March 12: Entering Medicare – Not as Simple as You Think  

Often, the hardest and most important decisions regarding the utilization of the Medicare system arise at the point at which individuals first become eligible to enter Medicare. It might appear to be relatively straightforward, but ‘when to enter Medicare’ and ‘how to use the system effectively’ is, in fact, quite complex (and confusing and frustrating). This presentation will examine:

• The rules governing enrollment into Medicare
• Why individuals may wish to delay enrollment and the consequences of choosing to delay.

April 9: IRMAA – Increasing the Cost of Medicare Coverage

An IRMAA (Income-Related Monthly Adjustment Amount) is an extra cost added to the premiums paid by individuals in Medicare who have ‘higher-incomes’. An IRMAA can add hundreds of dollars a month to the cost of Medicare coverage. However, in a majority of circumstances, an individual’s IRMAA can
be reduced or eliminated through appeal. This presentation will look at:

• Who is subject to an IRMAA and how they are notified
• How the IRMAA amount is calculated
• How to appeal the assignment of an IRMAA

May 14: Prior Authorization – Limiting Peoples’ Access to Essential Healthcare

Prior Authorization is a process of obtaining approval from health insurance providers before a health care service can be performed. It’s a cost-control measure imposed by insurance companies that effectively limits access to expensive medical treatment and prescription drugs. Even if the treatment or medication is ‘covered’ by the insurance plan, patients can still be blocked from access to essential care through prior authorization. This presentation will examine:

• How prior authorization is imposed on healthcare services and medications
• The prior authorization review process
• And if access to treatment if denied, how the patient can appeal the decision

June 11: Medigaps

Medicare has evolved to the point where private insurance products are an indispensable characteristic of the system, keeping the costs of healthcare more affordable (somewhat), but profoundly changing the original expectations and dynamics of the Medicare benefit. This presentation will examine a specific private insurance option of Medicare – Medigaps. We’ll look at:

• How Medigaps work
• Strengths and weaknesses of Medigaps
• The unique rules associated with Medigap coverage

July 9: Advantage Plans

This presentation will examine another private insurance option of Medicare – the Part C Advantage plans. We’ll look at:

• How Part C Advantage plans work
• Strengths and weaknesses of Part C Advantage plans
• The very real risk they pose for Medicare enrollees accessing necessary healthcare services

August 13: Coordinating Medicare and Medicaid Benefits – “Dual Eligible” Beneficiaries

Millions of Americans are enrolled in both the Medicare and Medicaid programs – they are called “dual eligibles.” This presentation will examine the characteristics of dual eligibility, ranging from:

• The benefits that each program (Medicare and Medicaid) provides
• How each program coordinates with the other
• The special problems that dual eligibility generates

September 10: Changing Coverage in the Medicare System

Medicare provides opportunities for enrollees to periodically change their coverage options. When and how depends on the type of product. We’ll look at the enrollment periods for Advantage Plans (HMOs and PPOs), Part D Plans (prescription drug coverage), and Medigaps (supplement plans). There are the initial enrollment period, annual enrollment period, and special enrollment allowances for each of these products. During this session, we will examine:

• How each enrollment option works
• How to effectively utilize them to achieve the best coverage under the Medicare system

October 8: The Current Status of Medicare and Medicaid

What is the current condition of the Medicare and Medicaid systems? How well are they surviving under the Trump administration? And, what changes appear on the horizon for them in 2026 and beyond? This presentation will be an opportunity for a panel of healthcare experts and practitioners to provide their observations and opinions on the status of Medicare and Medicaid, and beyond that the American healthcare system at large. Where are we at now, Where are we going, and What can we do – to access as effectively as possible the healthcare services and products that we need.