Welcome to your essential update for May 2026. If you’ve been feeling like the world of health insurance is moving faster than you can keep up with, you aren’t alone. Between shifting pharmaceutical programs and complex federal regulations, staying informed is a full-time job.
Luckily, it’s our full-time job. At Total Benefit Solutions Inc, we don’t just watch the changes; we navigate them for you. This month, we have three major updates that will impact how you access care, how much you pay for prescriptions, and how your business stays compliant with Medicare rules.
The July 2026 Ozempic/GLP-1 “Bridge Program”
One of the most frequent questions we’ve received lately is: “Will Medicare finally cover weight-loss drugs?”
The answer is changing. Starting July 1, 2026, a new Medicare GLP-1 Bridge Program is set to launch. This program is designed to help beneficiaries access specific GLP-1 medications that were previously difficult to get covered for weight management.
What You Need to Know:
- The $50 Copay: Eligible beneficiaries may be able to access a monthly supply of certain weight-loss medications for just $50.
- The Specific Drugs: Currently, the “Bridge” focuses on medications like Wegovy and Zepbound when prescribed for weight loss and maintenance.
- The Ozempic Distinction: It is important to note that Ozempic is primarily approved for Type 2 Diabetes. If you are taking Ozempic for diabetes, you will continue to access it through your standard Medicare Part D plan. The “Bridge” program specifically targets those using these medications for obesity and related health risks.
This is a massive step forward for preventative health. If you’ve been struggling with the high out-of-pocket costs of these medications, reach out to us today. We can help you determine if your current Part D plan or the new Bridge Program is the best fit for your health needs starting this July.
Deep Dive: Medicare Secondary Payer (MSP) Rules
Don’t let the technical name scare you away. Medicare Secondary Payer (MSP) rules are the “who pays first” laws of the insurance world. If you are 65 or older and still working, or if you own a business with older employees, getting this wrong can lead to massive headaches and even bigger fines.
The “Under 20” vs. “Over 20” Rule
The most common mistake we see involves employer size. Here is the breakdown:
- Small Employers (Fewer than 20 employees): If you work for a company with fewer than 20 employees, Medicare is the Primary Payer. This means Medicare pays your medical bills first, and your employer’s group plan pays second. (Warning: If you don’t sign up for Part B in this scenario, your small group plan may refuse to pay anything until Medicare “pays” its share, leaving you with 80% of the bill!)
- Large Employers (20 or more employees): If your employer has 20 or more employees, the Employer Group Health Plan (GHP) is the Primary Payer. Medicare is secondary. In this case, you may be able to delay Part B without penalty (as long as your coverage is considered “creditable”).
Disability and MSP
The rules change if you are on Medicare due to a disability. For disabled beneficiaries, the employer must have 100 or more employees for the group plan to be primary. If the company is smaller than 100, Medicare stays primary.
The $1,000-a-Day Warning
The federal government takes these rules very seriously. Employers who fail to report their status correctly or who try to “push” older workers onto Medicare (to save the company money) can face penalties of up to $1,000 per day, per beneficiary.
“Navigating MSP rules is like walking through a minefield without a map,” notes Dr. Ben E. Fitz. “But we have the map. We help small businesses apply for the Small Employer Exception (MSP-SEE) and ensure individuals don’t get stuck with massive unpaid medical bills.”
Why You Need an Advocate
Whether it’s understanding your rights under the new AAMSI standards, navigating the GLP-1 Bridge, or staying compliant with MSP rules, you shouldn’t have to do it alone.
Health insurance companies have teams of lawyers and experts designed to protect their bottom line. At Total Benefit Solutions Inc, we are your team. We are independent brokers, which means we work for you, not the insurance carriers. We shop the market, compare the fine print, and we never accept “no” as an answer when fighting for your benefits.
Medicare changes every year, but our commitment to your health and financial security remains constant.
Ready to take the next step?
Don’t wait until you’re facing a penalty or a denied claim. Let’s review your coverage today.
Contact Total Benefit Solutions Inc:
- Website: www.totalbenefits.net
- Phone: (215) 355-2121
- Address: 1530 Bustleton Pike, Feasterville, PA 19053
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