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Your trusted guide to a strong and secure retirement! | |
LBA Quarterly Newsletter - Fall Edition
2025 • Quarter 4 • Issue 16
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Robert Dumais
Principal, LBA
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| ALERT: MORE THAN EVER, UPCOMING MEDICARE CHANGES SHOULD NOT BE IGNORED | | | |
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Beautiful family.
Cool car.
Not a fit!
Picking a Medicare plan can be the same.
Let LBA help you find a plan that fits you.
| | Key Medicare Updates for Rhode Islanders | Here are several changes in the Medicare Advantage sector that may impact you. We strongly suggest that you do not try to navigate this alone! Whether you are already on Medicare, or are looking at Medicare coverage for the first time, LBA can help you understand the changes and decide your path moving forward. | | |
Blue Cross RI: Because of millions of dollars lost in 2024 and rising health costs, premiums will be increasing, and benefit cuts are anticipated in 2026.
United Healthcare: Starting July 1, 2025, Brown University Health’s hospitals are out-of-network for their Medicare Advantage beneficiaries. Brown University physicians stay in-network with United Healthcare through at least the end of 2025. A special enrollment period was created allowing affected United Healthcare Medicare Advantage members in Rhode Island to switch plans.
Aetna: Seems to be coming on strong in 2026 and we are anxious to see the details of what they will have available.
Part D changes (2026): The annual out-of-pocket limit rises to $2,100 (from $2,000). Premium-control rules change, allowing plan premiums to increase more (cap moves from $35 to $50). In summary, part D plans have gotten much richer over the last couple of years, but premiums will be rising.
To clear the air, we don’t blame the carriers for how they are responding in a difficult marketplace. But it is important that you stay alert so you understand how you will be impacted. While in our discussion we focus more on Rhode Island, at LBA we also service people living in many other states.
Feeling a bit overwhelmed? At Legacy Benefit Advisors, we know Medicare isn’t a "set it and forget it" system. That is why our team is here to provide no cost, ongoing support to help you make decisions that align with your health, lifestyle, and budget, now and moving forward.
| | It is all about taking care of yourself and your family. | | |
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The Calendar Matters More Than You Think
Medicare has its own rhythm and if you know the timing, you can avoid penalties and save money.
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Annual Enrollment (Oct 15 – Dec 7): This is your once-a-year opportunity to review or change your Medicare Advantage or Part D drug plan. During this timeframe, you can make plan changes which will be effective 1/1/26. (Limitations may apply.)
Medicare Advantage Open Enrollment (Jan 1 – Mar 31): If you are already in an Advantage plan, this is your chance to switch plans or return to Original Medicare. (Limitations may apply.)
Initial Enrollment (around your 65th birthday): The first and most important window to join Medicare without lifelong penalties.
Special Enrollment Periods: Triggered by life events like retirement or moving, or changes in response to carrier implications. Rules for these have changed recently (more on that below).
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What else is new in Medicare for 2026?
A lot has changed since last year, and more changes are coming. Here are the highlights you need to know:
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Part B Costs Are Rising: The base monthly premium is now $185 but in 2026 the base rate is going to be $206.50.
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Drug Costs Are Capped: Starting January 2025, there has been a $2,000 annual cap on out-of-pocket prescription costs. The cap goes up to $2,100 in 2026. For those who face big bills early in the year, Medicare also offers a new Payment Plan to spread those costs evenly throughout the year.
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Unused Advantage Benefits: Advantage plans now must tell you if you haven’t used certain benefits like dental or vision. This is a nice reminder not to leave money on the table.
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Special Enrollment Period Rules: Starting this year, people with both Medicare and Medicaid (dual eligibles) can no longer switch freely between Advantage plans monthly. Reviews during open enrollment are now more important than ever.
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Looking Ahead: Congress is debating auto-enrollment into Medicare Advantage starting in 2028, which could reduce your freedom of choice. This proposal has many critics, but it’s one more reason not to go it alone.
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Part D Premiums May Rise in 2026: Current policy shifts could push drug plan premiums higher in the coming years.
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Often people will come to see us and say they want the “best Medicare plan available”. The problem is there isn’t a “best” option. Original traditional Medicare with a supplement might be best for some people, while an advantage plan might be best for others. In summary, the right plan depends on your health, your lifestyle, and your budget. I like to warn people that when you come in to meet with someone on our team, they will ask you a lot of questions because they are trying to dial you in as best as possible.
My wife and I have been Medicare beneficiaries now for three years. FYI, we started with an Advantage plan and are still on an Advantage plan, however, we have changed plans three times and will likely change again in 2026. It’s not that our health has changed much, thankfully we are still healthy, but the marketplace has changed around us and we are responding.
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Avoiding Common Pitfalls
Over the years, I’ve seen folks make avoidable mistakes like delaying enrollment and paying penalties for life, or choosing plans that don’t cover their doctors or missing prescription drug coverage gaps. That is why we strongly suggest reviewing plans every year. One conversation really could save you thousands.
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⭐️ "Legacy Benefit Advisors made Medicare simple for me. I went from feeling overwhelmed to completely confident in my coverage."
⭐️ "My LBA representative explained everything in plain English and saved me from a very costly mistake."
⭐️ "I didn’t even know I had options. Thanks to LBA, I got a plan that actually fits my life."
⭐️ "I felt like I had a trusted partner through the entire process."
⭐️ "The best part? Their service was free—and worth every penny I didn’t have to spend!"
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Medicare is one of the biggest financial and healthcare decisions of your retirement. It’s not just about signing up—it’s about making sure your plan works for you year after year. It is not just a cost issue! The wrong plan can limit your access to the best quality care. With costs rising, new protections on prescriptions and pending laws that could reshape the system, there has never been a more important time to review your coverage.
Remember, Legacy Benefit Advisors is here to help, free of charge. Whether you’re enrolling for the first time or reviewing for the tenth, we’ll walk the journey with you.
Until next time,
Bob Dumais, Principal
Legacy Benefit Advisors
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Got Questions?
Get in touch with us anytime!
Whether you’re curious about Social Security, Medicare, long-term care, or just want to make sure all your bases are covered, Bob Dumais and the Legacy Benefit Advisors team are just a call or email away. We’re ready to help you make informed decisions and build the retirement you’ve been dreaming of.
Here’s to your retirement with less worry, more comfort, and a lot of heart. Thank you for letting LBA be part of your journey.
| | We have covered so many critical topics in our many quarterly newsletters over the past few years. We've created a simple roadmap to all of these great articles for your benefit. | | |
LBA consultants aremembers of
OPEIU Local 25
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Robert Dumais, Principal
275 West Natick Road
Suite 450
Warwick, RI 02886
401-868-1400 (O)
774-991-3369 (M)
401-737-0330 (F)
| | P.S. Add me to your contacts so we can continue to keep you in the know and don't hesitate to hit "reply" to contact us. | | | | |
