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What retirees should know about 2026 Medicare changes, shrinking networks, and how to avoid costly coverage mistakes

Insights from my recent Healthy & Wealthy Retirement conversation with healthcare expert Matt Wicklund

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Most people approaching retirement make the same two costly health-insurance mistakes:

1️⃣ They shop only on premium, and

2️⃣ They don’t verify whether their doctors and specialists are in network.

Those oversights often lead to higher total costs and unpleasant surprises—especially as new legislation and expiring subsidies reshape coverage rules.

Below is a summary of the key points Matt Wicklund shared in our discussion.

1️⃣ Mistake #1: Shopping Only on Premium

A lower monthly premium can hide a much higher max-out-of-pocket (MOOP) limit. That means you might “save” $100 per month but risk paying tens of thousands if you actually need care.

Tip: Compare total cost of care—premium + deductible + copays + expected use. A plan that looks cheaper rarely is if you need even moderate care.

2️⃣ Mistake #2: Not Checking the Network

Many retirees confirm their primary doctor is in network but forget about specialists. The second-most-frequent doctor is often the one that’s out of network—triggering those “surprise” bills.

Quick fix: Before you enroll, list your PCP, specialists, clinic, and hospital, then confirm each is covered by that exact plan (and year).

3️⃣ HSA Plans Are Powerful—But Only If Funded

High-deductible health plans (HDHPs) paired with HSAs can work well, but only if you’ve built roughly $10k–$15k in the HSA. Underfunded HSAs often backfire in the first year a claim hits.

4️⃣ The “Big Beautiful Bill”: What to Watch for in 2026

Matt Wicklund explained that the new “Big Beautiful Bill” (OBB) and the expiration of the Inflation Reduction Act’s enhanced premium tax credits could reshape costs in 2026.

• Premium Tax Credits (APTCs): The extra subsidies created under the Inflation Reduction Act run through the 2025 plan year and are set to expire January 1, 2026 unless extended.
• Reimbursements: Reductions in federal reimbursements may squeeze Medicare Advantage and individual-market plans, particularly in rural areas.
• Rural access: Some Advantage plans are already exiting less-populated counties, raising concerns about longer drives and fewer providers.
• More paperwork: Programs like Medicaid and MinnesotaCare could require more frequent eligibility renewals—potentially every six months or quarter.

Because these provisions are still being implemented, it’s best to treat them as watch items and build flexibility into your financial plan.

5️⃣ Medicare Basics in a Minute

• Part A (Hospital): Usually premium-free; covers ~80 % of inpatient costs.
• Part B (Medical): Doctors, ER, outpatient care; standard premium $185/month for 2025, with income-based IRMAA surcharges (two-year lookback).
• Part C (Medicare Advantage): Private plans bundling A + B (often D); networks and costs vary.
• Part D (Prescriptions): Drug coverage (stand-alone or inside Advantage); IRMAA can apply here too.

Matt stressed that one-time income events—like large Roth conversions or stock sales—can trigger IRMAA surcharges two years later, so coordinate with your advisor before year-end.

6️⃣ Retiring Soon? Timing Matters

• Turning 65: Enroll in Part A and B at SSA.gov about three months before your birthday month if you’ll use Medicare immediately.
• Still working? Coordinate Part B start with your employer plan to avoid gaps.
• Under 65 and retiring early: Meet with a broker 90 days before coverage ends to price Marketplace plans and APTC eligibility.

(And remember: Social Security and Medicare don’t call or email you first. If you get a “Medicare” phone call, hang up and verify by mail.)

7️⃣ Why Your County Still Matters

Premiums and networks are set by rating areas (often county lines). Metro areas offer more choice and competition; rural counties may see higher costs and less access. If you’re moving for retirement, include health-care access in your location analysis along with taxes and housing.

8️⃣ Work with a Broker—It Costs the Same

You pay the same premium whether you buy directly or through a broker. A broker adds value by verifying your providers and prescriptions, handling claims issues, and re-shopping each year as plans change.

As Matt put it: “If an insurer isn’t coming to your kitchen table when things go wrong, make sure your broker will.”

🟩 Takeaway

You don’t have to navigate health insurance alone. Ask questions, verify your network, and plan for the total cost—not just the premium. Doing the heavy lifting now prevents bigger surprises later and sets you up for a healthier, wealthier, and happier retirement.

🔗 Next Steps with Sona Wealth

• New Clients Get Your Sona Free Retirement Review→ Schedule a 15-minute call
• Watch the full interview with Matt Wicklund on YouTube → (Click Here)
• Subscribe to our newsletter for weekly planning tips and policy updates →(Click Here)

Disclosures

Sona Financial LLC, DBA Sona Wealth and Sona Wealth Advisors, is a registered investment adviser with the state of Minnesota. All views, expressions, and opinions included in this communication are subject to change. This communication is not intended as an offer or solicitation to buy, hold, or sell any financial instrument or investment advisory services. Any information provided has been obtained from sources considered reliable, but we do not guarantee the accuracy or completeness of any description of securities, markets, or developments mentioned.

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To health and wealth!

Mark Struthers, CFA, CFP®, CRC®, RMA®

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This commentary is provided for general information purposes only, should not be construed as investment, tax, or legal advice, and does not constitute an attorney/client relationship. Past performance of any market results is no assurance of future performance. The information contained herein has been obtained from sources deemed reliable, but is not guaranteed.