Hey, it's Paul

This week we're looking at why your Medigap premium can shift even when your coverage hasn't, and what actually drives those increases. I'll also walk through the ways one out-of-pocket maximum can mean very different financial exposure, plus the Medicare Advantage questions worth asking before you commit.

And if you haven't listened yet, Wise Guys Retirement Talk is live on Apple Podcasts, Spotify, and YouTube.

Got a Medicare question? Hit reply. I get back to every response.

Your Medigap premium looked reasonable when you enrolled. A few years later, the same plan costs noticeably more, and you wonder whether you missed something.

Insurers set Medigap premiums using three pricing methods: community-rated plans charge everyone the same, issue-age-rated plans set the price based on your age when you enroll, and attained-age-rated plans increase with age.

Attained-age rating is the most common method nationwide.

Medical inflation, carrier claims experience, and regulatory changes also push rates up.

In 2026, many New York carriers are implementing double-digit adjustments because of rising medical utilization.

Some people ignore the yearly rate changes and discover they've accumulated:

Review your supplement every year. A quick comparison can often save you hundreds of dollars annually, and in guaranteed-issue states like New York, you can switch anytime without health questions.

Wondering if you're paying too much? Hit reply and I'll run a complimentary rate check for you.

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One out-of-pocket maximum sounds like a simple safety net. In practice, the protection depends on the type of Medicare coverage you have, and the differences can be large.

Here's a clear view of how the limits work in 2026. An out-of-pocket maximum is the most you would pay for covered care in a year before your plan pays the rest.

Medicare Advantage plans have an annual maximum for covered medical services. That cap can still be several thousand dollars.

Medicare Part D now has a $2,100 annual cap on covered prescription drug costs.

Medicare Supplement plans work differently. Depending on the plan you choose, they can dramatically lower your out-of-pocket costs.

This is one of the biggest areas of confusion I hear about. A hospital stay or a new prescription is stressful enough without discovering that your financial exposure was higher than you expected.

Read the full breakdown

Medicare Advantage enrollment keeps growing. More than half of eligible Medicare beneficiaries are now in a Medicare Advantage plan, according to KFF. Small differences in networks, costs, and coverage now affect millions of decisions each year.

Research from KFF has also found that only about one in ten Medicare Advantage enrollees switches plans during open enrollment. Many people stay in the same plan even when costs, drug coverage, or doctor networks change from year to year.

That makes a careful comparison worth the time. Plans can look alike on paper and work very differently in real life. Medicare Interactive's consumer checklist breaks the comparison into six areas worth checking before you enroll:

• Doctors and facilities: Confirm your current providers are in the network, and check the specialists, hospitals, home health agencies, and skilled nursing facilities you may want later.
• Access: Know the service area, whether you need referrals to see a specialist, and how care outside the area works beyond urgent or emergency services.
• Costs: Compare premiums, deductibles, copayments, and the annual out-of-pocket maximum.

• Prescriptions. See if your medications are on the covered drug list and review your pharmacy options.

• Extra benefits. Check whether the plan covers extra services Original Medicare does not.

A plan that fits your doctors, drugs, and budget is easier to live with. Use this checklist before any enrollment decision, and review your options each year.

PPO limits: For PPO plans, check the separate caps for in-network and out-of-network care.

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