3 Things 1-19-26

Thing One

When Medicare Advantage Works—and When It May Be Challenging

Recently, I worked with a client enrolled in a Medicare Advantage plan who experienced a serious fall. Following the injury, the client required skilled nursing care. When the family began exploring facility options, they learned that the nursing home they preferred was not part of the plan’s provider network. This created additional challenges at an already stressful time and highlighted some of the practical considerations that can arise with certain Medicare plan designs.

During the care process, a nurse mentioned that a Medicare Supplement plan might offer broader provider flexibility in situations involving post-acute or long-term care. While we are currently in the Medicare Advantage Open Enrollment Period, it is important to understand that moving from Medicare Advantage to a Medicare Supplement plan typically requires medical underwriting in many states. After a significant change in health, approval for a supplement plan may be more difficult, which can limit future options.

Medicare Advantage plans are popular for several reasons. Many offer low or even zero monthly premiums and include additional benefits such as dental, vision, hearing, fitness programs, and prescription drug coverage. For individuals who are generally healthy and comfortable with managed care, these plans can be a good fit and provide meaningful value.

At the same time, Medicare Advantage plans function differently than Original Medicare with a supplement. They generally rely on provider networks, and coverage is typically limited to in-network hospitals, physicians, and facilities except in emergencies. Certain services may require prior authorization, and coverage for skilled nursing or rehabilitation care can vary by plan and by provider. In addition, plan benefits, provider networks, and drug formularies may change from year to year.

One important consideration that is sometimes overlooked is long-term flexibility. While Medicare Advantage plans are guaranteed issue during certain enrollment periods, access to a Medicare Supplement plan later on often depends on health status. This makes it especially important to evaluate not only current needs, but also how a plan may function if health circumstances change in the future.

No Medicare option is universally right or wrong. Each choice involves trade-offs between cost, access, flexibility, and additional benefits. Understanding how Medicare Advantage and Medicare Supplement plans work—particularly in situations involving serious illness or extended care—can help individuals make more informed decisions.

Reviewing coverage before a health event occurs allows for clearer planning and fewer surprises. Medicare decisions are personal and should be based on individual health needs, preferences, and comfort with managed care, rather than on cost or benefits alone.

Thing Two  

Richer Everywhere, Not Just at the Top

It’s a claim we hear constantly—and like many popular narratives, it contains a grain of truth while missing the larger picture.

There’s no question that rising asset prices disproportionately benefit those who already own more assets. That’s how compounding works. When markets rise, someone with $10 million invested will gain more dollars than someone with $100,000 invested, even if both earn the exact same rate of return. On a dollar-for-dollar basis, the wealthy absolutely get richer faster.

But that reality is often confused with a different—and much stronger—claim: that all or nearly all of the benefits of economic growth and asset appreciation are flowing exclusively to the top 1%, leaving everyone else behind. The data simply doesn’t support that conclusion.

According to the Federal Reserve’s Distributional Financial Accounts, as of Q2 2025 the top 1% of households held roughly 29% of total U.S. household wealth. That figure is frequently cited as evidence of accelerating inequality. What’s often left out is the historical context. In 2000, the top 1% held approximately 28% of total wealth. Over a 25-year period that included multiple market cycles, recessions, recoveries, and unprecedented monetary policy, the share of wealth held by the top 1% has remained remarkably stable.

This does not mean wealth inequality isn’t real. It is. The absolute gap between households has widened because total wealth has grown dramatically, and higher-wealth households naturally benefit more in nominal terms from rising asset values. But acknowledging inequality is very different from claiming we are on an irreversible path toward a permanent economic divide where gains accrue only to a tiny elite.

What often gets overlooked is that wealth has increased across nearly every segment of the population. Homeownership rates, retirement account balances, and participation in equity markets have all expanded over time. Middle- and lower-income households may not capture the same dollar gains as the top 1%, but they have still experienced meaningful improvements in net worth compared to prior generations. The economic pie has grown, even if the slices are uneven.

The danger of the “top 1% got everything” narrative is not that it highlights inequality—that discussion is necessary—but that it implies economic mobility is disappearing and broad-based progress is impossible. History and data suggest otherwise. While outcomes are unequal, opportunity and wealth creation have not been zero-sum.

The world, and the U.S. economy in particular, is getting richer in more places than headlines often suggest. But you have to look beyond simplified talking points and examine the data carefully. The story isn’t one of universal prosperity, nor is it one of total capture by the wealthy. It’s more complex—and more hopeful—than either extreme allows.

Thing Three

Just A Thought  

"If you can't fly then run, if you can't run then walk, if you can't walk then crawl, but whatever you do you have to keep moving forward." - Martin Luther King Jr.