Medicare Advantage

And for people eligible for both programs, there's this pretty intuitive argument that having the same organization accountable for both sides creates more opportunity to coordinate care and benefits and incentives and But I actually, I worry a little bit in the context of our broader healthcare system, we could experience some unintended consequences with these new requirements.

For example, they don't apply to all DSNPs and they certainly don't apply to the much larger universe of standard Medicare Advantage plans.

And I'm not suggesting they should apply across the board, but this creates an interesting tension where in an effort to simplify choice and promote integration, we may ultimately reduce the number of de-SNP choices available to some dual eligible people while leaving them with a very large number of Medicare Advantage choices that may offer little or no integration with Medicaid.

In effect, we may be simplifying one dimension of choice while introducing complexity somewhere else.

And this matters lot because people don't necessarily choose coverage based on whether we as healthcare professionals consider it integrated like I've said this so many times integration isn't sexy right people choose a health plan and because their doctor participates with that health plan or because a particular drug is covered or because the supplemental benefits meet their immediate needs or they recognize the name of the health plan and they trust that name.

And that makes integration incredibly difficult to evaluate because there's not one intervention called integration, right? It looks different across states and programs and health plans, and even for the subpopulations that we're talking about.

And while we're trying to measure its impact, the world around it keeps changing.

Medicare Advantage policy is changing.

Starting on October 15th, UnitedHealthcare commercial plan members will once again have in-network access to WakeMed hospitals, outpatient clinics, and specialty physicians.

The new deal does not cover WakeMed hospitals or specialists for members on Medicare Advantage plans.

So to come at 11, we're bringing you an alarming new warning about the growing risk of artificial intelligence.

What we're learning about a revelation from OpenAI that it's documented six additional examples of its AI

It's a really important opportunity for, like I said, people who are already in Medicare to review their current Medicare Part D, which is the standalone drug plan.

And Medicare Part C, which is the Advantage plans.

So these two parts of Medicare, they are private insurance companies that have a contract with Medicare.

So what that just means is they have to renew that contract, and there could be some significant changes for the upcoming year.

Amanda Higgins with the Dodge County ADRC says plan costs and coverage can change each year.

The fall open enrollment is for current Medicare beneficiaries.

October 15th through December 7th, it's a really important opportunity for, like I said, people who are already in Medicare to review their current Medicare Part D, which is the standalone drug plan, and Medicare Part C, which is the Advantage plan.

So these two parts of Medicare, they are private insurance companies that have a contract with Medicare.

This is Chip Maxwell, and you're listening to the Retire Smart Podcast with David Brooks.

With Medicare open enrollment approaching, David sits down with financial advisor Blake Grimm to break down the key changes coming for 2027 and the important decisions retirees face when choosing between Medicare, employer coverage, Medicare Advantage, and supplemental plans.

They also discuss how healthcare costs, taxes, HSAs, and even moving to another state can affect your overall retirement strategy.

Joining us in the studio this week, we have the Medicare extraordinaire man himself, Blake Grimm.

all this, of course, in the class, the four main parts, A, B, C, and D of Medicare.

But a lot of people don't realize.

So what we call open enrollment is the biggest time of year when people have the opportunity to make changes, but those changes are limited to, so your drug card is typically what you're changing, or if you're on what's called Medicare Part C, Medicare Advantage plans, which are very popular because they usually have this, they think it's free, it's not free, but a zero premium currently on a lot of these plans.

Those you do have to typically wait unless you have a qualifying event for this open enrollment, which starts October 15th,

It could be a buying opportunity, but it may take one to two quarters to fix the problems that got disrupted.

Walmart is partnering with ScanHealth to sell Medicare Advantage plans to older adults.

This is fascinating to me to see big retail companies like Walmart and Costco get into Medicare plans.

They may also include benefits related to pharmacy, vision, food, and over-the-counter products.

The plans will be available for selection during the Medicare Advantage open enrollment period, which begins October 15th.

I'm fascinated by both Costco and Walmart as obviously they're big retailers, but 10 years ago, you wouldn't have thought of them as healthcare companies.

I have an event coming up.

The American Medical Association has reported that physicians spend more time on administrative work than they spend with patients.

Health Affairs reported in June 2025 that Medicare Advantage insurers denied 17.7% of initial claims from hospitals and physicians, although 57% of denials were overturned following resubmission and appeal.

Challenging those decisions takes time and resources.

Patients may be left waiting for medications, tests, or treatments.

The S&P down 34, and oil closed 3% lower, 102.43 a barrel.

And Walmart, partnering with the nonprofit insurer Scan Health Plan to sell Medicare Advantage plans to seniors to save money.

Tom Busby, Bloomberg Radio.

Ready to get spooked at Camden Park? They're this week's 50-50 Friday.

To me, the business represented two things.

One, risk adjustment had expanded and Medicare Advantage had leaned in to use it.

Very heavily.

Yeah, very heavily.