Patricia Smith Engelage, Medicare Consultant

08/25/2026

Trump administration to end Medicare premium subsidy program

Some of you have asked about this, so here is the scoop. This headline is MISLEADING. This is not a political statement. This is my attempt to remove politics from this issue - your cost of RX.

The premium subsidy provided to Part D plan insurers, which was put in place as part of the Inflation Reduction Act, was scheduled to end Dec 31, 2026. The Trump Administration is not ending it, it was going to end.

The subsidy was put into place to keep stand alone Part D premiums lower. Why would they do this? Because the changes implemented from the Inflation Reduction Act - lower out of pocket cap on RX, cap on plan premium increases, and increased cost share to the insurance company in catastrophic coverage - put a larger proportion of the cost of RX on the insurer. They knew without subsidizing premiums and putting a cap on premium increases, the insurance company would jack up premiums to help offset their cost.

We won't know what affect the planned termination of this subsidy will have on stand along Part D premiums for 2027 until October. But, Part D plans are not going away.

I recently read an article published by Paragon Health Institute that basically puts the blame for your higher copays/coinsurance/ and premiums on the Inflation Reduction Act.

I would prefer to see the journalists and experts report on why the retail cost of RX in the U.S. is multiple times more than people in other countries pay for the exact same medications.

The Inflation Reduction Act changes to Part D may not be perfect but I see it as an attempt to reduce how much Medicare beneficiaries pay for their RX.

An article by Adweek states that pharmaceutical ad spend has grown from $12.2 billion in 2015 to an estimated $39 billion in 2025. Pharmaceutical Care Management Association (PCMA) cited 1.35 million drug commercials aired in 2025, and that 58% of Medicare drug spending was for drugs advertised directly to consumers. Only the U.S and New Zealand legally allow direct-to-consumer advertising for prescription drugs.

If I were the Medicare Czar the first step I'd take it to prohibit advertising prescriptions drugs. Perhaps the $39 billion spent on ads could be spent on research and development and lower the retail cost of our medications.

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08/25/2026

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08/20/2026

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Stay safe on social media! will never reach out to you to ask for your Medicare Number on any social media site. If someone messages you directly and says they’re a “Medicare agent”, don’t respond and report it at https://go.medicare.gov/4w84nvD.

08/03/2026

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07/21/2026

07/15/2026

https://youtu.be/FsZddVAFeuI?si=08YwvkYkNboH67RY

Dr Oz, the Medicare Czar, has been posting some nice exercise videos on staying healthy. If you are not following the Medicare page, you should check it out!

Coordination exercises are one of the best things you can do to kee...

07/15/2026

My cousin has been posting some funny, if not corny jokes on his FB page and if decided to start sharing them with my friends - enjoy! 😅

02/26/2026

Great advice! If you don’t know who is calling let it go to voicemail if they really need to speak to you they will leave a message

📞 Stay alert — Medicare will never call you unless you’ve contacted us directly first. Never share your Medicare Number with anyone except your doctor or people you know should have it. Protect your info and protect yourself! https://go.medicare.gov/3YtDpj4

01/15/2026

If I were the Medicare Czar...
Many of you have probably heard me say this about my thoughts on ways Medicare could help lower some heath care costs which could help make Advantage plans better and lower premiums for Medigap supplement policies.

Here is an example. This is excerpts from an article on Fortune about the disparity in how Doctors and Hospitals are compensated.

Medicare has paid more for services and procedures provided in a hospital than in a physician practice. This discrepancy has enriched hospitals and strengthened their ability to acquire physician practices.

Adopting site-neutral payments — that is, paying hospitals and private physician offices the same amount for the same care — would allow independent physicians to compete on equal terms with hospital-affiliated doctors. Such competition will ensure that patients have choices in where they can seek care and cut premiums and copays in the long term.

Site-neutral payment enables healthcare services to be delivered in the lowest-cost setting that can safely and effectively provide them. Medicare’s payment disparities distort those decisions by rewarding hospitals simply for being hospitals, regardless of whether a service could be delivered just as well — or better — in a physician office or ambulatory surgery center.

Removing those financial incentives would allow care to be organized around quality and access rather than distorting care into forms most favored by bureaucrats.

For example, Medicare reimburses $1,375 for a colonoscopy performed in a hospital outpatient department — and $862 for one performed in an independent ambulatory surgery center.

This has left a growing number of physician practices vulnerable to acquisition by larger hospital systems. In a separate study by the AMA, the need to negotiate higher payment rates was named as the top reason doctors sold their practices.

The result is a health sector that is becoming less competitive and more consolidated by the day — a trend that is raising costs for both patients and taxpayers.

When hospitals become larger and compete less with smaller physician offices they have less incentive to keep prices down. The result is of course an increase in healthcare spending and higher insurance premiums for patients.

Site-neutral payments can correct these market distortions — and deliver significant savings in the process. According to one study, adopting site-neutral payments across Medicare could save the program $202 billion over a decade — and cut beneficiaries’ premiums and cost-sharing by a combined $134 billion.

There’s no economic reason Medicare should pay different amounts for the same care based solely on where it’s delivered. The hospital lobby may be the most important reason this disparity exists. Site-neutral payments would restore some common sense to the entitlement’s structure — and bring about a more competitive healthcare market for both patients and taxpayers.

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12/21/2025

Sounds like a great service. If anyone uses it please share how it works and how your experience was. This could be helpful for some of my clients