Senior Healthcare- Pamela Steenhoek

06/11/2026

What’s Going On With Medicare Advantage Plans? Understanding the Changes to HMOs and PPOs

If you’ve been hearing that Medicare Advantage plans are changing, you’re not imagining it. Across the country, many beneficiaries are discovering that their plans have been discontinued, benefits have been reduced, or favorite doctors are no longer in network. So, what is happening?

A Changing Medicare Advantage Landscape

For years, Medicare Advantage plans have grown rapidly in popularity. Seniors were attracted to low or even $0 monthly premiums, prescription drug coverage, annual out-of-pocket maximums, and extra benefits such as dental, vision, hearing, fitness memberships, and over-the-counter allowances.

However, 2026 has become a turning point for the industry.

Insurance companies are facing rising healthcare costs, increased utilization of medical services, and changes in government reimbursement formulas. As a result, many carriers are reevaluating their Medicare Advantage offerings.

Why Are Plans Changing?

Several factors are driving these changes:

1. Higher Medical Costs

People are using more healthcare services than insurers anticipated. Increased hospitalizations, specialist visits, and outpatient procedures have significantly raised costs for Medicare Advantage carriers.

2. Changes in Medicare Funding

The Centers for Medicare & Medicaid Services (CMS) have adjusted payment formulas and implemented new regulations affecting Medicare Advantage plans. Many insurers say reimbursement increases have not kept pace with actual healthcare expenses. (Centers for Medicare & Medicaid Services⁠)

3. Prescription Drug Changes

The redesign of Medicare Part D and implementation of the Inflation Reduction Act have shifted some financial responsibility to insurance companies, adding additional pressure to plan profitability.

What Does This Mean for HMO Plans?

Health Maintenance Organizations (HMOs) typically require members to use a defined network of doctors and hospitals and often require referrals to see specialists.

Because HMOs allow insurers to coordinate care more closely and manage costs, many carriers are placing greater emphasis on HMO products.

For beneficiaries, this may mean:

• More HMO options available in certain areas.

• Narrower provider networks.

• Increased emphasis on primary care coordination.

• Lower premiums compared to PPO plans.

The trade-off is less flexibility when seeking care outside the network.

What About PPO Plans?

Preferred Provider Organizations (PPOs) have traditionally been popular because they allow beneficiaries to see providers both inside and outside the network without referrals.

Unfortunately, PPO plans have been among the hardest hit by recent changes.

Many carriers have:

• Eliminated PPO plans entirely in certain counties.

• Reduced the number of $0 premium PPO offerings.

• Increased copayments and coinsurance.

• Narrowed provider networks.

• Reduced supplemental benefits.

Industry analyses show a significant decline in $0 premium PPO offerings for 2026 as insurers attempt to control costs. (Milliman⁠)

Are People Losing Their Plans?

In some cases, yes.

Millions of Medicare beneficiaries have received notices that their plans will not renew for the following year or that service areas have changed. These individuals must choose a new Medicare Advantage plan or consider returning to Original Medicare during eligible enrollment periods. (actuary.info⁠)

This does not mean Medicare Advantage is disappearing. It does mean consumers need to review their Annual Notice of Change (ANOC) carefully each year.

What About Prior Authorization?

One of the biggest concerns surrounding Medicare Advantage has been prior authorization.

Many beneficiaries and physicians have expressed frustration over delays in obtaining approval for certain tests, procedures, and treatments.

CMS has implemented new requirements intended to improve transparency and strengthen appeal protections. Plans must follow stricter standards regarding medical necessity determinations and appeals processes. (American Hospital Association⁠)

Even so, beneficiaries should continue to ask questions, understand authorization requirements, and appeal denials when appropriate.

Is Medicare Advantage Still a Good Choice?

The answer depends on the individual.

Medicare Advantage remains an excellent option for many people, especially those who:

• Prefer lower monthly premiums.

• Want built-in prescription drug coverage.

• Value annual maximum out-of-pocket protection.

• Are comfortable using provider networks.

• Appreciate extra benefits like dental and vision coverage.

However, beneficiaries who prioritize unrestricted provider choice, travel frequently, or have complex medical needs may want to carefully compare Medicare Advantage plans with Original Medicare combined with a Medicare Supplement plan.

The Bottom Line

Medicare Advantage is evolving.

The days of assuming that last year’s plan will automatically be the best choice for next year are over. Annual reviews have become more important than ever.

Beneficiaries should compare plans each year, verify that their physicians remain in network, review prescription drug formularies, and evaluate whether an HMO or PPO best fits their healthcare needs and lifestyle.

The good news is that choices still exist. The key is understanding the changes and working with a knowledgeable Medicare professional who can help navigate this increasingly complex marketplace.

Medicare isn’t one-size-fits-all. The best plan is the one that meets your unique health needs, budget, and priorities.

Pamela Steenhoek
281.904.5447

05/19/2026

The standard monthly premium for part B is projected under the Trustees’ intermediate assumptions to reach $218.60 in 2027. If that holds, retirees will have absorbed two consecutive years of double-digit premium increases, a stretch that steadily chips away at the buying power of Social Security raises for more than 60 million beneficiaries.

04/14/2026

Is this new idea fair to the people who have been paying into Social Security their entire lives?

I’ve been following the recent discussions coming out of Washington, and I think this is something we all need to be paying attention to.

There are proposals being talked about right now that could significantly change how Social Security and Medicare work:
• One idea is to cap Social Security benefits at around $50,000 per year—even for those who paid in at much higher income levels over decades.
• Another is to increase Medicare taxes on individuals earning over $185,000, meaning higher earners would contribute even more into the system.

Here’s the real question…If someone has worked hard their entire life and consistently paid into Social Security based on their income, is it fair to limit what they receive later?

Social Security has always been presented as a system where your benefits are tied to what you put in. Changing that structure could feel like moving the goalposts for millions of Americans who planned their retirement around it.

On the other hand, we also have to acknowledge reality:
• People are living longer
• Healthcare costs are rising
• And both Social Security and Medicare are under financial pressure

So where’s the balance? Do we preserve the original structure and risk the system running short…
Or do we make changes now that could impact those who have contributed the most?

There’s no easy answer—but your voice matters in this conversation.

If you have an opinion, I strongly encourage you to reach out to your elected officials:

• Find your U.S. Representative: https://www.house.gov/representatives/find-your-representative
• Contact your U.S. Senators: https://www.senate.gov/senators/senators-contact.htm
• Call the U.S. Capitol switchboard: (202) 224-3121

As someone who works closely with individuals and families planning for retirement, I see firsthand how much people rely on these benefits—and how important it is to stay informed.

Some of you are waiting to collect SS at age 70. Should you be if your SS may be capped at 50k per person?

This post is coming from me because I care about these Senior Issues. Owner, Pamela Steenhoek: Steenhoek Medicare, Life And Health Insurance Agency… And is this fair?

All questions and comments regarding public policy issues, legislation, or requests for personal assistance should be directed to the senators from your state. Please be aware that as a matter of professional courtesy, many senators will acknowledge, but not respond to, a message from another senato...

03/26/2026

My oldest son, Daniel Pearson Steenhoek II, recently launched his business…

Wrench Financial

Hello, I recently launched Wrench Financial which focuses on bookkeeping, tax strategy, accounting systems/processes and forward looking planning.

Since I just started I am offering up to two months free of services until I get booked up.

I’m a CPA and have extensive experience helping small businesses in the 2-10M revenue range.

I’m currently on a month and half long free engagement where I’m diagnosing processes/systems/etc. One client at the end of our first meeting, said she felt like a huge weight had been lifted.

I was surprised and said, “I haven’t really done much yet. There is a lot more to do.”

I’m hopeful these services can turn into longer term valuable contracts for my clients and myself. I enjoy helping. Let me know if you need help in this space and I may have capacity to get you some free help if you’re quick.

Long-term, my focus is on home services but if you have a construction or service business, this is a very close second as there is a lot of overlap.

Wrench Financials offers accounting, bookkeeping, & CFO services for home-service businesses. Improve cash flow, boost profits, & increase financial clarity.

03/26/2026

Turning 65? Here’s What You Need to Know About Medicare Part B

One of the biggest (and most confusing) milestones as you approach age 65 is Medicare—especially Part B. This is the part that covers doctor visits, outpatient care, preventive services, and more. And while it might seem simple to just “sign up,” the timing actually matters more than most people realize.

Why Signing Up for Part B at 65 Is So Important

When you turn 65, you enter what’s called your Initial Enrollment Period. This is a 7-month window that includes:
• 3 months before your birthday month
• Your birthday month
• 3 months after

If you don’t enroll in Part B during this time—and you don’t have qualifying coverage—you could face:
• Lifetime late enrollment penalties
• Delays in coverage
• Gaps in your healthcare protection

The penalty alone is something to take seriously. For every 12-month period you delay Part B without proper coverage, your premium can increase by 10%—and that increase sticks with you for life.

When It’s Okay to Delay Part B

Now here’s the good news—NOT everyone needs to enroll in Part B at 65.

If you’re still working and covered under an employer group health plan (or covered under your spouse’s active employment plan), you may be able to delay Part B without penalty. This is called having “credible coverage.”

Credible coverage means:
• The insurance is from active employment (not retirement or COBRA)
• The coverage is considered as good as, or better than, Medicare

In this situation, you can delay Part B and enroll later during a Special Enrollment Period when that coverage ends—without penalties.

But Be Careful…

This is where many people make costly mistakes. Not all coverage counts as credible. For example:
• COBRA does NOT count
• Retiree plans usually do NOT count
• Marketplace (ACA) plans do NOT count

If you delay Part B based on the wrong type of coverage, you could end up paying penalties and waiting months for your coverage to begin.

The Bottom Line

Medicare Part B isn’t just another checkbox—it’s a decision that can impact your finances and healthcare for the rest of your life.

• If you don’t have credible coverage → enroll at 65
• If you do have credible employer coverage → you may be able to delay safely

When in doubt, ask questions. Getting this right the first time can save you thousands of dollars and a lot of stress down the road.

If you or someone you know is approaching 65 and unsure what to do, I’m always happy to help guide you through it step by step.

Message me anytime 💙

Pamela Steenhoek
281.904.5447

03/14/2026

“Have questions about Medicare? Contact Steenhoek Medicare, Life and Health Insurance Agency LLC for a complimentary Medicare review.”

281.904.5447

03/14/2026

The 5 Biggest Medicare Mistakes Seniors Make (And How to Avoid Them)

Medicare is one of the most valuable benefits available to Americans as they reach retirement age. However, many seniors unknowingly make costly mistakes when enrolling or choosing coverage. A little knowledge can help you avoid these pitfalls and protect your health and finances.

Here are the five most common Medicare mistakes seniors make.

1. Missing the Initial Enrollment Period

Many people think they can sign up for Medicare whenever they want. Unfortunately, that’s not the case.

Your first opportunity to enroll is called the Initial Enrollment Period, which begins three months before you turn 65 and ends three months after.

If you miss this window and don’t have qualifying employer coverage, you could face lifetime penalties when enrolling in
Medicare Part B.

The penalty is 10% added to your premium for every year you delayed enrollment.

2. Assuming Medicare Covers Everything

Many seniors are surprised to learn that
Medicare does not cover all healthcare expenses.

Original Medicare generally does not cover:

• Routine dental care
• Vision exams and glasses
• Hearing aids
• Long-term custodial care

Because of these gaps, many people consider additional coverage such as Medigap or Medicare Advantage plans.

3. Not Reviewing Prescription Drug Coverage

Prescription drug plans can vary widely in cost and coverage.

Each year formularies change, which means medications covered this year may not be covered next year under
Medicare Part D.

Reviewing your drug plan annually during open enrollment can help ensure you are getting the best coverage for your medications.

4. Ignoring Out-of-Pocket Risk

Original Medicare includes
Medicare Part A and
Medicare Part B, but it does not have a yearly cap on out-of-pocket expenses.

This means major health issues could lead to large medical bills.

Many seniors choose supplemental coverage to protect themselves from these unexpected costs.

5. Not Asking for Help

Medicare can feel complicated, and many people try to navigate it alone.

But every individual situation is different—retirement timing, employer coverage, medications, and doctors all play a role in choosing the right plan.

Speaking with a licensed Medicare advisor can help you understand your options and avoid costly mistakes.

The Bottom Line

Medicare decisions can affect your healthcare and finances for many years. Taking time to understand your options—and getting guidance when needed—can help ensure you choose the coverage that fits your needs and budget.

Avoiding these common mistakes can save you money and give you peace of mind about your healthcare coverage.

Pamela Steenhoek, Medicare Broker 281.904.5447

02/28/2026

Medicare Part D now has a $2,100 annual out-of-pocket cap for covered drugs. Once you reach that amount, you pay $0 for covered medications the rest of the year.

But you do not pay $2,100 on day one. You still pay deductibles and copays until you reach that limit.

With this new cap, it’s important to compare total annual cost — not just the monthly premium. Some higher-premium plans make sense, but many people (especially those taking generics) may do very well with a lower-premium option.

You can compare plans at Medicare.gov or call 1-800-MEDICARE for unbiased help.

Always ask:
What is my total estimated annual cost?
Are there lower-premium options that cover my medications?
Why is this plan being recommended?

An informed decision is the best protection.

The official U.S. government website for Medicare, a health insurance program for people age 65 or older and younger people with disabilities.

02/08/2026

In ancient medical texts, the castor plant was called Palma Christi because its leaves looked like the hand of Christ healing the sick. Today we know that its power lies in a single molecule: Ricinoleic Acid.

The majority of oils remain on the skin surface. Castor oil has a molecular weight that allows it to pe*****te through the corneal stratum to the deep dermis and subcutaneous tissue. There, it does something no drug can do right: Stimulate Lymphatic Flow.

The Mechanism: Your lymphatic system is the body's sewer, but it doesn't have a pump (like the heart). Castor oil increases the production of lymphocytes (white blood cells) and stimulates the contraction of the smooth muscle of the lymph vessels. It's like unclogging a biological pipe. It is traditionally used to dissolve cysts, reduce fibroids, and decongest a fatty liver.

The Liver Pack:

Soak a cotton flannel fabric in Castor Oil (Organic and Hexane-free, very important!). ).

Put it on your liver (right ribs).

Put a bag of hot water on top.

Relax for 45 minutes. Do this 3 times a week. You will sleep like a baby because your body is finally taking out the trash.

Source: Journal of Naturopathic Medicine, "Immunomodulation through castor oil packs", Study on lymphocytes count.






Caseros
Natural

01/29/2026