EPISODE 30 - Medicare Advantage: How to Make Changes & Ensure You Have What’s Best for You

In this informative episode, we sit down with Melissa Mlasco, a Medicare Representative and Certified Financial Fiduciary with over 25 years of experience helping seniors navigate retirement and healthcare decisions.

Melissa breaks down the complex world of Medicare Advantage (Part C)—how it works, how it’s changing in 2026, and what every senior should know before choosing or changing plans.

You’ll learn:
💡 The difference between Original Medicare and Medicare Advantage
💊 How upcoming changes will impact premiums, drug plans, and out-of-pocket costs
🏥 Why choosing the right network of doctors matters more than ever
💰 How to save money while keeping comprehensive coverage

Whether you’re turning 65, assisting a loved one, or reevaluating your current plan, this episode will help you make informed, confident decisions about your healthcare.

📞 Contact Melissa Mlasco:
Futurity First | medicaremadeforyou.org
| futurityretirementadvisors.com

At Team Senior™, our mission is to guide you and support you through the maze of Southern Oregon Long-Term Care.

📞 For Team Senior resources, call: 541-295-8230

Or visit our website for more information: https://www.teamsenior.org/

Transcript

Episode 30- Medicare Advantage

Host: Jamie Callahan
Guest: Melissa Mlasco, Medicare Representative & Financial Advisor

JAMIE CALLAHAN: Hi, this is Jamie Callahan with the Team Senior Podcast. Our goal is to simplify aging. Society grooms us to plan for retirement, but what about life beyond retirement, where the rubber meets the road? Perhaps you've had a stroke, or you've been diagnosed with cancer, or maybe you're forgetting things and now you have dementia. That's our area of expertise, and we are here to share our insight.

And now, the Team Senior Podcast.

Hi, this is Jamie Callahan, and we are in the studio today with Melissa Mlasco. She is a Medicare representative, and I'm going to let her tell you all about herself and her company.

MELISSA MLASCO: I'm Melissa Mlasco, and I have been in the industry now for almost 25 years. I started originally as a Medicare agent and then transitioned into helping my clients with other needs in retirement. And so I am an investment advisor. I'm a certified financial fiduciary, and I manage assets and help people in the area of Medicare. Also, I also address the need of long-term care because that is the main reason why people die today without assets. And so that comes complete in someone's financial plan. But Medicare is always the first step. So that's always the door opener that I'm usually talking to people about, to be able to address their needs in Medicare.

As a certified financial fiduciary, then it's my responsibility to make sure that I'm always acting in the client's best interest and always putting that at the forefront. And so I'm really good at designing financial plans and guiding people through retirement. But again, healthcare is always the first step. So that's what I'm excited to be here today to talk about.

JAMIE: Nice. So I want to talk just briefly about being a fiduciary, because not all Medicare reps are fiduciaries. Tell us what a fiduciary does and why somebody might want that.

MELISSA: So a fiduciary—again, my mom taught me to put other people first before myself. But I'm also held to the standard of the law of making sure that the client's best interest is followed. I do that as far as financial planning and investment planning for the client and guiding them through retirement, working with cash flows, and making sure that all of their different areas that affect their life are touched each way as far as what is in their best interest.

Again, it goes always back to: What would I do? How would I put myself in their shoes? And in that case, what's the best way to guide them? So having all of the experience educationally-wise to be able to make great decisions for people and to educate them—because that's always my first step—is I want everybody to know how Medicare works. I want them to understand how the concept of Medicare works: A and B and D and Part C, which I think we're going to talk about mainly today. And if I educate somebody and have them understand how Medicare works first, then they're able to make better decisions and not just take what it is I'm going to suggest.

JAMIE: I totally agree, Melissa. One thing that has been a sore spot for me over the years in getting to know people and different Medicare plans that they are on is that I know that in this area—which I'm sure is true in every area—if you have certain kinds of Medicare, you cannot use certain hospitals, certain home health companies, things like that. And so having somebody who is truly on your side, like Melissa, makes a really big difference. I want to talk today a little bit about Medicare Advantage. Walk us through what part that's considered and what exactly is Medicare Advantage.

MELISSA: Sure. That's a really great question, and that's always where I start. So Medicare Advantage, when you have Medicare Part C as it's known, you no longer have traditional A and B and D. It's all rolled into one. And so then Medicare steps out of the picture, transfers your responsibility over to a private insurance carrier—which, ooh, that sounds scary. However, so does the government running your program.

JAMIE: So true.

MELISSA: So when you have Medicare Advantage, then you're basically on a plan that's all lumped together, and it all is supposed to work to coordinate your care.

JAMIE: That's great. And I have worked with several different kinds of Medicare Advantage. What types do you represent?

MELISSA: So I'm an independent, and so I have no loyalty to any insurance carrier. I am basically looking for the best fit to my client. And I'll be quite frank with you, 2026 is going to be very difficult. I've been leading to—

JAMIE: Or people have been leading me to know that is going to be—

MELISSA: Yes. We're going to be in a position where we're going to be limited as far as networks of doctors and plans. And I'm not going to get into any specific plans today. But what we're going to be looking at is: Who are your doctors? Who is your pharmacy? And how do we coordinate your care and make sure that you have access to all of your doctors that you need to go to? Because, quite frankly, it's easier to change your plan than it is to change your doctor.

JAMIE: That's so true.

MELISSA: And having the appropriate person to lead you down that path is going to be critical as we roll into 2026.

JAMIE: Yes. A hundred percent. A hundred percent. Let's talk about the main benefits and features, because I want to keep focused on Medicare Advantage. What are the main benefits or features that make Medicare Advantage plans attractive to seniors?

MELISSA: So the main benefits that make seniors attracted to Medicare Advantage would be that they have a very low premium. Your other option is going to be either a retiree plan, or it's going to be a Medicare supplement. And Medicare supplements are getting more and more expensive these days. So you figure an average 65-year-old turning 65—for a Medicare supplement, that premium's going to probably run you about $160 a month. And then on top of that, you're going to have your prescription drug plan. Depending upon what prescriptions you're taking, that's going to range anywhere from zero to up to $2,000 in copays per year.

So the Medicare Advantage plan, you pay a lower premium, but it's more of a pay-as-you-go. So, you know, you're saving that premium, but then you're paying for your expenses as you go along.

JAMIE: I totally understand that. In consideration of choosing plans and comparing plans, there has to be some challenges and trade-offs for people to be aware of before enrolling. What are those?

MELISSA: So the challenges of choosing a Medicare Advantage would be that you would pay a higher premium if you were going to go out of network—if you're going to go out, or excuse me, outer—you would pay a higher copay if you were going to go out of network. I correct myself. So we want to make sure that your network is secure and that you have all of your doctors within the network for your group that you're seeing.

JAMIE: That makes perfect sense. Okay, so essentially what you're saying is that when you're meeting with somebody, you're going to have a conversation about: Is your provider in the network? What are the costs, prescription drug coverages, supplemental benefits—all the things. What factors do you emphasize when comparing plans?

MELISSA: So we would compare your copays, the different copays that you would have when you were seeing a provider. We would want to make sure that the plan that we were choosing had the lowest maximum out-of-pocket that we could. So we're going to be a little bit challenged for 2026. A lot of these maximum out-of-pockets are going to be as high as, say, $6,800 per calendar year.

JAMIE: Wow. Yeah. Okay. That's a big change.

MELISSA: That's a big increase.

JAMIE: Yeah. The other thing we're going to look at is additional benefits. So a lot of these plans also come with dental. They're going to come with a gym membership. We're going to want to make sure that you're using your gym membership. The plan is going to encourage you to be able to stay healthy. And so by saving money on either a retiree plan and keeping your own money in your pocket, not paying out the premiums, then you can afford to go ahead sometimes to pay as you go for your services.

MELISSA: And so there's a focus on preventative measures?

JAMIE: Yes. And so all of the plans are going to come with an annual physical, again, a gym membership. It's going to come with coaching on helping you stay healthy, and of course, connecting care. So making sure that your primary care physician is working directly with your specialist.

JAMIE: So you mentioned some other benefits like vision, dental, hearing. Are there Medicare Advantage plans that include those things?

MELISSA: Yes, they do. Most of them do. So those are going to be actually added features that are going to benefit your original Medicare and are going to give you extra benefits that original Medicare does not cover.

JAMIE: That's amazing. When you have a client that comes and meets with you and you select a plan together, I would imagine you're meeting with those clients on an annual basis so that you can reevaluate premiums, formularies, networks—all of those things. Talk us through how you reach out to your folks that are in your network, your clients, to meet with them again.

MELISSA: So yesterday, all of my clients got what's called a scope of appointments. That means that I'm allowed to speak to them about their Medicare Advantage. They all got that in their inbox, and I had probably 1,200 of them respond to make sure that they are going to be all set and that they know we're on gear to be able to make sure that they have the right plan. By December 7th, we reevaluate every single client's prescription drug plan and their Medicare Advantage plan throughout this time. We don't celebrate Thanksgiving.

JAMIE: That's such a great point for somebody that works in insurance.

MELISSA: We are located at 2516 Crater Lake Avenue, and we literally go across the street to Safeway to grab our Thanksgiving dinner while we are sitting there making sure that every single client's prescription drug plan is the correct one and their Medicare Advantage for 2026.

JAMIE: Talk about commitment.

MELISSA: Yeah, and the big deal is the prescription drug plan. So we want to make sure that your prescription drug plan has the right plan if it's in the Medicare Advantage. So when you have Medicare Advantage, it also coincides with your prescription drug plan. So knowing what your prescriptions are, we have every single one of our clients' prescriptions, and we're able to then go ahead and know what their copays predicted are for the year based on what it is they're taking right now.

JAMIE: What an incredible service. So we know that the Medicare Advantage plan works with prescriptions. It has to collaborate with several other types of services as well, like Medicaid, employer retiree benefits, Medigap policies. Talk me through that.

MELISSA: As far as retiree plans, you might have a choice. Say it's PERS—that's a common one for Oregon. PERS—a lot of times those plans are expensive. So the PERS plan right now, I believe, is running around $240 a month, and sometimes you can go ahead—and that's in addition to your Medicare Part B. So your Medicare Part B premium is $185 a month. So you pay that on top of that, and sometimes you can go ahead and get a Medicare Advantage plan that's a zero premium that can go ahead and complement Medicare and also provide other benefits that maybe your PERS isn't.

The other would be if you had a Medicare supplement. So if you had a Medicare supplement, you might be paying a high premium. The average premium for an 80-year-old in our area is going to be about $160 a month. So you're basically, in a sense, giving the insurance company the money upfront in exchange for not having any responsibility. With a Medicare Advantage plan, you might be paying a zero premium, but then you would also be paying as you go. So you can calculate in your head how much you would be paying out for premiums if that was the case.

JAMIE: I would guess that these are some of the factors that contribute to, like, myths and misconceptions when it comes to Medicare Advantage plans.

MELISSA: Yes. And again, that goes back to—we're going to tell you honestly if it's a good idea for you to stay on whatever plan it is you're already on. We're going to suggest that we're going to keep you on your plan, and then we're going to move forward in that direction as opposed to changing you, because, again, it all comes back to what's in the client's best interest.

JAMIE: Understood. Understood. So I know that this is going to be a little bit of a loaded question, but I know that everybody wants to hear what your opinion is, because you have been doing this for so long and you are so good at it. What trends or changes do you see in the Medicare Advantage space that will affect seniors over the next few years?

MELISSA: So the big trend is the cutbacks that the government is going to be giving the Medicare Advantage plans. So in 2019, the Inflation Reduction Act was passed, and basically the Biden administration went ahead and set forth with the proposal that in 2024, at the end of that—so December 31st—then no longer would people have the donut hole for the prescription drugs. And so for 2025, we started then with the insurance companies being the ones who were responsible for the amount over $2,000.

So prior to that, in 2024, everyone had a maximum amount, or they had an allowance, of $5,900. Once they spent their allowance, then they would fall into what's called the donut hole. Then they were responsible for 25% of the costs while they were in the donut hole. Once they reached the catastrophic, which was over $8,000, then they went into that phase, which they didn't have any responsibility. So there was something called the donut hole, and that was in 2024.

The Inflation Reduction Act eliminated the donut hole, and what they did was they capped everyone's prescription drugs at $2,000. They told all of the insurance companies that, "Hey, guys, you guys are responsible for all of the costs above $2,000 on prescription drugs for 2025." What do you think insurance carriers do when you affect their bottom line?

JAMIE: Sure. They raise premiums.

MELISSA: Absolutely. And they lower benefits. And then, "Oops, this is election year. Ooh, I guess we're going to go ahead and throw you guys $300 billion." And they did that in August of 2024 in order to prop up 2025. So what's happening in 2026? That's a good question. So what's happening in 2026 is that they're getting less money than they did in 2024. And so therefore, they have went ahead and raised maximum out-of-pockets, which is a big deal. For 2025, our maximum out-of-pocket for one of our main companies in Oregon was $3,405. Now that maximum out-of-pocket is $7,000.

JAMIE: Oh my gosh. That is so painful. I just don't even know how folks are going to keep up with the constant cost of everything arising.

MELISSA: Yeah. And it really only affects those in the subpar population that really are using services a lot. So it is a hard situation. It's almost like we've taken away from one area and fixed this area, and now we've shifted over to the other area, and we're going to be costing people more money in the area of medical because of the prescription drug plan.

JAMIE: That's the nature of everything when it comes to politics. Take away from one thing and give it to another until we realize that doesn't work, and then we try something else. For someone who's approaching Medicare eligibility, who doesn't currently have any Medicare in place—maybe because it's age, maybe because they've just delayed enrolling for whatever reason—what advice would you give them as they start evaluating their options?

MELISSA: So if you're getting ready to turn 65, then we want to make sure that we've looked at all of your different options, whether that's a retiree plan that involves the veterans, whether that's you choosing a Medicare supplement or a Medicare Advantage. You've got three different roads to go down. And again, we want to make sure that whatever road you go down is the right one for you. You can switch from road to road as you go throughout life, but you can only go down one road at a time. Sometimes that involves making sure at that particular moment we're choosing the right road.

And when do you get to choose? You get to choose when you're in your initial enrollment period. So your initial enrollment period is three months before your 65th birthday and the month of your 65th birthday, and three months after. You also are in what's called a special election period when you quit working. We haven't discussed that at all. So we want to talk about those people that sometimes—gosh, our full retirement age now is 67. Yay. And so there's a lot of people out there that are continuing to work past the age of 65, and they're going to be retiring later and keep working until they elect their Social Security.

At that point, you're in what's called your special election period. And so your special election period—again, you've got that window where we want to make sure that when your coverage that you have ends, that your new coverage starts. So those are the different times. There's also the special election period if you move out of the area. So if you move out of your service area and you're on a Medicare Advantage, you're given an opportunity—it's 60 days—in order to choose another plan from that point when you notify Social Security or Medicare that you've moved.

JAMIE: Got it. So I want to go back and touch on something that you just said. You said that the new full retirement age is 67. What does that mean to people?

MELISSA: What that means is the amount that you are going to receive your full retirement Social Security benefits is going to be at the age of 67. If you take it prior to that, then you're going to take a reduced amount. And if you continue all the way to the age of 70—and this is all prorated, so it doesn't matter what—you can choose a magic number. "Hey, I want to retire when I'm 68," or "I want to retire when I'm 69." It's all going to be prorated per month. So your Social Security increases by 8% per year for every year you postpone it.

JAMIE: So for someone who is planning to retire right now at the age of 65 and take their full Social Security benefit, that is not going to be possible starting next year?

MELISSA: No. They get to go ahead and take their full Social Security benefit. It's just—it's a reduced amount.

JAMIE: Okay. So the amount is reduced by 8% per year for every year that you take it early, take it ahead of time.

MELISSA: Yes.

JAMIE: Okay. I understand. Okay. Share a story with us. Share a story of a client who benefited from getting the right plan through your assistance.

MELISSA: Gosh, I just saw one today, actually, before I left here. And so they are paying—they're in their eighties, and they're paying $170 a month for their Medicare supplement. And they don't go to the doctor very often, which I was a little confused over, but maybe they're rare. But they're paying out over $3,000 a month—or a year—in premiums. And so if you think about it, they're pretty close to that maximum out-of-pocket for Medicare Advantage.

So they were able to save the premium. They're also now getting assistance from Asante, where if their medical bills are too high and they can't afford it, they were given the letter that allows them to get extra help. And so we switched them over to a Medicare Advantage plan—or we're going to do that on October 15th when they're allowed to do that. And we're going to have them come back in and sign those papers. But they're able to save that premium, and they're actually pretty low income. That's an example of somebody now—they're going to have some dental coverage, they're going to have a gym membership, which they're actually excited about at the age of 82. And that's a big assist.

JAMIE: I love that so much. Yeah. Saving them all of that money and giving them benefits that they weren't presently benefiting from.

MELISSA: Yeah. And there's a lot of people out there, too, on retiree plans or veterans that don't understand that they're able to get a Medicare Advantage plan that's going to give them the extra benefits and then also come in to back up so that if the veterans—if they weren't going to cover their—if they wanted to go outside and be able to go to a different doctor and decide not to go through the veterans plan for seeing a primary care physician, they could go ahead and do that.

JAMIE: I love that. I love that, especially for the veterans. I'm a big veteran advocate. Melissa, thank you so much for being here today. If someone wanted to reach out to you for assistance with Medicare, share with them how they would do that.

MELISSA: Sure. I am Melissa Mlasco, and I'm with Futurity First. And our website is futurityretirementadvisors.com. We also have the website medicaremadeforyou.org. So medicaremadeforyou.org or futurityretirementadvisors.

JAMIE: Futurity Retirement Advisors. Melissa, thank you so much for coming in today. And I will close again like I always do, that if any of this is something that you're interested in and you are struggling to reach out to Melissa on your own, or maybe you wake up a year from now and you remember this podcast, you're always welcome to reach out to Team Senior, and we will help you get in touch with her. Thank you so much, Melissa. We appreciate you coming in.

MELISSA: Oh, this is so wonderful, Jamie. Thank you.

JAMIE: You're very welcome. Bye-bye.

Thank you for listening to the Team Senior Podcast. We're here every week sharing new and relevant information. Remember that we're just a phone call away. Team Senior can be reached at 541-295-8230. Again, 541-295-8230. Until next time, this is Jamie Callahan.

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