Living on a fixed income is hard, which is why many Americans depend on Medicare to help with medical expenses. But Medicare isn’t static, and it’s important to stay up to date with changes, whether you’re on Medicare yourself or care for someone on Medicare.
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Personal finance expert Suze Orman has stressed the importance of staying on top of developments with Medicare. Specifically, she says there are two important Medicare issues you need to be aware of and address as soon as possible.
Quick Take: Trump Administration vs. Medicare
Before you can take advice from financial experts as to what to do about your healthcare, it’s important to take note of what President Trump is changing with it. Here are some key takeaways from what his administration has altered or proposed when it comes to your Medicare:
- The appointment of Robert F. Kennedy Jr. to head the Department of Health and Human Services (HHS) has resulted in the termination of 10,000 jobs from varying research programs and the streamlining of operations by consolidating 28 divisions within HHS to 15. This included the Centers for Medicare and Medicaid decreasing its workforce by approximately 300 employees, which could greatly disrupt your service.
- The administration has blocked Medicare from covering obesity drugs and has moved to stop weight management treatments from being covered under the 2026 Medicare Advantage and Part D policies.
- Dr. Mehmet Oz is the new administrator for the Centers for Medicare and Medicaid Services (CMS), and claims he’ll modernize Medicare, the marketplaces and Medicaid. This effort would include improving transparency to give Americans the information they need about costs, equipping healthcare providers with better information about the patients, simplifying access to life-saving treatments and identifying and eliminating fraud, waste and abuse.
Keep reading to learn more about these important developments and what Orman thinks you need to know to navigate the Medicare system.
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Appeal Coverage Denials
In a recent post on her site, Orman said that anyone enrolled in a Medicare Advantage plan typically needs to get pre-authorized approval for major care costs. If an insurer denies a preauthorization request, however, that doesn’t mean it’s a hard no.
Orman cited a study by the Kaiser Family Foundation (KFF) that found when patients appealed an initial denial, the insurer reversed its decision in more than 80% of cases after appeal.
There’s a clear reason for this. Insurers often must cover these costs to honor Medicare Advantage policies, but the same KFF study found that just 10% of people file appeals after being denied coverage.
Denying coverage in the first place is a simple way for the insurance company to hope the insured just goes away, saving the company money. After all, actually paying for health services cuts into the business’s bottom line.
Whether you’re on a Medicare Advantage plan or you’re caring for an adult on one, it’s crucial to remember that “no” doesn’t always mean “no” when it comes to insurers. If coverage was denied once, there’s a good chance the insurer will change its mind after an appeal.
New Part D Drug Cost Caps
As of the beginning of 2025, there is a $2,000 cap on what Medicare enrollees must pay out of pocket for prescription drug costs. This change should save the majority of Medicare patients who access prescriptions through their plan a good deal of money. However, even those savings will come at a cost.
This new cap is also expected to cause insurance companies to increase monthly premiums for Part D prescription drug plans. Orman suggested it may even cause insurers to change their rules on what drugs they’re willing to cover.
You should have already received your Plan D 2025 renewal notice, which Orman advises to pay close attention to. Not only do you need to know what your premium will be, but you must ensure that the medications you’re currently prescribed will still be covered by your insurance company at an affordable rate.
Final Take To GO: Take the Time To Shop Around
The bottom line is that Orman suggests you shop around for the most cost-effective Part D coverage — or a more affordable plan in general when possible. When you review options for better coverage, make sure a new plan covers any prescribed drug you use, and consider both the monthly premium and any copays.
Orman recommended using the government’s Medicare Plan Finder to shop for plans available in your area. You can also ask a trusted Medicare insurance agent to help you search for and analyze different options for 2025.
Caitlyn Moorhead contributed to the reporting for this article.
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This article originally appeared on GOBankingRates.com: 2 Important Medicare Issues That Suze Orman Wants You To Understand
