Matt dives into a specific healthcare topic to help those in the industry, and those outside of it, better understand the market drivers causing today’s healthcare challenges.

CMS announced the 2026 Medicare cost structure. Part B premiums rise $17.90 monthly to $202.90. The annual deductible jumps $26 to $283. Part A deductibles increase $60 to $1,736.

These numbers look small until you do the math on a fixed income.

The 2026 Social Security COLA increase is 2.8%. That translates to roughly $56 more per month for the average beneficiary. The Medicare Part B premium increase alone consumes 32% of that gain before you see a dollar. 

Senior poverty rates hit 15% in 2024, up from 14% in 2023. The highest among all age groups. The only age group where poverty increased.

The COLA formula fails seniors because it measures costs for working-age households. It does not reflect what retirees actually spend money on. Healthcare, housing, and utilities consistently run higher than general inflation. The formula ignores this reality. 

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The 2025 National Health Care Fraud Takedown charged 324 defendants with schemes involving over $14.6 billion in intended losses. One transnational criminal organization alone submitted $10.6 billion in fraudulent Medicare claims for durable medical equipment. They exploited stolen identities of over one million Americans across all 50 states.

Medicare loses approximately $60 billion annually to fraud, errors, and abuse.

The response to this systemic bleeding is to raise premiums on fixed-income seniors by nearly 10%.

CMS prevented over $4 billion in fraudulent claims from being paid in the months leading up to the 2025 takedown. The infrastructure exists to stop fraud. The costs of previous failures get passed directly to beneficiaries through premium increases.

Healthcare budgeting uses last year's budget as ground zero. We never dive into understanding the waste, unnecessary services, billing issues, or fraud that went into the budget for the prior year.

Prices always go up each year. They never come down.

The increase seems small enough that people swallow it and move on. That has been the model for decades. Keep patients coming back because they know they need healthcare insurance. Keep the money coming in larger amounts each year.

Small enough to absorb. Large enough to compound.

When medication costs surpass 10% of a person's medical expenses, seniors skip doses or avoid filling prescriptions altogether. Premium increases push more beneficiaries across that threshold each year.

I saw this as a chronic pain patient after breaking my neck. Patients split their doses over multiple days rather than take the full dose as prescribed. This causes side effects. The medication does not work as intended. Other patients miss bill payments for housing and food. The stress increases. This causes other illnesses.

Research shows that morbidity and mortality associated with poor medication adherence costs $528.4 billion annually. Nearly one in four Americans who take prescription medications say it is difficult to afford them. 29% of older adults did not take their medicines as prescribed at some point in the past year due to cost.

Up to half of older adults do not take medications as directed. Hospitalization rates due to adverse drug effects are 4 to 7 times higher in older patients than in younger patients.

System failures in healthcare always affect patients.

The Affordable Care Act knighted three or four big insurance companies as the winners. UnitedHealthcare, Aetna/CVS, Elevance, and Cigna. The federal government guaranteed that everyone in the US would buy health insurance. The federal government subsidized it for 10 years.

These companies pocket nearly $100 billion in revenue per quarter.

They have had decades of vertical integration. They captured the insurance company, the pharmacy, the specialty pharmacy, the PBM, and even providers. The Federal Trade Commission should have stepped in long ago to stop this and ensure competition. It never has.

The three largest PBMs control approximately 80% of the prescription drug market. CVS Caremark, Express Scripts (owned by Cigna), and OptumRx (owned by UnitedHealth Group) create vertically integrated monopolies where insurance, pharmacy benefits, and pharmacies exist under one corporate umbrella.

For 2024, 60% of OptumRx's revenues came from other affiliated businesses within UnitedHealthcare Group. CVS Health's pharmacy and PBM segments generated $53 billion in internal transactions.

UnitedHealthcare's Medicare Advantage patients got 55% sicker on paper in the space of just one year when doctors working directly for United treated them. When those same UnitedHealth Group doctors treat patients in traditional Medicare, they do not increase diagnosis levels.

Insurers win when patients look sicker and get less healthcare.

Most seniors bow down to the system because they were raised to always default to their doctor. The doctor knows best. They do not see that the doctor today is just a pawn in the system. Doctors are being used as a means to financial ends.

The doctor-patient relationship is no longer the pinnacle of what reasonable means in healthcare. Barriers and blockers inhibit that relationship and limit the ability to get the care patients need and deserve.

When these 2026 cost increases hit and a senior cannot afford their copay or deductible, patients blame the doctor for the problems they face in healthcare. They miss the larger system impacting them.

The cost increases do not just extract money. They poison the one relationship seniors still trust.

The lack of trust you have in your doctor is not your doctor's fault. It is the constraints they face to survive in today's healthcare marketplace. Just like you do not like being forced to pay for someone else's needs, they do not want to have to provide care for free.

Doctors are getting paid less to do more. Your premiums are increasing to pay for other people's care.

In today's political environment, it seems that Medicare or Medicaid must default before we get real reform. Or we have to do the hard work of educating the public about what has happened to healthcare since the ACA.

Nothing in life is free. The same goes for healthcare. If others get something for free, it costs you money.

With that knowledge, we can move patients in the right direction. We can keep them focused on the relationship that they used to have with their doctor. Bad health policy and players like vertically integrated health insurance companies took that relationship from them.

Check out the beliefs of your local senators and congressmen on healthcare. Understand how those who are supposed to serve you are actually treating you as patients. Understand how those decisions have impacted you financially.

Get educated. Get involved.

The alternative is watching the slow boil continue until the system collapses under its own weight.