers will now face penalties if they raise prices faster than the rate of inflation for Medicare-covered drugs. This rule began in 2023, but will have stronger visibility and impact by 2026.

Coming Down the Road After 2026:

More drugs will be added to Medicare’s negotiation list annually.
By 2029 , up to 60 Part D and Part B drugs may have negotiated prices.

Finding Relief: How Medicare Supports Safe and Effective Pain Management

Tue, 18 Nov 2025 15:30:03 GMT

Living with pain can affect nearly every part of your life — from your sleep to your work, activities, and social life. Whether your pain is short-term following an injury, or a long-term condition like arthritis, the goal is the same: to manage it safely and effectively so you can live as fully and comfortably as possible.

For Medicare beneficiaries, it’s important to know that Medicare covers many pain-management services designed to help you find relief while reducing the risks that can come with certain medications or procedures. Understanding your options, and working closely with your doctor, can make a real difference in improving your quality of life.

Why Pain Is More Than Just Pain

Pain isn’t just a physical issue. Over time, it can take a toll on your mental and emotional health, limit your independence, and make it harder to enjoy daily activities. Yet many people live with unnecessary discomfort because they don’t know what resources are available or worry that seeking treatment might lead to complicated medications or costs.

Today’s approach to pain management is far more holistic than it once was. Instead of relying only on prescription drugs, health care providers now emphasize personalized, whole-body strategies that can include therapy, movement, counseling, and medical care — often used together for the best results.

Medicare-Covered Services for Pain Management

If you’re a Medicare beneficiary, you have access to a wide range of covered services to help manage pain safely and effectively. Depending on your situation and your doctor’s recommendations, your care plan may include:

Physical therapy: Structured exercise and stretching programs that improve strength, flexibility, and range of motion.
Occupational therapy: Guidance to help you move more comfortably and maintain independence with daily tasks.
Chiropractic care: Manual manipulation for certain conditions like back pain, when prescribed by a qualified provider.
Acupuncture: Medicare covers acupuncture for chronic lower-back pain when performed by a trained practitioner.
Chronic pain management programs: Beginning in 2023, Medicare introduced specialized care management for chronic pain, which may include regular assessments, care coordination, and emotional support. These programs are designed to help patients manage ongoing pain without relying solely on opioids or other high-risk medications.

If your provider recommends any of these treatments, ask whether they’re covered under Medicare Part B (medical insurance) or as part of your Medicare Advantage plan , which may offer additional wellness benefits like fitness or stress-management programs.

Medication, Safety, and Opioid Use Disorder Treatment

For some people, pain-relief medications remain a necessary part of treatment. If your doctor prescribes medication, it’s important to:

Take it exactly as directed .
Store it safely and securely .
Communicate with your doctor about side effects or changes in your pain levels.

If opioids are prescribed, your provider should review the lowest effective dose and discuss alternative or supplemental options. Misuse of opioid medication can lead to dependence or addiction, so it’s crucial to stay in close contact with your care team.

If you or someone you know is struggling with opioid use, help is available . Medicare covers opioid use disorder treatment services , including periodic assessments, medication-assisted therapy, counseling, and follow-up care — for as long as you need them. Asking for help is a sign of strength, not weakness, and support can be confidentially coordinated through your doctor or a Medicare-approved treatment provider.

Learn more about working with your doctor to safely manage pain.

Non-Medical Approaches for Everyday Wellness

Many people find additional relief by incorporating complementary practices alongside their medical care. Your provider might suggest:

Yoga or tai chi to gently build strength and improve balance.
Meditation or deep-breathing exercises to manage stress and help the body relax.
Mindfulness-based programs that teach coping strategies for chronic pain.

While these practices aren’t always covered under Medicare, they can be valuable parts of a comprehensive wellness plan — especially when recommended by your provider.

Take Charge of Your Plan

You can better control pain when you address it early. If you notice new or worsening pain, don’t wait for it to become unbearable — talk to your doctor. Together, you can create a customized plan that combines medical care, movement, and lifestyle adjustments that work for you.

Here are a few steps to get started:

Schedule an appointment with your primary care doctor to discuss your pain symptoms.
Review your Medicare coverage to understand which treatments and services are included.
Ask about preventive options , such as physical therapy or acupuncture, before pain becomes severe.
Keep an open line of communication with your providers — pain management often requires fine-tuning over time.

Pain management is complex and personal. What works for one person may not work for another, but the goal is always the same: to reduce discomfort, restore function, and protect your overall well-being in the short-term as well as over time. From therapy and movement to medication support and care management, there are safe, effective tools to help you regain control and live more comfortably.

If you’re living with ongoing pain, talk with your health care provider today about your options. The right plan — and the right support — can help you feel better, move better, and live better.

See Medicare’s coverage details for pain management.

Honoring Veterans: Understanding How Medicare and VA Benefits Work Together

Thu, 13 Nov 2025 18:16:08 GMT

For many veterans, health care can feel confusing. Between Veterans Affairs (VA) health benefits and Medicare coverage , there’s sometimes uncertainty about what each program offers, how they work together, and whether you need both. The good news is that VA benefits and Medicare can complement each other, giving you more options for care and greater peace of mind.

VA Benefits vs. Medicare: What’s the Difference?

VA health care is provided by the U.S. Department of Veterans Affairs, while Medicare is federal health insurance for people age 65 and older (and for some younger individuals with disabilities).

The VA system offers care at VA medical centers and clinics for veterans who meet eligibility and service requirements. Medicare , on the other hand, gives access to a much broader network of doctors, hospitals, and specialists — both inside and outside the VA system.

Here’s the key point: You can have both VA and Medicare coverage , and many veterans do.

Having both allows you to choose where and how you receive care, which can be especially helpful if you move, travel, or live far from a VA facility.

Why Veterans May Want to Enroll in Medicare

Even if you’re enrolled in VA health care, it’s usually wise to sign up for Medicare Part A and Part B when you become eligible at age 65.

Here’s why:

Medicare Part A (Hospital Insurance) is typically free if you or your spouse worked and paid Medicare taxes for at least 10 years. It covers inpatient hospital stays, skilled nursing, and some home health care in non-VA hospitals and facilities. If you want to receive care outside the VA system, Medicare will help cover the costs.
Medicare Part B (Medical Insurance) covers doctor visits, outpatient care, preventive screenings, and durable medical equipment provided outside the VA system.

If you rely only on VA health benefits, your coverage is limited to care provided at VA facilities by VA-contracted providers. To use non-VA providers, you would need to get approval from the VA.

In other words, Medicare expands your access — especially in emergencies, when traveling, or when VA services are not easily available. Having Medicare in addition to VA benefits ensures you can receive care almost anywhere and avoid potential gaps.

How Medicare and VA Benefits Work Together

Medicare and VA benefits operate separately and cover different services.

If you go to a VA facility, the VA pays for the services you receive there.
If you see a doctor or get care outside the VA, Medicare pays (and you may owe a deductible or coinsurance, depending on your plan).

You generally can’t use both at the same time for the same service. But having both gives you flexibility: you can use your VA coverage when it’s convenient and rely on Medicare when you want to see other providers or access services outside the VA network.

Prescription Coverage for Veterans

Prescription drug coverage is another area where veterans can benefit from having both programs.

The VA offers low-cost medications through its pharmacies, but those medications must be prescribed by VA doctors, and if you get your prescription filled by a non-VA pharmacy, the VA won’t cover them.
Medicare Part D (or a Medicare Advantage plan with drug coverage) can cover prescriptions written by non-VA providers — such as your local doctor or specialist. However, you must fill those prescriptions through pharmacies that are part of the Part D plan’s network.

If you take medications from both VA and non-VA providers, enrolling in a Part D plan ensures you’re covered in all settings.

Medicare Advantage Options for Veterans

Some veterans also consider Medicare Advantage (Part C) plans , which are offered by private insurers. These plans provide all the same coverage as Original Medicare, plus often include additional services like dental, vision, hearing, and fitness benefits — which the VA and original Medicare typically don’t cover.

Because VA coverage can fill in some of the gaps, many veterans find that combining their VA benefits with a $0-premium Medicare Advantage plan offers a best-of-both-worlds approach.

If you’re a veteran turning 65 or already on Medicare, take time to review how your VA benefits and Medicare coverage fit together. Having both can expand your access to care, protect you from unexpected costs, and give you the freedom to choose where you’re treated.

This Veterans Day, we honor your service — and we’re here to help you make the most of the benefits you’ve earned. An experienced insurance agent can talk through it and help you understand your coverage — so call on us!