Maximizing your 2026 Medicare: from prescriptions to the use-it-or-lose-it benefits
Dr. Ed Weir, a former Social Security manager, who spent “decades inside the bureaucratic beast,” has provided a guide to maximize your Medicare.
The U.S. government has given insurance companies $13 billion for Medicare Advantage plans. Those who are signed up for the program may not think that they are paying anything, but Dr. Ed Weir, a former Social Security manager, says otherwise.
“You’re paying a ton into Medicare,” he states explaining that you’ve paid into Medicare for decades through your taxes and still are. With that in mind, he wants to “make sure you get everything you can out of it.” He posted an informational video on his YouTube channel this past week so you can do just that.
Maximizing your Medicare in 2026
We are still months away from the open enrollment period for Medicare, which begins October 15. However, beneficiaries will want to take advantage of time between now and then to get up to date on any potential changes that will be coming to their Medicare Advantage plans.
Weir warns that while you may think that you’ve had the same Medicare Advantage plan over the past few years, that in fact is not true. You may be with the same company and your plan has the same name, but he says that these plans are like Cinderella and disappear December 31st at midnight.
“And then January 1, a new plan, same company, same name, but all of the details can change,” he explains. He advises that it’s important that “when you’re able to change, you do change. Or at least you don’t necessarily have to change, but you have to review your plan to see if it’s worthwhile for you to change.”
Maximizing your Medicare prescriptions
Weir points out that most Medicare Advantage plans have a Part D prescription drug plan included. A lot of the companies have a “take it or leave it” policy when it comes to the formularies that they use so that beneficiaries use the drugs that they have in their inventory. He advises that if they have a drug that “just doesn’t work for you,” that you should ask for a formulary exception.
He also notes that Part D plans come with an out of pocket payment cap of $2,100 a year. Something that beneficiaries will be happy to learn is that while in the past that bill could hit them in the first month or two of the year, “smoothing” of the cap has been made automatic for this year. That means that payments will be spread out over the year easing the financial burden.
Also check with Social Security to see if they can provide you with extra help paying for prescription drugs. Weir notes that from his time at the SSA he saw hundreds of thousands of these applications and it’s “one of the easiest applications at Social Security” to file.
“Definitely reach out to Social Security and say ‘Hey, I want extra help.’ They’ll know exactly what you’re talking about,” he says.
Maximizing your Medicare use-it-or-lose-it benefits
Another thing that those on Medicare Advantage want to make sure they keep track of is the use-it-or-lose-it benefits that some programs offer, from flex cards to buy groceries or coverage for dental costs.
With the former, these benefits may be topped up periodically, but the prior amount of money allotted to a beneficiary expires at the end of a month or a quarter, depending on the plan. That means if the insurance company gives you a $100 a month to spend on groceries and you don’t use it, you’re letting $1,200 go down the drain and into the company’s pocket by the end of the year.
Likewise, while you may get $2,000 a year to cover dental costs, remember that amount will most likely reboot on January 1st next year, if your plan retains that benefit. So he says it would be wise to talk to your dentist to arrange to split up any work that you have to get done, over a two year period, or longer if need be, in order to maximize that benefit.
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