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Dear Connie,
I’ve had my Medicare Advantage plan for a few years, but lately it feels like I can’t keep up. Between my prescriptions and doctor visits, the costs keep climbing. I’m on a fixed income, and I’m scared I’ll have to choose between my medicine and my groceries. What are my options?
Worried,
Diane from San Antonio, Texas
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Local, licensed insurance agents with 25+ years of combined experienceDear Diane,
Thank you for asking this. Rising healthcare costs are stressful, and you’re not alone in feeling this way. The good news is that “unaffordable” usually points to one of four specific problems, and each one has its own fix.
Here’s an advantage you have: switching Medicare Advantage plans generally does not require medical underwriting, so your health cannot be used to deny you coverage during an eligible enrollment period, according to Medicare.gov. Let’s walk through the four causes.
If prescription drugs are driving up your Medicare costs, check if you qualify for Extra Help, also called the Low-Income Subsidy. It helps pay for your Part D drug plan, also known as Prescription Drug plan coverage or Medicare drug coverage.
For 2026, you may qualify if your yearly income is below the income limit of $23,940 (single) or $32,460 for a married couple, and your resources are below $18,090 for an individual or $36,100 for a married couple, not counting your home, one car, or certain personal belongings, according to Medicare.gov. Income and resource qualifications vary by state, and a Connie Health agent can help check your eligibility.
Extra Help can eliminate your Part D deductible, help pay your drug premium, and cap copays at $5.10 for generics and $12.65 for brand-name drugs in 2026.
According to Medicare.gov, the Bridge Program caps your GLP-1 copay at $50 a month through December 31, 2027. To be eligible for the Bridge Program, you must not be eligible to receive a GLP-1 drug through your Medicare drug plan and do not have type 2 diabetes, moderate-to-severe sleep apnea, or fatty liver disease. If you have type 2 diabetes, moderate-to-severe sleep apnea, or fatty liver disease, check with your insurance agent, as your Medicare drug plan may already cover a GLP-1 drug for you.
If you meet these requirements, there are three ways to qualify for the Bridge Program.
One limit: this GLP-1 $50 discount doesn’t count toward your Part D deductible or the $2,100 yearly out-of-pocket cap.
You can also ask about the Medicare Prescription Payment Plan. It spreads your yearly drug costs into monthly payments instead of one big bill at the pharmacy, per CMS.gov.
If doctor visits and copays feel unmanageable, ask about Medicare Savings Programs, especially the Qualified Medicare Beneficiary (QMB) Program. QMB can help pay your Part A hospital insurance and Part B premiums, deductibles, coinsurance, and copays.
Federal law says providers cannot bill QMB members for Medicare-covered cost sharing, including Medicare Advantage cost sharing, per CMS.gov. Dispute any bill you shouldn’t have received.
Medicare Advantage also has a built-in safety net: your yearly out-of-pocket maximum. An out-of-pocket max is the amount you pay out of pocket for in-network and out-of-network services. Once you hit your limit, your plan pays 100% for covered in-network care for the rest of the year.
Sometimes this isn’t really an affordability problem. Maybe your doctor left the network. Many Medicare Advantage plans include extra benefits, and yours may have cut one of these.
Check your Annual Notice of Change (ANOC) letter, sent every fall, according to Medicare.gov. If benefits have changed significantly, that’s a good reason to compare plans during the Annual Enrollment Period, per Medicare.gov.
Again, switching plans generally does not require medical underwriting. If your plan is discontinued, you may have Guaranteed Issue Rights and a Special Enrollment Period, so you may not have to wait, according to Medicare.gov.
Many people assume their Medicare Advantage plan got pricier when the increase actually came from Medicare Part B, since Medicare premiums are often deducted straight from your Social Security check. In 2026, the standard Part B premium is $202.90 a month, and the deductible is $283, according to CMS.gov. This applies no matter which plan you choose.
If you have Medicaid, qualify for both Medicare and Medicaid, or manage certain chronic conditions, you may qualify for a Medicare Advantage Special Needs Plan (SNP), such as a Medicare Advantage Dual-Eligible Special Needs Plan (D-SNP), per CMS.gov. These often include additional benefits and lower costs than standard Medicare Advantage plans.
Agent tip:
“Before you assume your plan is too expensive, pull out your Explanation of Benefits and ANOC letter. Sorting your costs into these four categories can help a licensed insurance agent find the right fix faster.”
Diane, your feeling that your costs are out of reach is usually fixable. Drug costs, medical bills, benefit changes, and Part B premiums each have a different solution. Reviewing your coverage every year can help you catch savings you might be missing.
Call (623) 223-8884 to speak with a licensed insurance agent for a no-cost plan review.
No-cost, unbiased serviceCompare all major plans and carriers Local, licensed insurance agents with 25+ years of combined experience
Yes, during Annual Enrollment or other eligible periods. Switching generally doesn’t require medical underwriting, so your health can’t be used to deny you a new plan.
Check if you qualify for Extra Help, which lowers the cost of your prescription drug coverage, including your premium, deductible, and copays. GLP-1 users can ask about the Bridge Program, which caps copays at $50 per month through 2027.
To be eligible for the Bridge Program, you must not be eligible to receive a GLP-1 drug through your Medicare drug plan and do not have type 2 diabetes, moderate-to-severe sleep apnea, or fatty liver disease.
If you meet these requirements, there are three ways to qualify for the Bridge Program. 1. You have a Body Mass Index (BMI) of 35 or higher. 2. Your BMI is 30 or higher, and you have certain types of heart failure OR high blood pressure that’s hard to control OR chronic kidney disease. 3. Your BMI is 27 or higher, and you have prediabetes, OR you’ve had a heart attack, stroke, or blocked arteries in your legs or arms.
Extra Help lowers Part D drug costs. Medicare Savings Programs, such as QMB, help pay for Part A and Part B premiums, deductibles, and copays. Many people qualify for both.
Yes. Every plan has a yearly out-of-pocket maximum, capped at $9,250 for 2026. After you reach it, your plan pays 100% for covered in-network care for the rest of the year.
You may, if you have Medicaid, qualify for both Medicare and Medicaid, or manage certain chronic conditions. A licensed insurance agent can check your eligibility.
Read more by Renee van Staveren
Since 2009, I've been writing about complicated, technical issues, with the goal of making topics like Medicare and healthcare easier to understand. I've been writing about Medicare since 2021 and healthcare since 2019. I am an AmeriCorps alumni. I enjoy gardening, reading, and DIYing.
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