Shownotes
We welcome back Josh Kinzel from Seniority Benefit Group for his sixth visit to the podcast. The focus of this conversation is on the upcoming changes to Medicare enrollment and coverage for 2026, as well as practical advice for those approaching or currently navigating Medicare options.
Breaking Down the Medicare Alphabet Soup
Josh walks us through the parts of Medicare and why understanding them is so important:
- Original Medicare includes Part A (hospitalization, generally free) and Part B (outpatient coverage, with a monthly premium).
- Original Medicare typically covers 80% of approved costs, but there’s no out-of-pocket cap for the leftover 20%. That’s where the choice between a Medicare Supplement (Medigap) plan and a Medicare Advantage (Part C) plan comes in.
- Medigap fills in gaps left by Original Medicare—giving simplicity and freedom to see almost any provider accepting Medicare. You add on a Part D drug plan for prescriptions.
- Medicare Advantage plans are administered by private insurance companies. The government pays these companies on your behalf, so the advertised zero-premium plans are real—but always remember, your Part B premium still applies. With Advantage, you’re often in an HMO or PPO network, may have to seek pre-approval for some services, and pay more out of pocket if major health issues arise.
What’s New for Medicare in 2026?
As usual, we’re recording before all federal rules are final, but here’s what we know:
- Part B premiums are expected to rise by about 11%, reaching an estimated $206.50 monthly.
- Part D drug plan costs may inch up, mainly as insurers adjust to the new $2,000 annual out-of-pocket limit (from the Inflation Reduction Act). While deductibles and catastrophic thresholds rise, costs for many drugs, especially for diabetes, are actually dropping.
- The infamous “donut hole” coverage gap is now virtually gone, making prescription coverage simpler.
- Talk continues about longer-term Part D and Advantage contracts (potentially covering more than one year) and the introduction of more pre-authorization (prior approval) steps, including the use of AI to address fraud and control costs.
Medicare Advantage and the “Free” Plan Question
A recurring theme is whether Medicare Advantage’s free or low-cost plans are really “free.” Josh explains that these plans are genuinely $0 premium because the government subsidizes them, but you’ll still pay the Part B premium, plus out-of-pocket costs when you use services. The trade-off is less predictability, more restrictions on doctor/hospital networks, and a risk of higher costs if you need significant care.
If you like this episode, please let us know. We appreciate the feed back, and your support of offset costs of producing the podcast!
MyCare Ohio: A New Managed Care Option for Dual Eligibles
We explore MyCare Ohio, a managed care model that combines Medicaid and Medicare benefits for those who qualify for both. Expanding to all 88 counties in Ohio, this program promises consolidation, fewer cards to carry, and—potentially—lower out-of-pocket costs for those with low income and assets. Eligibility, plan availability, and making sure your doctors are in-network are important considerations.
How Employers and Retirees Fit In
For people who are still working at 65 or have retiree health coverage, we emphasize comparing employer plans with Medicare options—never simply assuming your current coverage is best. Employers can use experts like Josh’s group to help employees or retirees make smart, cost-effective choices.
Moments
00:00 "Pre-Enrollment Medicare Insights Podcast"
04:21 Career Shift to Medicare Benefits
08:04 Medicare Coverage Gaps Explained
12:05 Medicare Advantage: Weighing Options
13:38 Medicare Advantage vs. Traditional Debate
19:08 Insurance Bids May Extend Duration
21:00 Medicare Approves without Prior Authorization
24:39 Pharmacy Vaccine Billing Issues
27:16 Navigating Insurance Plan Limitations
29:39 Medicare Advantage vs. Traditional Medicare
33:18 Medicare Advantage's Financial Appeal
36:27 "MyCare Ohio: Enhanced Medicare Advantage"
40:08 Medicare.gov: Comprehensive Resource Guide
43:04 Transitioning from Benefits to Medicare
46:00 Retiree Benefits Under Scrutiny
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Recorded in Studio C at 511 Studios. A production of Circle 270 Media® Podcast Consultants.
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Copyright 2025 Carol Ventresca and Brett Johnson
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Listener Disclaimer
The views and opinions expressed by the experts interviewed on this podcast are their own and do not necessarily reflect the views of the podcast hosts or any affiliated organizations. The information provided in these interviews is for general informational purposes only and should not be considered as professional advice. Listeners are encouraged to consult with qualified professionals for specific advice or information related to their individual circumstances. The podcast host and producers do not endorse or guarantee the accuracy, completeness, or reliability of any information provided by the experts interviewed. Listener discretion is advised.
Transcripts
We are looking forward our way. Hi, this is Brett. Now we have an all time super guest in our midst, his sixth visit to the studios. Our good friend Josh Kinzel, Benefit Advisor or the Seniority Benefit Group, is here to give an overview on the changes to be made to Medicare in 2026. Which means we started this in 2021.
Carol Ventresca [:No, 2020.
Brett Johnson [:2020. Yeah, that would have been 2020.
Carol Ventresca [:We're in our sixth year.
Josh Kinzel [:Yeah, it's kind of craz.
Brett Johnson [:Prepare for Medicare's annual open enrollment period, which is October 15 through December 7. Again, October 15 through December 7. Put on your calendars. As soon as this podcast is done, Josh walks us through this very important evaluation process, providing the details needed to make correct decisions on your healthcare needs for the coming year. Josh, thanks for joining us again for the sixth time.
Josh Kinzel [:It's great to be here. Thanks, Brett. Thanks, Carol.
Carol Ventresca [:Time flies when you're having fun.
Josh Kinzel [:I know, right? It does.
Carol Ventresca [:It does. And we've known Josh for a long time. He was a board member for our agency. But who then thought that we were going to be talking about Medicare as much as we have been in our podcast. I mean, goodness gracious. But thank you.
Josh Kinzel [:No problem for Happy to be here again.
Carol Ventresca [:And this is pretty exciting. We're going to. We got pictures with Josh and his number six sign, so we're going to put it on the website so everybody will see him in true colors here. That we're when as we laugh before we sit down and start talking about all of this really important stuff that.
Josh Kinzel [:Happens every year, we seem to. Yes, it's fun catching up.
Carol Ventresca [:The other thing that we do every year is that we're taping this podcast before all of the rules have actually been approved for Medicare, which usually is like at the 10th hour before the open enrollment starts. So we're a few weeks early. There could be some changes, but we're gonna provide everyone with all the information and resources that you need. The 2026 Medicare book has come out from federal government. I got my email giving me the link. So we will make sure that link is on our resources for everybody who is listening to us today. Before we really get into the nitty gritty, we gotta hear Josh's story. So tell us a little bit about you, your Journ Seniority benefit group and how in the world did you get into Medicare?
Josh Kinzel [:Oh, well, it's a long story, but I'll keep it short. Where it was really, when I was growing up, we were very close to cousins, aunts, uncles, hung out with them Every weekend. So my bubble was kind of small, just family wise. And most of my uncles were pipe fitters. And my one uncle was in hr and I knew I didn't want to work with my hands. And so my one uncle who was in HR said, josh, you're a people person. Do that. Get in here.
Josh Kinzel [:You get to travel, you get to talk to people. So I went to OSU to get a degree in hr and I realized I can't fire anybody, even if it's for legit cause I couldn't do it. It wasn't something that. But I was paying my way through college, so I was like, just get a degree. And I was fortunate enough to link up with Seniority Benefit Group my senior year at osu. And they had me answering phones and everything. So it was one thing where it's like an internship. It was an internship.
Josh Kinzel [:Yeah. And I, I didn't know that's what I wanted to do, but they had me working with employee benefits. I said, there's a connection with HR there. I do like that portion of it. On this end of it, I'm not firing anybody. But then we got into, I was representing health insurance and I started on individual plans where at that moment in time in 2006, they were still allowed to ask medical questions. So I didn't have that angst of needing to let somebody go, but I had that angst of, yeah, you need this insurance. You want this insurance.
Josh Kinzel [:I know it is something that we talk. I would love to, but something on your application said, you can't have it. So even that was something I told my boss. I go, this is very hard for me to do, to lay down at night knowing. He said, well, you don't make the rules. It's not you, and you have to compartmentalize it. And I understood that. But then he was kind of wise too, to say, well, why don't you try the Medicare side of our business here, where go to folks who are turning 65.
Josh Kinzel [:Because at that time we were representing individual plans, employee benefit plans, and also Medicare. So in 2008, I shifted over to that side of it. And ever since then, that's, that's what I've been doing. But what I love about it is, at least on the front end, there's no medical questions. You can pick the level of coverage you want. A lot of times when people transition to it, for the first time, I'm giving them good news that especially nowadays with deductibles being very high, you have the opportunity to lower Those in the Medicare world. So it was a started in hr, then started talking about insurance, got in with Seniority benefit group in 2006, and I've been there ever since. And it's been a wild ride, but it's been fun.
Josh Kinzel [:And people always say you find something you enjoy doing, it doesn't feel like work. And most days it's like that. Now, I only say that with disclaimer. We are coming up on that open enrollment that Carol talked about where it's like hair on fire. Busy. Yes, yes. So that's a tough part, but yeah, that's kind of how I got here.
Carol Ventresca [:You know, this is a perfect example of what I always told students when I was at Ohio State and told my clients at Employment for Seniors. The industries that are growing are those that serve older adults because there are so many of us. And this is absolutely. Talk about it an ideal time and place for you, but it's still an ideal time and place for kids who are graduating now.
Josh Kinzel [:Yeah, really is.
Carol Ventresca [:They're looking at going into that business services area. This is a place.
Josh Kinzel [:And the most amount of hires we've had recently are people who are just retiring or not retiring, coming out of college and in their 20s and. Yeah. So it's kind of fun to see that next wave come through, Right?
Brett Johnson [:Exactly. Yeah. Like, we know many Medicare open enrollment, for many of them, it's a slam dunk. I mean, they've gone through it over and over and over and over. But we talked about this before the podcast. We kind of are talking to also the people that it's new to them. I mean, it's complex as their healthcare issues are complicated. So we ask you for your advice and wisdom each year.
Brett Johnson [:With healthcare costs rising and benefits changing, it's important that we choose a plan that not only meets our needs, but one we can afford. The various parts of Medicare can be confusing, particularly if it's your first year. As I mentioned, what should our listener understand about Medicare, particularly what it covers and what it doesn't cover? Probably even more importantly.
Josh Kinzel [:Well, it is that Alphabet soup that we talk about all the time. So if you are new to Medicare, you're starting to realize, oh, there's A, B, C, D, or my friend has plan F or plan G or plan N. Lot of letters. A lot of letters. And what we find, too, is as great as we are tooting my own horn here of explaining on the front end, they're absorbing what they need to absorb at that time. But a year later, it's almost a re education process, which we're proud that we do every year, because it is something that it's always in our face and everything. But just to kind of break it down, as simplest terms is Medicare through the government is part A and part B. So that's original Medicare.
Josh Kinzel [:That's through the government's health insurance provided by the federal government. And part A doesn't cost anything and addresses hospitalization. Part B is the one that covers things outside of the hospital. So when you go to a doctor or have an outpatient surgery, that's B. So you need to have A and B to kind of be your baseline if you're jumping into Medicare. So you have A and B through the government that covers about 80% of a bill. So you have a $10,000 surgery, outpatient surgery. Medicare A and B covers about 8 of it.
Josh Kinzel [:And people say, okay, well, 80%, that's not too bad. But then they realize that the 20% that's not covered by original Medicare, there's no limit. So right now, when people are looking at their health insurance, there's a deductible, there's coinsurance, but there's also a maximum out of pocket. So we know at the end of the day, as much as we'd love to lower that maximum, there is some stop gap where with original Medicare, there's not. So now we have this issue, if you will, of deciding how do we address the 20% and prescriptions, which is a big cost for folks. So then there's two basic paths beyond that original Medicare. So you have A and B paying the government for that 80% coverage. Then you can either take option one or option two.
Josh Kinzel [:Basically, you can do a traditional Medicare supplement, and that addresses that other 20%. And that's where, if you're looking for something simplistic in nature, most amount of freedom, where you can go wherever they take Medicare and most of that 20% is covered. That's the direction you'd want to potentially go. And within that direction, there's those letter plans that if you're asking neighbors or friends, they might say, well, I have plan G. It's great. I have plan. My parents have plan F. They don't pay anything when they go to the doctor.
Josh Kinzel [:So those letters are for the supplement. Then we add a part D drug plan. So option one is you have A and B covering 80%. You have a supplement of some kind covering the other 20. Then you have a part D, as in drugs, covering your prescriptions, which we'll talk about a little bit more later on. But then the other path is Medicare Part C, which is Medicare Advantage, and these are through private insurance companies. And what happens is that you have to have A and B, then it's assigned to a private insurance company. The government pays that private insurance company to administer a plan.
Josh Kinzel [:So these are the plans that you see a lot of times on TV in the fall where you're not paying anything extra per month because the government pays that company on your behalf. But your trade off with that is that those will have networks of doctors. Those will be HMOs and PPOs. Not a negative thing, but things you want to be educated on.
Carol Ventresca [:So you have to make sure that it meets who you're. Who you want as your doctors.
Josh Kinzel [:Absolutely. So that's, that's why the first piece of advice is don't sign up for your neighbor's plan just because your neighbor likes it. It's. Everyone's different. And then just to finish off that, part C is that it is consolidated into one plan. So people like the idea of. It's like what they had through their employer. You show the same card at the doctor, hospital, pharmacy.
Josh Kinzel [:They like that simplicity. But there's trade offs, obviously.
Carol Ventresca [:You know, the other thing that, because I follow the traditional plan, but at the time, the connector that we use through our pension to get into Medicare warned me that if you go to a part C plan and something happens, you may not be able to go back to A and B, which tends to be, I wanna say, more stable in what it covers. Those part C plans can change a lot.
Josh Kinzel [:Yeah, there are more variables with the part C plans. The trade off kind of makes sense because with the part C plans, they're going to be less expensive. So you would just inherently think that, okay, there's going to be some trade offs. And there are. And a lot of people can live with the trade offs. But you're right, Carol, where if you go Medicare Advantage and then want to change to the supplement later on traditional, there's some medical questions that could change. That's always kind of in the background saying they might because the Affordable Care act removed health insurance or the pre existing from individuals. So they're trying to make it be on supplements as well.
Josh Kinzel [:But at the moment, yeah, you'd have to answer questions to get there.
Carol Ventresca [:Because when you're 65 and you get Medicare, you may not really have any major issues. No medication or only one. And then suddenly you're 80 and you got a list of doctors and prescriptions and you want to transfer back and it's almost, at this point it's almost impossible to do that.
Josh Kinzel [:And the main thing I want to get across the folks when we're talking about those two options and, and bringing that up, that yeah, there might be some pre existing conditions that you'd have to be aware of. That doesn't mean that Medicare Advantage is a bad spot to be stuck in. As long as we can navigate it appropriately and be on the plan that has our doctors, it's still going to cover the things that we're looking to have covered. You just might have to pay more out of pocket than you would have on traditional Medicare. So it's still the insurance angle of do you pay more upfront with the supplement for less or maybe more stability, less out of pocket when you use it or are you okay with a little risk and that's what you have with those Medicare Advantage.
Carol Ventresca [:I want to clarify something too because my being on Medicare A and B, traditional I pay for my Medicare. You mentioned that the government pays for.
Josh Kinzel [:Part C, Medicare Advantage.
Carol Ventresca [:So how does that happen?
Josh Kinzel [:So what happens in those two paths again? So with the supplement, traditional Medicare, Medicare pays out of their own coffers. They pay 80% of a bill. So then your supplement, whoever you're paying your premium to, pays the other 20%. It's an insurance company that pays the other 20. With an advantage plan or part C, the government says, hey, we're going to pay an Advantage, an individual company here, we're not going to also pay the 80%. So then they just budget and say, hey, we're going to pay the Advantage company maybe $1,300 a month for somebody to be on their plan. But now they take on the risk. So the private insurance company takes on the risk entirely.
Josh Kinzel [:So if you end up in the James, for instance, for a month and it's $2 million, if you're on an Advantage plan, you pay your CO pay. The Advantage plan takes care of the rest of that $2 million. If you're on traditional Medicare. Traditional Medicare, the government pays a lot of that $2 million. So the government is even okay depending on administration and everything, different ways of thinking of insurance. But they do say, look, I mean it is a, yeah, we're paying these private insurance companies but now we're not on the hook for the 80%. And so you'll read like anything else you can read somebody that argues that traditional Medicare is better for the government, somebody else argues that Medicare Advantage, it's a very, it's an issue that's always Talked about.
Carol Ventresca [:Right, right. Well, and my cousin who was in the insurance world and I laugh a lot because I'm always saying insurance is based on taking risk, but actually we're taking the risk. They don't. So that's really important to make sure when you do an advantage plan, you really know what they are covering and what they're not covering. Okay. So I mentioned when we were talking before we started taping the podcast, there are not a lot of changes compared to last year. There are a few and I thought we wanted to make sure that we cover that, but it's nothing compared to what it was last year. Nothing bad is happening.
Carol Ventresca [:It's all good. So when we're looking at the changes going into 2026, Medicare Part B is going to increase about 11%. So it's going up to $206.50.
Josh Kinzel [:Yeah, that's the estimate. I'm sure it will come in close to that, if not that. Exactly.
Carol Ventresca [:Okay, so again, we'll give you the resources to make sure you check all these things out. Costs of Part D medications may increase a little, but deductible levels and catastrophic thresholds will also increase. But the actual cost of drugs, including those for diabetes, is decreasing.
Josh Kinzel [:So let's talk about that for a second and explain how we got there. So the Part D this year, in 2025, it was the first because Inflation Reduction act, there is now a maximum out of pocket for somebody, an individual, on their medications. They won't pay more than $2,000 in a given year on covered medications. This is the first year that that's rolled out or was implemented. So the insurance companies are using that as well. We didn't know how to price it. We didn't really know how that was going to affect our bottom line. So now that they've had a year into it, they're now saying, well, we have to maybe charge more.
Josh Kinzel [:We took on too much from that. So to your point of saying they may increase, we do expect those prescription drug plans, the premiums to continue to increase to try to offset some of that. But the good news is that the CO pays on the diabetic insulins has remained in effect. So it's the insurance companies maybe taking advantage of a catastrophe here and saying, oh, we have to charge more. And it's. It is hard to feel bad for insurance companies bottom lines, but that sounds.
Brett Johnson [:Like they need to fire some people.
Josh Kinzel [:For not figuring it as well.
Brett Johnson [:Supposedly they're supposed to be the smartest person in the room.
Josh Kinzel [:I know. Yeah, I Know, but that's kind of led to. Now they're warning us as brokers, hey, you know, your clients are getting letters this month saying what it's going to cost next year and it's, they're not going down so.
Carol Ventresca [:Well, actually mine can't go down because my monthly cost was zero.
Josh Kinzel [:Yeah.
Carol Ventresca [:And thank goodness, knock on wood. Who knows, we'll see what it. But I, but as a word of warning to those who are new going into Medicare, if you're ending up doing a part D plan, don't just look at what the monthly premium is. Understand how they're going to charge you. Because I was in a plan one time and it was a different charge every month. I never could figure out what was going on. And that's why I kept switching until I found one that they showed me. Basically this is what you should expect each month.
Josh Kinzel [:Yeah. And it is still amazingly just an estimate because throughout the year some of these prescription just prices can change, which is kind of wild too.
Carol Ventresca [:That's true.
Josh Kinzel [:But yeah. And with the Inflation Reduction act, one of the other changes was people always talked about the donut hole. That was like a big, big thing, big term. And whenever I meet with somebody, they're like, well, tell me about the donut hole. And that was where when the prescription drug plans came out, there were different stages. You had a deductible, then co pays and you reach this coverage gap or donut hole where it's like you had no insurance. Since then, with the Affordable Care Act, Inflation Reduction act, they've removed that. So now they put in that limit.
Josh Kinzel [:You have a deductible on plans, you have coinsurance, but you won't pay more than that $2,000. So there's not this donut hole anymore.
Carol Ventresca [:Right.
Brett Johnson [:So it's a full pastry, not a donut.
Josh Kinzel [:Correct. Corre. Yeah, yeah. There's no hole in there. Yes.
Carol Ventresca [:That was the most confusing thing.
Josh Kinzel [:It was and hard to explain.
Carol Ventresca [:And yeah, yeah, I saw some, also some place where they were doing some projections of what they thought was going to change. There's a possibility that those prescription plans could actually end up becoming more than just one year at a time. You could, you might be able to move into a plan that you'll have for a couple of years.
Josh Kinzel [:They're hoping the thought behind that is letting the insurance companies project. And yeah, it's hard for that. At least that's what they're saying is it's hard for us to come up with only a 12 month and then we have to resubmit our bids in the summer of every year for the following year. So they are thinking of maybe making those into a longer and same with Medicare Advantage. They've talked about potentially doing that too so people don't have to continually look every year they're like okay, well this is what I'm gonna ride with at least for two years. It's just maybe a little bit of comfort there.
Carol Ventresca [:Well, and if your medical needs are simple, no big deal. But boy, if your medical needs are complex, that is. It takes a lot of work to get through all this information.
Brett Johnson [:Yeah, I guess as long as they leave it as an option. Not that you're forced to a two year.
Josh Kinzel [:I know. And that's part of the hang up.
Brett Johnson [:Of it be okay, you know. But then it's still another confusion point. Yeah, well it's or a question point. Should I, should I, should I Then you're always going to follow the money and I'm sure they'll incentivize the two year and it may not be the right thing for you. Yeah, right.
Carol Ventresca [:One of the other things that I saw in all of these projections that traditional Medicare may be starting to add some pre approval steps which they didn't do that much.
Josh Kinzel [:Well and I'm glad you brought that up because this is our moment of AI. AI has reached Medicare. Yeah, I know, I know. And Ohio is one of the pilot programs or one of the states that said yeah, we're in on this. Where to Carol's point. Medicare run by the government maybe not as efficiently as they would like to. A lot of times you would have a, anytime a doctor said yeah, you need this, Medicare would say fine. I mean if the doctor said it, it's coming in from a doctor's office, we'll pay her 80% and move on to the next.
Josh Kinzel [:And what really kind of brought that to light is my, my mother in law's husband is on traditional Medicare and he got a call from his supplement company and they were like Mark, have you had 26 catheters put in this month? And he was like, I haven't been to the doctor in six months. He's like, well we've been forced to pay for 25 of them. Medicare is now approving the 26th. We're just trying to maybe get involved here. So it was just to the point of my point being Medicare just really does approve everything. So it made it, it's an easier ride for folks. Another advantage of the traditional Medicare is that you don't have to really go through as much prior approval. The government in its infinite wisdom have said, well if we have AI programs that might be able to operate as these insurance companies with the prior authorization and pre approvals, maybe we'll implement that on our Medicare claims process.
Josh Kinzel [:So it might be hairy a little bit initially here. As we know AI is fallible and so there might be something where traditional Medicare would have said yeah, that's approved, that's fine, go ahead. AI might say, well have they tried X, Y and Z first before Medicare is going to pay its 80%. So there is a long term. I think it will ultimately help cut back on like my mother in law's husband's case where Medicare is just paying willy nilly, but I think there'll be some.
Carol Ventresca [:Was that an issue of fraud?
Josh Kinzel [:Yeah, yeah.
Carol Ventresca [:That somebody took on his account?
Josh Kinzel [:Yeah, yeah, somebody. Whoever was billing for those catheters were getting the 80% from the government and my times millions of people. Times millions of people. Yeah, well.
Brett Johnson [:And I think you got to keep in mind too, from what I'm hearing, if I understand this correctly, the use of AI isn't in this situation. Again, I'm assuming is not the general. We type in stuff into AI and get an answer. It's going to be a walled model. I would assume that it's protected and it's going to be trained properly. I'm not trying to give them the benefit of the doubt. I'm just saying maybe it's something we don't worry about too, too much. But it's that, okay, it's gonna happen and understand, okay, it's a model they're devising up and it's within a walled garden.
Carol Ventresca [:I think the concern that I would have though is, and thank goodness I've never had to go in for a surgery or anything like that. But so many people who are in those other plans have to sit and wait for decisions or get automatic no's.
Brett Johnson [:Right?
Josh Kinzel [:Yeah.
Carol Ventresca [:And so that would be, you know, I've always assumed that, okay, well Medicare is probably not gonna be that hard to get through. But yeah, it could become an issue.
Josh Kinzel [:Well, and even just this morning I was meeting with a client who is on an employer sponsored plan that his surgery down at OSU has been denied three times. So he's rolling over into Medicare just because they when he asks the surgeon, well what if I came in here with Medicare? He'd say, well you'd be fine. It's your private insurance company that's kind of holding it up. So for now, Medicare still Really is a soft landing spot.
Carol Ventresca [:So in terms of those pre approvals, do you think that's going to become effective this year?
Josh Kinzel [:I do think it's going to, yeah. They're going to start rolling it out and it might not be. I don't mean to be doom and gloom with it, but just be aware that they're.
Brett Johnson [:Be aware.
Josh Kinzel [:Yeah, be aware.
Carol Ventresca [:One more thing that I. And you may have other items, but one other thing that I saw. So we're supposed to still be getting our free vaccines for shingles and Covid and flu and RSV and all. There could be some issues of availability and there are still some that may require now a prescription.
Josh Kinzel [:Well, yes, for both of those accounts. But the other thing I wanted to bring up specifically with that is some folks, pharmacies, a lot of times people go to the pharmacy to get their vaccine. And not every pharmacy, most of the vaccines are covered under the medical portion of your plan, not the prescription piece. So not every pharmacy is able to bill your medical side. So again, talking to somebody the other day that she said, well, I went to get my COVID vaccine at Kroger and Kroger denied it, saying we can't. It's not showing up under your prescription plan. If you get those done at a doctor's office, it just seems to be easier just as a public service. Now if you're getting.
Josh Kinzel [:You want to have those done and you have a trip to the doctor, it's much easier to get them done at the doctor's office. But there are quantities that kind of like the Ozempic, where when a lot of people want them and need them, it's tough to ramp all that up. But what I wanted to bring up was that not every pharmacy can bill those to make those free. So don't think that if you go to a pharmacy and they say, oh, well, that's not covered. It might not be covered the way they're trying to bill it. So just try to unwind that a little bit.
Carol Ventresca [:Especially if that like that Kroger not only has a pharmacy, but they got one of those little minute clinics. Yeah, the minute clinic may be able to.
Josh Kinzel [:Might be able to bill.
Carol Ventresca [:Yes, bill it.
Josh Kinzel [:Yeah.
Carol Ventresca [:Okay, good point, Josh. Thank you. Any other changes that I didn't bring up?
Josh Kinzel [:I'm always very impressed by just to kind of. To let the audience behind the curtain. Carol is very, very sweet and very, very nice to send these prior. And I was looking through these. This list and I'm like, wow, that really is hitting everything. So Bravo, Carol. Very, very good.
Carol Ventresca [:Well, as I say, every year I really purposefully go through this because now I'm prepared to do my open enrollment in a couple of weeks.
Josh Kinzel [:Yeah.
Brett Johnson [:So this whole thing just prepares for.
Josh Kinzel [:I don't care.
Brett Johnson [:It has nothing to do with anything. But she's just getting herself right.
Carol Ventresca [:It's me. It has nothing to do with the podcast, right?
Brett Johnson [:Nothing at all.
Carol Ventresca [:Exactly.
Brett Johnson [:No, no, no. Exactly.
Carol Ventresca [:I'm telling you, at least I'm not charging you for all of this.
Brett Johnson [:That's a good point. That's a good point. So it would seem with everything we're talking about here, that you need to have a really good grasp of your own medical history in order to determine the best plan to meet your healthcare issues and be honest about it, quite frankly. So are there specific items that we can forget or choose to leave out that can be detrimental in meeting the health needs? I mean, when you're talking to someone, it pretty much put everything out there. Maybe there's nothing that should not be discussed.
Josh Kinzel [:Yeah. And it's interesting because when someone like myself as a broker in the community, we have to go through all the different testing and certifications, and a lot of them say, and it's. I understand the reasoning behind it, maybe where they say, well, you can't tell somebody, do that plan because of a medical diagnosis that you have. So it kind of ties our hands to ask too much. But to your point, Brett, it is good to be honest. It's not as if anything you say during those meetings is going to come back to bite. You might be even bringing something up where you say, hey, I'm on an Advantage plan, Josh, but I want to go to a supplement, I'll bring out those medical questions that you need to answer. And if you go through, and some of them are, yes, I don't want to put you through the hassle and the hope of maybe being able to get it when you can't.
Josh Kinzel [:So transparency is certainly key. We try to get.
Brett Johnson [:Because you don't make any more money with any suggestion, any advice you give.
Josh Kinzel [:But back to what I was saying earlier. I mean, it removes just for me. Again, selfishly, that I'm in a position where I don't have to say, oh, man, if they sign up for this Medicare Advantage, I'm taking my kids to Hawaii. But if they sign up for that supplement, I don't know what I'm going to do for dinner. It's not that the government is actually pretty good with regulating what each of these plans can pay Brokers like myself and our company. So that part is nice. We truly are just looking and trying to figure out are you type of individual that would maybe be more comfortable in a supplement and a drug plan or Medicare Advantage? My parents, who are still happily married for 47 years, my mom has Medicare Advantage, my dad has a supplement. So they work as long as you're educated with what you know going in.
Josh Kinzel [:So give all the information, whoever you're talking to, give them the information, give them the list of medications, give them the doctors, give them anything that you might have pending that is all helpful for them to give you a suggestion.
Carol Ventresca [:Right. Well, I think people too, they're sitting down and nobody wants to go through all of this stuff, but immediately they look at the cost of prescription and the prescriptions they have currently and which doctors they're going to. Are there other things? Like for instance, somebody has gotten into playing pickleball and they're running all over the place. Should they maybe look and see, well, if I get hurt, is that covered? I mean, can you even do that? Is that.
Josh Kinzel [:Well, another just general comment to make when you're trying to decide, okay, do I go Medicare Advantage, do I go with traditional Medicare? What you were saying, Carol, are you worried that maybe one path won't cover the service that you need, but the other path would? How we're protected there is that the government says, look, if you go with a Medicare Advantage and we're going to pay that private insurance company to be your insurance, they have to cover what we would cover as original Medicare. So insurance companies can't cut out a pickleball injury or they can't cut out a pre existing condition where. So if a surgery is covered by original Medicare, it's going to be covered by the Medicare Advantage plan. Where the hiccup might come in is the Advantage plan might come back and say, hey, well, we do need prior authorization, but ultimately that service is still going to be covered if it's approved. And you just might have to pay a higher amount for that on an Advantage versus traditional Medicare.
Carol Ventresca [:And even if you're paying a little bit more, it's certainly not the whole thing.
Josh Kinzel [:Correct? Correct.
Carol Ventresca [:Okay.
Josh Kinzel [:Correct.
Carol Ventresca [:All right. Okay. So as we're talking about medical Medicare Advantage plans, those monthly premiums are normally lower free. There are many health and financial issues at stake. When we choose our plans and we're stuck with those for a year, you can't pop in and out of different plans. Are these free plans really free? We've kind of talked about this A little bit. Insurance companies have to make a profit.
Josh Kinzel [:Oh yeah.
Carol Ventresca [:You know, they're not going to do this out of the goodness of their hearts.
Josh Kinzel [:Correct.
Carol Ventresca [:How can you explain, or can you explain how those Advantage plans are going to be able to provide free services and most importantly, what clients should look for when they're reviewing those Advantage plans.
Josh Kinzel [:Just to take a step back and how they're funded and how they're zero. They really are zero additional dollars. And I want to stress that it's not any additional money, but you do still have to pay for your Medicare Part B. So you still have that premium, which right now is 185 going up for 2026. But you do need to have that. And how it works is that the government is paying that private insurance company that you select anywhere between $1,000 to $1,300 we've heard per month. So the insurance company is saying, we just want that government check. We want that $1,000 a month on your behalf.
Josh Kinzel [:And we're hoping that we get enough folks on our plan that we have more people that were collecting a thousand and not paying anything out than we don't. So there really can be good plans that are quote unquote free. Just look at it. It's a plan that really costs $1,000 or $1,300 a month. Then you look at it differently, say maybe this does carry some value. And it does. As long as you're okay with the biggest trade off with those Advantage plans. Just always look at your network, make sure your doctors are in that network and realize that you will have some out of pocket.
Josh Kinzel [:The only time, and this is where they're trying to get better with the advertising is you'd see on TV where they'd say everything's zero. The premium zero. Your doctor visits are zero. Your hospital, that is specifically for folks who are on Medicare and Medicaid. And I know there's a question about that coming up. But the general population that doesn't have both these free plans, these $0 plans can be very good because they're funded by the government. But you do have that trade off of you're going to pay co pays and maybe pay out of pocket in a worst case scenario of around five or six thousand. So you have to be okay with the back end risk in order to have the $0 plan.
Josh Kinzel [:But somebody who doesn't go to the doctor very often is somebody that would look at that and say, well, shoot, if I'm not paying anything most months, most years, I'M going to come out ahead. And that's true. And it's amazing how many times over the years where I'm just trying to figure. I thought like maybe you could figure out what somebody's going to do just based on. And some of our highest net worth clients are the ones that say, oh, give me a Medicare Advantage, I'll keep the extra premium and I'll invest that somewhere else. And if I have to, I'll go to a doctor that's in network and I have to come out of pocket six grand. That's okay. I can do that.
Josh Kinzel [:So really it's been fun to realize you really can't pigeonhole anybody in any of that. Like you just. You have to look at everybody individually because what you think might be the case is people just have different ways of looking at it.
Carol Ventresca [:When you're talking too about making sure that your doctors or doctors you like are in the plan, one thing I have heard, people are having issues. I don't know that we have it in Columbus as much. So we have some really large, very good hospital groups. But I have heard that folks are not able to get doctor's appointments or they're waiting months to get into a doctor's office. Now I know things like dermatology and stuff like that.
Brett Johnson [:Specialized for sure.
Carol Ventresca [:Some of those are way. But is that an issue in those Advantage plans? If the network of doctors is a.
Josh Kinzel [:Small network, I think that it's more of a global issue with our health insurance as it's set now even looking at me trying to schedule a endocrinologist visit for my son, it's months out or me trying to get a dermatology. Just checkup every. It's. You schedule it now for next April.
Carol Ventresca [:Right.
Josh Kinzel [:I mean, I think it's just more that it's not if you show up or try to schedule with an Advantage plan, that's going to kick you out or if you show up with a supplement, they're going to let you in sooner. I think it is more of a issue with. Some of these specialists are just getting really backed up.
Carol Ventresca [:Okay, good.
Brett Johnson [:Yeah. The new MyCare Ohio Managed Care program combines Medicare and Medicaid benefits into one plan for eligible individuals. It was piloted in several counties here in Ohio and will be implemented throughout the state. Coming up in this next year in all 88 counties, it's touted to give the individual a single managed care provider and more seamless health care. Now, can you talk a little bit more about the plan? How an individual can determine if they're eligible. And the disadvantages maybe a limit of number of plans available. Maybe that's. Maybe that's the only disadvantage or what you've heard so far.
Josh Kinzel [:Yeah. Yeah. And this is my only disclaimer is I'm not the professional on this particular topic in our office but we have one. His name's Court Everhart. So I did I checked with him before I came on here to kind of give us an idea. But it is. It is a another layer here that we add when we're talking about folks who are on Medicaid as well because the different payer for someone who has low income low assets. But what my Care Ohio the spirit behind it was consolidation really for folks.
Josh Kinzel [:So it wasn't. I'm showing one card over here and they. They don't administer all of is a plan that you. It's like the Medicare Advantage but supercharged in the sense like when I reference those.000 that they're all saying on TV000 with the MyCare Ohio plans folks really do have very little out of pocket when they go to use it. But there are four companies at least for now that you're able to choose from. So it does reduce the amount that you can right now it's Anthem, Buckeye Care Source and Molina. So then Court was telling me too mycare Ohio is a subset of different plans. There are other plans that are are out there for folks who aren't fully eligible for Medicaid but partially eligible for Medicaid.
Josh Kinzel [:So then it adds an extra wrinkle where people say oh well I want one of those MyCare Ohio plans. And then we run the prior authorization for it to see if they qualify and they oh well you're only half Medicaid eligible. And so then there's another subset of plans which but I understand the spirit of it is trying to streamline those services that this one plan will consolidate the Medicaid payers the Medicare payers into one plan. And in Franklin county at least it has been available and they are expanding it to the rest of the state. So in spirit I do think it.
Brett Johnson [:Will help and obviously has had a decent track record this year to be.
Josh Kinzel [:Able to work and it's yeah it's been out for the keys there to your point Brett where we have to make sure your doctors are in it. So it is a managed care plan just like we've talked about with Medicare Advantage. We have to make sure your doctors are in it. We have to make sure you continuously qualify for it. So court was another. He said another thing is that just you want to check with Jobs and Family Services, if you need to apply for Medicaid, you want to check with Medicare. They are able to tell you if there's different things that we can use as brokers. If you provide us information, we can see if you qualify for these plans.
Josh Kinzel [:I understand, like I said, the spirit of it and I hope it does work out because the last thing somebody with low income, low assets should need to worry about in this country is being able to go access security. Yes, yes.
Carol Ventresca [:And I've heard that in some situations folks only actually had one plan that they could choose from. So now actually having four plans is to their advantage. Now there's the opposite also occurred. There were places you could be where you got more than four. So that's been an adjustment, but four is better than just one.
Josh Kinzel [:But the main point to leave with there is just it is new, it is rolling out for a lot of these counties across Ohio. Just make sure you're checking with someone whether it's a broker like us or if you're not qualified for Medicaid, explore that with Jobs and Family Services to see if you are. Because some people are shocked by the qualification limits where they think, oh, that's not me. But the world has changed and things are getting more expensive and some of those limits are different now. So it never hurts a check.
Carol Ventresca [:Right? Right, Absolutely. So we mentioned earlier that we're taping this before actual open enrollment window begins and some decisions haven't been made and finalized for 2026. Can you give us any tips on what those issues are? And I just want to remind our audience we will have these resources for you so that you'll be able to check it out. But you know, how can our listeners find this most up to date information?
Josh Kinzel [:Now I will give credit to the government on medicare.gov it is a very, it's a wealth of knowledge. It's an intimidating for folks because it has all the information you would ever want to know about Medicare. And you really don't know how to navigate that maybe. But that Medicare.gov is a really, really good resource. What I would tell too, we're taping this in September and whether you listen to it in September or not, but that's when every year if you're on a prescription drug plan or a Medicare Advantage plan, there's a federal law that that insurance company has to tell you what your plan change will be coming up. So look in your mailbox, you get that what's called an annual notice of change, where it will lay what you have on one side of the page and say what it's changing to on the other side. And most of the time when we reach out to everybody and people engage with us and we review the plans during the open enrollment, most of the time people don't like to change unless there's a real good reason for it. So you look at this and you notice a change, you might not need to do anything.
Josh Kinzel [:And that could be the best path forward. Even though you see all these ads trying to froth you up to make you think what you have is not best, maybe it is, maybe it still can be. That is a solution there. But like we talked about earlier, with not a lot of changes in 2026, we're looking at what the Part B premium will finalize with. But just look for that annual notice of change and see if you can live with those changes. If you can. It makes it a real easy fall. You don't have to do anything.
Josh Kinzel [:It just automatically rolls over.
Carol Ventresca [:So Josh, now when do those annual notices have to be out?
Josh Kinzel [:They have to be in your mailbox by the end of September.
Carol Ventresca [:And if it's like it was last year, it may have been October by the time I actually got mine. So just keep looking and making sure you're getting that information. I also mentioned earlier that the handbook is out. The link to that handbook is out from the federal government to those who are listening, that handbook is huge. I mean it is really huge. If you are on Medicare. I know it's long. I know it's big.
Carol Ventresca [:Just take some time and look at it. If you have older relatives who are on Medicare, please make sure that somebody is going through all this information with them. It is really complex and they may need some help. So two, there are groups like Seniority Benefit Group that is there and free of charge for you. So go and find the resources you need. Don't make assumptions because it could be a costly assumption if you're not careful.
Brett Johnson [:Seniority Benefit Group and other connectors support individuals and organizations in their evaluation of Medicare plan. So talk more about Seniority Benefit Group and particularly the role in assisting employers as they manage their employee benefits packages.
Josh Kinzel [:Well and as I said before we started as an employee benefits firm where we would go to small group that was kind of our specialty. Anything under 50 employees and deliver their health insurance and go through and shop just like individuals are doing with their Medicare plans. We would do for and have relationships with the HR department. Find for their employees. And so that has kind of been a unique position we've taken into this Medicare space. We're no longer doing the employee benefit side, but we're absolutely reaching out to HR folks and saying, look, we know your employees are asking, hey, I'm turning 65, what do I do? And so how we connect with those HR individuals and just say, we can take that off your plate and it will more than likely help your bottom line if someone goes onto Medicare instead of stays on the employer plan. And that individual, what we've seen over the past 15 years, those employer plans are just more and more costly for the employer to deliver and what that turns into higher deductibles and so more watered down benefits, more coming out of that individual's paycheck just to have the insurance. So we just say, hey, look, put us in as a resource during your open enrollment time and say, you can absolutely stay on this plan, but if you're eligible for Medicare, it might make some sense to talk to Josh or someone there at Seniority Benefit Group to just compare, because that's another misconception that some folks will have is they'll say, well, am I allowed to be on Medicare and still work? Absolutely, you can, you can absolutely do that.
Josh Kinzel [:So it's something that we've really tried to push out to employers. Just saying this isn't a way of you forcing them off the plane. You're not allowed to do that. They know that. But it might just be a win win situation. And more and more often it is where the employer isn't paying their side of the premium, the employee gets a better set of benefits. So kind of everybody wins there.
Brett Johnson [:Yeah, it's nothing to do with Social Security. That's what in our mind is work in Social Security. It's totally different beast.
Carol Ventresca [:And there are a lot of folks who assume their employer insurance is better, maybe cheaper, maybe free. And so why should I go on Medicare when in actuality it not only helps them because the Medicare coverage could be better, but also one of the things that we have talked about is how employers can do a better job of recruiting and retaining older workers. And what are the benefits they can provide? Well, one of the things they can do is they don't have to worry about full insurance, but they can become the supplement to somebody's Medicare. And it's cheaper for them, cheaper for the employer, and it really helps the individual because that supplement could be a chunk of change every month. But so those are the things that again, just to tell our AUDIENCE make sure you are really thinking through that. Don't assume your employer insurance is the best way.
Josh Kinzel [:Yeah. Or even retiree benefits any longer where those have changed. They've been under pressure to deliver the same level of benefits to retirees because now more and more retirees are actually utilizing that benefit. And so we're seeing some of those change where people say oh well my employer, don't worry about it, we don't need to talk because they have a retiree plan. And we say well let's just take a look at it, let's just see. And if it is something that's still really good, then we say okay, yeah, you're right, go that way, that's fine. But we're seeing more and more of these retiree plans almost being offered just to say they offer it where it's not really a benefit anymore. So just to your point, Carol, just look and compare.
Josh Kinzel [:Don't assume.
Carol Ventresca [:Right. Get, get, get a second opinion. If you, if you have really good health insurance, you are able to get a second opinion. So do that second opinion on your insurance up front. So good. All right. We are going to share all the resources and articles and information. I found a bunch of stuff on the Kiplinger site on Medicare this year so I'll make sure all of that is included and a link to the Medicare and you'd which is the handbook that comes from the government.
Carol Ventresca [:Josh, this is always a great interview. We love having you here every year. Any last words of wisdom?
Josh Kinzel [:We've kind of said it throughout as just don't do it alone. You don't need to do it alone. We live in an area fortunately and there's a lot of folks, as much as I want to say I'm the best person out there and you should come to me and our company. A lot of people are well intentioned sometimes gets lost with you're getting these calls unsolicited. You feel like you're being sold. Wherever you're listening to this, there is someone in your community more than likely that has a passion to help people, people like we do. We would love to help anybody out there, but just don't do it alone. There's really no point to do that.
Josh Kinzel [:There's no cost involved with most of us and if you do that just be maybe a warning if somebody says yeah, I'll review it for you but it's going to cost. There's plenty of free resources so don't worry about that.
Carol Ventresca [:Absolutely. And groups like Seniority Benefit Group, we'll give a shout out to Central Ohio Area Agency on Aging, which does a phenomenal job of Medicare workshops. Even though my insurance was covered at first through my pension and I had a connector, I didn't know what questions to ask, so I went to a Medicare workshop just so I knew what questions to ask. So yeah, take advantage of all of the community resources for listeners who are outside of Central Ohio. We'll also include some information for you that is just as relevant.
Josh Kinzel [:Yep. And our company Seniority Benefit Group helps anywhere throughout Ohio and 17 other states. So just even if you have a relative or someone you know outside of Ohio completely, we still might be able to help.
Carol Ventresca [:So just or at least refer them.
Josh Kinzel [:On or at least refer them off.
Carol Ventresca [:Wonderful. Super great. Thank you.
Brett Johnson [:Many thanks to our Medicare expert guest Josh Kinzel from the Seniority Benefit Group for joining us today. Listeners, you thank you for joining us. You know, you're going to find the contact information and resources we discussed in the podcast Show Notes on our website@lookingforwardourway.com and we're looking forward to hearing your feedback on this or any of our other podcast episodes.
