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Hold the Line Financial: Medicare, estate planning, & living benefitswith heart, strategy, and grit.

10/19/2026

💜 **MEDICARE NEGOTIATED LOWER DRUG PRICES. SO WHY MIGHT YOUR PRESCRIPTION STILL BE EXPENSIVE?**

There's good news coming for certain prescription medications in 2027.

Medicare's Drug Price Negotiation Program is expanding, with negotiated prices for **15 additional drugs** scheduled to take effect January 1, 2027.

But before you assume that means your prescription will automatically cost less, there's something important to understand.

**The price Medicare negotiates and the amount YOU pay at the pharmacy are not necessarily the same thing.**

💊 **WHAT IS MEDICARE DRUG PRICE NEGOTIATION?**

Under the Inflation Reduction Act, Medicare can negotiate prices for selected high-cost medications that meet federal eligibility requirements.

The goal is to reduce spending on certain expensive drugs.

The first negotiated prices took effect in 2026. Another group follows in 2027.

These medications treat conditions including diabetes, respiratory diseases, and certain cancers.

**BUT HERE'S THE DISTINCTION.**

A negotiated price does not mean:

✗ Every medication becomes cheaper.

✗ Every beneficiary pays the same copay.

✗ Every prescription is automatically covered.

✗ Prior authorization and other coverage requirements disappear.

✗ Every use of a medication qualifies for Medicare coverage.

Your specific plan's coverage and cost-sharing rules still matter.

💜 **LET'S TALK ABOUT GLP-1 MEDICATIONS.**

You've probably heard about medications such as Ozempic and Wegovy.

These drugs have received considerable attention for diabetes, weight management, and other approved uses.

But **the reason a medication is prescribed matters.**

Traditional Medicare Part D rules generally exclude drugs when used solely for weight loss, although coverage may be available for other medically accepted indications. Specific federal coverage changes and plan requirements must also be checked for 2027.

A negotiated price does not, by itself, make every use of a medication eligible for coverage.

That's an important conversation to have with your prescriber and prescription drug plan.

📋 **WHAT SHOULD YOU ASK ABOUT YOUR MEDICATIONS?**

☐ Is my medication included in the 2027 formulary?

☐ Is it one of the drugs with a negotiated Medicare price?

☐ What will MY copay or coinsurance actually be?

☐ Does the plan cover it for my prescribed medical condition?

☐ Does it require prior authorization or step therapy?

☐ Would another plan provide better overall coverage for all my medications?

**AND DON'T FORGET THE $2,400 PART D OUT-OF-POCKET THRESHOLD.**

In 2027, the annual out-of-pocket threshold for covered Part D medications is $2,400.

Once you reach it, you generally pay $0 for covered Part D drugs for the remainder of the calendar year.

But your monthly plan premiums don't count toward that threshold, and drugs excluded from Part D coverage generally don't count either.

💜 **THE BEAN TAKEAWAY**

Lower negotiated drug prices are an important development.

But a national announcement doesn't tell you what YOUR prescription will cost.

The only useful comparison is one that considers your actual medications, your medical needs, your pharmacy, and the coverage rules of the plans available to you.

**Know your coverage. Use your coverage. Live your life.**

Compare your options at Medicare.gov/plan-compare, or reach out if you need help making sense of the details.

📞 **Call Bean — 435.632.9259**

**Bean Here Done That**
Powered by Hold the Line Insurance
Licensed in UT | AZ | ID | NV

*Not affiliated with or endorsed by the U.S. government or the federal Medicare program.*

10/18/2026

💜 **YOUR PRESCRIPTION IS COVERED. BUT IS IT COVERED THE SAME WAY IN 2027?**

Here's something I want every Medicare beneficiary to understand:

**A medication can still be on your plan's drug list and become more expensive—or more difficult to obtain.**

How? Let's talk about three things that don't get nearly enough attention.

💊 **1. FORMULARY TIERS**

A formulary is your prescription drug plan's list of covered medications.

Plans organize medications into tiers, which help determine what you pay.

A drug might remain covered in 2027 but move to a tier with different copays or coinsurance.

And higher tiers don't always mean a simple, predictable dollar amount. Some medications require you to pay a percentage of the drug's cost.

**What to check:** Your medication's exact name, strength, formulation, tier, and estimated cost.

💊 **2. PRIOR AUTHORIZATION**

Your doctor prescribes a medication. Your plan covers that medication.

So you're good, right?

Not necessarily.

Prior authorization means the plan requires additional approval before it will cover certain prescriptions.

Your prescriber may need to submit medical information showing why the medication is appropriate.

A drug can be on the formulary and still require prior authorization.

**What to check:** Does your medication require approval in 2027? If you're already taking it, will your existing authorization remain valid?

💊 **3. STEP THERAPY AND QUANTITY LIMITS**

Step therapy generally requires trying another medication before the plan covers the requested drug, subject to applicable exceptions.

Quantity limits restrict how much medication the plan covers within a specified period.

Neither automatically means your prescription is excluded. But either can create complications if you discover the requirement when you're ready for a refill.

**What to check:** Are there new restrictions? Does your current dosage or refill schedule fit the plan's rules?

📋 **BEAN'S PRESCRIPTION CHECKLIST**

Before December 7:

☐ Make a complete list of your medications.

☐ Include the strength, dosage, and frequency.

☐ Check each medication against the **2027 formulary**.

☐ Compare tiers and estimated costs.

☐ Look for prior authorization, step therapy, and quantity limits.

☐ Verify your pharmacy's network status and pricing.

☐ Ask about formulary exceptions if a needed medication isn't covered appropriately.

☐ Compare your estimated annual prescription costs—not just the plan premium.

**ONE MORE THING:** If a plan denies coverage, you may have the right to request a coverage determination, exception, or appeal. There are established procedures and deadlines, and your prescriber may need to provide supporting information.

💜 **THE BEAN TAKEAWAY**

“Covered” is the beginning of the conversation, not the end.

You deserve to know what your medication will cost, what approval requirements apply, and what your options are if coverage becomes a problem.

Start with your 2027 plan documents and Medicare.gov/plan-compare.

Need help understanding what you're looking at?

📞 **Call Bean — 435.632.9259**

**Bean Here Done That**
Powered by Hold the Line Insurance
Licensed in UT | AZ | ID | NV

*Not affiliated with or endorsed by the U.S. government or the federal Medicare program.*

10/16/2026

💜 **MEDICARE PART D IS NOT ENDING IN 2027. BUT SOMETHING THAT HELPED KEEP PREMIUMS DOWN IS.**

And before somebody tells you that everyone's prescription coverage is going up $492 a year, let's talk about what is actually happening.

The federal government is ending a temporary Medicare Part D premium stabilization program on December 31, 2026.

**What was this program?**

It was a temporary financial arrangement that helped insurance companies adjust to changes in Medicare prescription drug coverage. Its purpose was to help stabilize premiums while new federal drug-cost protections took effect.

That financial assistance is ending. **Your Medicare Part D benefit is not.**

💊 **SO, WILL YOUR PREMIUM INCREASE?**

Possibly. But not everybody will see the same change.

Some plans are increasing premiums. Others are changing deductibles, formularies, or pharmacy cost-sharing. Some plans are leaving certain markets entirely.

And here's something important: A lower monthly premium does not necessarily mean lower prescription costs.

Let's say you're comparing two plans:

• Plan A costs $30 per month, or $360 annually.

• Plan B costs $90 per month, or $1,080 annually.

Plan B costs $720 more per year before you've filled a single prescription.

Is Plan B worth the difference? Maybe! If it covers your medications more favorably, it could still cost less overall.

**The answer is in the medications, not the premium alone.**

💜 **WHAT PROTECTIONS REMAIN FOR 2027?**

✓ The annual Part D out-of-pocket threshold is $2,400 for covered prescription drugs.

✓ Covered insulin continues to have a monthly cost-sharing limit of no more than $35.

✓ Eligible beneficiaries can use the Medicare Prescription Payment Plan to spread covered out-of-pocket drug costs across the year. It does not reduce the total amount owed.

✓ Medicare's prescription drug price negotiations continue.

**A VERY IMPORTANT DISTINCTION:**

That $2,400 threshold does NOT include your monthly plan premiums. It also doesn't mean every medication you take is covered.

Your plan's formulary, coverage rules, and pharmacy arrangements still matter.

📋 **YOUR 2027 PRESCRIPTION DRUG CHECKLIST**

Before you renew or change your plan:

☐ List every medication, including its dosage and how often you take it.

☐ Check whether each medication is on the 2027 formulary.

☐ Look for prior authorization, step therapy, or quantity limits.

☐ Verify your preferred pharmacy and whether another pharmacy would cost less.

☐ Compare your estimated TOTAL annual cost, not just the monthly premium.

☐ Read your Annual Notice of Change.

And if you're pairing a Medicare Supplement Plan G with a standalone Part D plan, remember: **Plan G does not pay your Part D prescription deductible or copays.**

💜 **THE BEAN TAKEAWAY**

The headlines tell you what's changing nationally. Your plan documents tell you what's changing for YOU.

Don't make a decision based on a frightening dollar figure, a familiar company name, or the lowest advertised premium.

Make it based on what your medications will actually cost and whether your coverage meets your needs.

You can compare plans yourself at **Medicare.gov/plan-compare**.

And if you'd rather have someone walk through the details with you, I'm delighted to help. No pressure. No obligation.

📞 **Call Bean — 435.632.9259**

**Bean Here Done That**
Powered by Hold the Line Insurance
Licensed in Utah | Arizona | Idaho | Nevada

*Not affiliated with or endorsed by the U.S. government or the federal Medicare program.*

10/16/2026

💜 **“MY DOCTOR TAKES MEDICARE.”**

Wonderful! But I have another question.

**Does your doctor take YOUR Medicare plan?**

Those are two very different questions, and the answer can make a significant difference in what you pay and where you receive care.

Let's talk about **IN-NETWORK vs. OUT-OF-NETWORK** and why it matters.

📌 **WHAT DOES IN-NETWORK MEAN?**

An in-network provider has a contract with your specific insurance plan to provide covered services under agreed payment arrangements.

Generally, that means:

✓ Your plan recognizes the provider as participating.

✓ You receive the plan's applicable in-network cost-sharing.

✓ Your services are subject to the plan's coverage rules, including any referral or prior authorization requirements.

**But here's something people often miss:** A medical group may accept your insurance while a particular specialist, facility, or service is handled differently.

📌 **WHAT DOES OUT-OF-NETWORK MEAN?**

An out-of-network provider does not participate in your specific plan's network.

Depending on your plan, that could mean:

• Higher copays or coinsurance.

• A separate out-of-network deductible or spending limit.

• No coverage for certain nonemergency services.

• Potential additional financial responsibility.

**Now let's look at the differences between plan types.**

**HMO — Health Maintenance Organization**

Most routine care must come from in-network providers, except for covered emergencies, urgently needed services in certain circumstances, and other applicable exceptions. Some HMOs require referrals to specialists.

**PPO — Preferred Provider Organization**

PPOs generally allow covered care outside the network, but you usually pay more. Out-of-network coverage does not mean every provider will accept your plan or agree to treat you.

**ORIGINAL MEDICARE**

With Original Medicare, you can generally see any doctor or hospital in the United States that accepts Medicare. You aren't restricted to a Medicare Advantage provider network.

However, Original Medicare has its own deductibles and coinsurance, and without supplemental coverage, those expenses can add up.

📋 **YOUR 2027 PROVIDER CHECKLIST**

Before keeping or choosing a Medicare Advantage plan, verify:

☐ Is my primary care physician in network?

☐ Are my specialists in network?

☐ Is my preferred hospital in network?

☐ Are my imaging center, outpatient surgery center, and other frequently used facilities covered?

☐ Do I need referrals to see specialists?

☐ Does my plan require prior authorization for services I currently receive?

☐ What happens financially if I need care outside the network?

☐ Have any of these arrangements changed for 2027?

**ONE MORE IMPORTANT DETAIL:**

Don't rely exclusively on an online provider directory.

Networks can change, and directories can contain errors. Confirm with the insurance company AND the provider's billing office using the **exact plan name and plan ID**.

And ask whether the provider is accepting new patients under that plan.

💜 **THE BEAN TAKEAWAY**

A plan's benefits mean very little if you can't access the care you need—or discover too late that accessing it costs considerably more than you expected.

**Know your network before you need your network.**

If you're reviewing coverage for 2027, start with your doctors, specialists and hospitals. Then look at what those visits will actually cost.

Need help sorting through the details? I'm happy to review them with you.

📞 **435.632.9259**

**Bean Here Done That**
Powered by **Hold the Line Insurance**
Licensed in UT | ID | AZ | NV

*Not affiliated with or endorsed by the U.S. government or the federal Medicare program.*

10/15/2026

💜 **AEP IS HERE. AND MEDICARE IS CHANGING.**

We're starting the 2027 Annual Enrollment Period with some serious news.

According to CNN, nearly **3.2 million Medicare Advantage members** will need new plans because their current plans are being discontinued.

And that's just the beginning.

Other members may face higher out-of-pocket limits, prescription costs or changes to the benefits they've come to rely on.

**Here's what I want you to know: Your plan doesn't have to disappear for your coverage to change.**

That $0 premium? It doesn't tell the whole story.

That doctor you've seen for years? Let's verify the network.

Those prescriptions? Let's check the 2027 formulary, restrictions and what you'll actually pay.

And if everything still works beautifully? We'll celebrate that, too!

I'm not interested in changing your insurance just to change it. I'm interested in making sure your coverage still works for **YOU**.

**AEP opened today, and we already have five appointments on the calendar!**

Now it's your turn.

📞 **Call or text 435.632.9259 and tell me you want your 2027 Medicare review.** We'll find a time that works.

No obligation. No charge for my help. Just real answers.

**Bean Here Done That**
Powered by **Hold the Line Insurance**
Licensed in UT | ID | AZ | NV

*Source: CNN reporting on 2027 Medicare plan changes. Not affiliated with or endorsed by the U.S. government or the federal Medicare program.*

\

10/15/2026

💜 'TWAS THE NIGHT BEFORE AEP...

'Twas the night before AEP, and all through the place,
The agents were ready to meet face to face.

The calendars were open, the coffee was hot,
The questions were coming—and we welcomed the lot!

The formularies were checked, the networks reviewed,
With premiums and copays and deductibles too.

Some folks loved their coverage and wanted to stay,
Others had questions about a better way.

“Does my doctor still take it? What will my drugs cost?”
“Will I keep my benefits? I'm feeling quite lost!”

But Bean had her coffee, her glasses, her flair,
And a whole lot of patience for Medicare!

No pressure, no promises, no fancy sales pitch,
Just sorting through details to see if there's a switch.

And if your plan's working? Well, that's just fine too!
The point isn't changing—it's what's right for YOU!

So as AEP opens, there's no need to fear,
Bean Here. Done That. And I'm right here! 💜

📅 October 15 – December 7, 2026
📞 435.632.9259
📍 Utah | Idaho | Arizona | Nevada

Bean Here Done That
Powered by Hold the Line Insurance

10/09/2026

It's Friday night. Let's bust a few Medicare myths before somebody's cousin gives you advice at dinner. 😂

MYTH: Medicare covers everything.
FACT: Medicare covers a lot — but deductibles, copays, coinsurance and services that aren't covered still matter.

MYTH: All Medicare plans are basically the same.
FACT: Networks, benefits, prescription coverage and your potential out-of-pocket costs can be very different.

MYTH: If I don't change anything, nothing changes.
FACT: Oh, I wish. Your plan can change from year to year — and so can premiums, copays, drug coverage, benefits and provider networks.

MYTH: If something isn't working, I'm just stuck.
FACT: There are specific Medicare enrollment periods when changes may be available, depending on your circumstances.

And this is exactly why I don't want you choosing coverage based on a commercial, a postcard, or what worked for somebody else.

Ask questions. Get the facts. Understand what you're choosing.

And if you're confused?

Ask Bean. That's literally why I'm here. 💜

📞 435.632.9259

Bean Here Done That
Powered by Hold the Line Insurance

10/09/2026

Medicare is about more than a plan. It's about your life.

When I sit down with someone to review Medicare coverage, I'm not just comparing premiums and copays.

I'm thinking about whether you can keep seeing the doctors you trust.

Whether the prescriptions you rely on are covered in a way you can afford.

What happens financially if next year turns out to be a really healthy year — and what happens if it isn't.

And whether your coverage lets you spend more time living your life and less time fighting with your insurance.

That's the part of Medicare that matters to me.

A plan can look fantastic on paper. I want to know how it's going to work when you actually need it.

Your doctors.
Your prescriptions.
Your coverage.
Your budget.
Your peace of mind.

That's what we're reviewing for 2027.

📞 435.632.9259

Bean Here Done That
Powered by Hold the Line Insurance

10/09/2026

“My doctor said they take Medicare.”

Okay.

Now I'm going to be annoying and ask another question. 😂

What exactly do they mean by that?

Because “we take Medicare” does not automatically mean your doctor participates with every Medicare Advantage plan available in your area.

Original Medicare and Medicare Advantage aren't the same thing when we're talking about provider access.

And even with Medicare Advantage, a provider may participate with one carrier, one network or one particular plan — and not another.

That's why I don't want to hear:

“They told me they take Medicare.”

I want the actual provider checked against the actual plan we're considering.

Same doctor.
Same Medicare cardholder.
Very different answer depending on the coverage.

These are the little details that don't feel little when you're standing at the front desk trying to make an appointment.

Know before you go.

📞 435.632.9259

Bean Here Done That
Powered by Hold the Line Insurance

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Saint George, UT
84790

Telephone

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http://www.holdthelineinsurance.com/

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