Blog
Losing Medicaid at 65+: What It Means and How We Can Help | 05.22.2025
For many people 65 and older, Medicaid has been a lifeline—helping cover healthcare costs that Medicare alone doesn’t.
Recently, we have seen a wave of people losing their Medicaid benefits. Whatever the reason - income changes, redetermination issues, or confusing paperwork, it’s creating real stress for seniors.
If you (or someone you know) has recently lost Medicaid coverage, you are not alone—and there are steps you can take to avoid losing health benefits or access to care.
Let’s walk through this:
Q: What Happens When You Lose Medicaid?
A: Losing Medicaid can affect your coverage in several ways:
Medicare Savings Programs: If Medicaid was paying your Part B premium (usually $185/month in 2025), you may now have to pay it yourself—unless you qualify for another savings program.
Extra Help (Low-Income Subsidy): If you received help paying for prescriptions through Medicaid, you may lose your Extra Help benefits too—meaning higher copays at the pharmacy.
Dual Special Needs Plan (D-SNP): If you were enrolled in a D-SNP, losing Medicaid can mean you’re no longer eligible for that plan, and could be disenrolled unless you take action.
Long-Term Care or Home Support: If Medicaid helped with long-term care or in-home assistance, losing coverage may affect those services.
Special Enrollment Period (SEP): You may be eligible for a special enrollment period to change your Medicare plan after Medicaid loss—but timing matters.
Q: This is really overwhelming. What can/should I do?
A: You can do these things right now:
Don’t Ignore Notices
Medicaid loss often happens after a redetermination. If you get a letter, open it—and bring it to us. We can help you understand it and respond.Check for Other Programs
You may still qualify for partial Medicaid or other programs like QI-1, SLMB, or LIS (Extra Help) that can ease the financial burden.Review Your Medicare Plan
If your Medicaid status has changed, your Medicare plan may need to change too—especially if you were in a D-SNP or had enhanced drug coverage.Act Quickly
You may qualify for a Special Enrollment Period, but it’s usually time-limited. Acting fast protects your access to care and keeps costs down.
We’ve helped dozens of Oregonians navigate the loss of Medicaid with clarity and compassion. Here's what we do:
One-on-One Help: We explain your options clearly and help you understand what’s changing—and why.
Plan Reviews: If your Medicaid is ending, we help you re-evaluate your Medicare plan to make sure you're not paying too much or missing out.
Timely Action: We track deadlines and Special Enrollment windows so you don’t have to.
This IS overwhelming. And - you are not alone. We are local, experienced, and here to help you make the best decisions with confidence and calm.
If you’re 65+ and just got a Medicaid termination letter—or are worried one is coming—schedule a review with us today.
Let’s talk through your options and get you set up with the coverage that fits your life now.
👉 Book your appointment at www.calendly.com/medicaremarkfuchs/medicaid-loss.
Medicare Mark Fuchs LLC—local help, lifelong care.
CMS 'Final Rules' and Why They're Worth Paying Attention To | 05.07.2025
First, what is a “final rule”?:
A “final rule” is Medicare’s way of saying, “We’ve made up our minds. This is how things will work next year.” (Remember ‘Who Wants to be a Millionaire’? This is CMS’s “Final Answer”.)
The purpose of the final rule is to ensure that everyone — from local pharmacies to nationwide insurance plans — is on the same page and following the same rules.
So - when you hear that CMS (Centers for Medicare & Medicaid Services) has issued a “final rule,” it means the government has made a decision about how certain parts of Medicare will work in the future.
Here’s how the process works:
CMS makes a proposal.
Called a “proposed rule”, CMS announces what they might change — for example, how much insurance companies get paid for Medicare Advantage plans, or what changes might be coming to drug coverage.They ask for public input.
Doctors, insurance companies, advocates — even everyday people — can send in their opinions during a designated timeframe. CMS reviews the feedback.CMS makes it official.
After considering the input, CMS releases a “final rule.” This is the version that becomes the law going forward. It includes all the important details that insurance companies and Medicare plans must follow in the coming year.
Why Should You Care About a Final Rule?
Because they tell us things like:
How Medicare plans will change.
What benefits might be added or removed.
How much the government will pay insurance companies.
Whether you might see more (or fewer) options in your area.
Final rules very much affect you and your coverage. When new plan information is released, or something has changed and you notice it in a doctor bill or at the pharmacy, is is very likely due to a CMS Final Rule.
Anytime you receive something that has you confused or questioning your coverage, schedule an appointment with Mark. He is happy to look at it with you and get to the bottom of your concerns.
Social Security Identity Verification | 03.27.2025
If you receive Social Security benefits—including Medicare, Social Security Disability (SSDI), or Supplemental Security Income (SSI)—you may have heard about new identity verification requirements. These changes are designed to prevent fraud, and we combed through a notice on the SSA website to glean the important pieces as it pertains to Medicare beneficiaries (click here to see the full article).
Who Needs to Prove Their Identity?
For most people, nothing changes—you do not need to prove your identity unless:
✔️ You are applying for benefits for the first time.
✔️ You are changing your direct deposit information.
If you are already receiving benefits and not making any changes, your payments will continue without any action on your part.
*** BENEFICIARIES BEWARE ***
Social Security will never text or call you to confirm your identity. If you receive a text or phone call asking for your information, ignore it—it’s a scam!
How to Prove Your Identity Securely
The easiest and safest way is by using a my Social Security account online.
If you are applying for Medicare or SSDI, you can verify your identity by phone.
If you are applying for retirement, survivors, or auxiliary benefits, or changing direct deposit information, you must visit a Social Security office in person.
Impact to Medicare Beneficiaries
If you receive Medicare benefits through Social Security, your payments will continue without any changes.
However - if you change your banking information, you will need to verify your identity using one of the approved methods.
If you have additional questions about how this impacts your Medicare coverage, reach out to Medicare Mark Fuchs for trusted guidance. We’re here to help you navigate these changes with confidence!
Stopped Before it Started: The $2 Generic Drug List | 03.18.2025
The Trump administration has officially ended efforts to launch a $2 generic drug discount program for Medicare enrollees. The program, initially developed under the Biden administration and first previewed in 2023, aimed to make about 150 common generic drugs available for just $2 per prescription. CMS officials estimated that this initiative could have benefited 32 million Medicare Part D enrollees, helping them save on essential medications. However, with the administration rescinding support for the project, the program will no longer move forward.
Key takeaways include:
No $2 generic drug list* under Medicare Part D.
Potentially higher out-of-pocket costs for common medications, plan-dependent.
Limited access to ultra-low-cost prescriptions - again, plan-dependent.
Continued reliance on plan formularies, which vary in coverage and pricing.
Unclear reasons for canceling the program or how much money CMS expects to save.
For Medicare beneficiaries, this means carefully reviewing your Part D drug plan is more important than ever. Many plans do offer low-cost generic drugs, but coverage varies widely.
With his expertise and access to 15 insurance carriers, Mark can help you navigate your options. If you’re concerned about drug costs or need a plan review, schedule a consultation today to ensure you have the right coverage for your situation.
*From CMS.gov: Medicare $2 Drug List Model List RFI Sample Drug List (RFI = Request for Information, which means these were drugs under consideration.)
No Surprises Act at Risk: Why Medicare Beneficiaries Should Take Notice | 03.11.2025
The No Surprises Act, signed into law in 2020, was designed to protect Americans from unexpected medical bills. However, recent job cuts at the federal office responsible for overseeing this protection (the Center for Consumer Information and Insurance Oversight, or CCIIO) are creating uncertainty in how disputes between insurers and medical providers are handled.* While the core law remains in place, the impact of these cutbacks could mean:
Longer delays in resolving disputed medical bills.
Weaker enforcement of patient protections.
Potential cost increases as insurers and providers struggle with a backlog of cases.
Less support for consumers trying to file complaints about billing issues.
Uncertainty around new rules that were supposed to make the process more efficient.
For those on Medicare, this highlights an even greater need to understand your coverage and avoid unexpected costs. While the No Surprises Act primarily applies to private insurance, Medicare beneficiaries can still face out-of-network charges in some situations.
Now more than ever, working with a trusted Medicare expert ensures you’re prepared and protected. If you have any concerns about your coverage, schedule a call with Mark today to review your plan and avoid unexpected surprises.
Oregon IRS Offices Closing - Impacts to Medicare | 03.04.2025
UPDATE 8/1/2025: While the Bend and Salem offices remain on the government’s “wall of receipts” list of lease cancellations, no further information has been released regarding closure dates, and both offices remain open.
As announced at the end of last week, the federal government will be closing two out of three IRS offices in Oregon (Bend and Salem), leaving only the Portland location open. Here's how this affects Medicare and your retirement planning:
This will cause delays in verifying income, accessing tax records, or resolving financial matters tied to retirement planning.
Very specifically —> Less people on staff means less people available to process IRMAA (income related annual adjustment) appeals.
Social Security offices are already experiencing longer delays for Medicare enrollment and wait times for essential services are increasing. While these changes are out of our hands, what we can do is help you navigate them:
Start now - If you are nearing 65 or planning for retirement, taking action early is no longer "just good advice"—it is essential to ensuring a smooth transition to Medicare.
Check out our FAQ page for details on planning.
Get expert help - These larger system changes reinforce why having a trusted expert on your side makes all the difference.
Schedule a call - it's ok to just ask a question; there is no minimum knowledge required and no obligation to take any action. We're here to help, always.
Don’t Wait to Enroll: Why Early Action Matters for Medicare Parts A & B | 02.19.2025
We’re going to make this direct, and as clear as possible: Start as early as you can enrolling into Medicare Parts A & B. Time is not necessarily on your side, and here’s why:
Social Security offices are currently not taking walk-ins.
Phone hold times with Social Security are stretching several hours.
In-person appointments are being booked several months out.
Why this matters:
A quick turnaround once you’ve submitted is not guaranteed; waiting too long to apply for A & B could mean a delay in obtaining coverage, some of which could include penalties.
You need to have Part B before you can enroll in either a Medicare Supplement with Part D or a Medicare Advantage plan.
The sooner you take action, the more options you’ll have - and the smoother your transition to Medicare will be.
ALSO IMPORTANT - knowing ahead of time which coverage path is right for you (Medicare Supplement with a PDP or Medicare Advantage) is equally important. Given potential delays in obtaining Part B*, waiting to make these decisions can create unnecessary stress and limit your choices.
Don’t do that to yourself!
Book an appointment to map out your timeline. Avoid any avoidable problems that might come up. Medicare should be about peace of mind, not panic.
*We are not saying this WILL happen; we are saying it COULD happen, and to plan accordingly.
Contract Negotiations between Insurance Companies and Hospital Networks | 02.12.2025
A lot happens behind the scenes in Medicare/insurance/healthcare that we never hear about. Increasingly, however, we ARE hearing about insurance companies and hospital systems renegotiating their contracts, because clients/patients receive letters notifying them of a negotiation in process and the potential for disruption in care if the negotiation is unsuccessful.
These can be disruptive, disconcerting, and alarming to receive.
Here are a few thoughts from where we sit as an entity independent of both the insurance companies and the hospital networks, though definitely within the crosshairs of the conversation:
We have seen several of these negotiations with companies over the last few years, and while it is stressful to receive the notices, it is required by CMS that they be sent, and negotiations themselves are not an unusual occurrence.
We do not get advance of ‘inside’ notice of these - our independence of all insurance companies is excellent for maintaining neutrality in recommending a fit for you; this also means we are not privy to internal communications within those companies.
We consistently keep ears to the ground for things like this and respond the best that we can - as soon as we hear of something, available information is posted to this website in the announcement bar of the homepage.
ACTIONS YOU CAN TAKE:
Schedule a call to cover your current situation and to put a plan in place should we need to pivot and look at other options: Click here to book.
Check our homepage often and follow the links to the source updates - this is the most current information we have, and we’ve made it available and easily accessible for you.
While we can’t control these negotiations, we can help you understand your options and navigate any potential disruptions.
Our commitment is to you, not the insurance companies, and our goal is always to ensure you have the coverage that fits your needs. We get how frustrating - and scary - these can be, and we will always work to keep the most current information available to you, both on the negotiations and on your options.