Mark Cuban’s Medicare Alert for Retirees Before Enrollment Ends

Medicare open enrollment is underway, giving beneficiaries a chance to review and adjust their coverage until Dec. 7.

As seniors weigh options that could improve benefits and ease costs, Mark Cuban is urging them to pay attention to a warning he says matters for everyone on Medicare.

Transparency gaps can drive up Medicare prices

When comparing Medicare plans, it is easy to run into frustration over unclear pricing. Cuban says that reaction makes sense. In his view, health care remains expensive in part because insurers and hospitals operate under confidential pricing agreements, leaving hospitals without a clear picture of what their own services actually cost.

Speaking on a recent KFF podcast, Cuban said, “The fundamental issue is transparency and trust … [and] there are a lot of hospitals that don't know their costs. They just know their cash balance.”

He contrasted that with other industries, where companies generally have better access to product-level cost data. Because hospitals often do not fully know what individual services cost, Cuban said they rely on accounting methods that spread expenses across many services.

“It's not run like a real business,” he said on the podcast.

Why the fix is hard

Cuban says the solution depends on changing the rules so that contracts involving federal, state, or local agencies must fully disclose their terms and prices. In his view, health insurers and hospitals will not become more transparent unless government officials require public disclosure and enforce it.

He has also called for public release of contracts alongside hospital pricing details, with a penalty of $1 million per day for those that fail to comply.

“The ONLY way you are going to know the carriers and hospitals followed through and adhered to the rules, without gaming them, is by making them publish their contracts,” Cuban wrote on X.

Cuban has criticized Medicare before as well. He has estimated that large insurance companies cost every U.S. family an extra $800 a year because of rising Medicare Advantage expenses and government spending that exceeds what would be needed to fund traditional Medicare.

Steps to pursue better Medicare coverage

Although the broader trends Cuban highlights are beyond the control of any individual retiree, there are still ways to reduce Medicare expenses and choose coverage more carefully.

With open enrollment in progress, here are several things to review.

Confirm that your doctors and hospitals are still in network

Networks change from year to year, and that can affect whether you can keep seeing the doctors you prefer.

The best place to check is the Medicare Plan Annual Notice of Change, or ANOC, that was mailed in September. It outlines changes in coverage, costs, and other plan details that take effect at the start of the next coverage year.

Review prior authorization rules

Prior authorization requirements vary by plan. Original Medicare generally has fewer such hurdles than Medicare Advantage.

Even among Medicare Advantage plans, the rules can differ a lot, which is one reason it can pay to compare options carefully.

Check your prescriptions against next year’s formulary

A plan’s drug formulary can change from one year to the next. Make sure your medications will still be covered under your plan.

If a drug remains on the list, see whether it has moved to a higher tier, since that can raise your out-of-pocket costs.

Know the annual out-of-pocket limit

If your prescription plan has a deductible, you pay those medication costs yourself until you reach that amount. After that, you typically pay 25% coinsurance until you reach the plan’s out-of-pocket maximum.

That maximum is $2,400, which is $300 higher than the previous year. Knowing the figure can help you budget while comparing drug plans during open enrollment.

Consider whether Original Medicare fits better

Some people may decide that moving from Medicare Advantage to Original Medicare makes more sense. Open enrollment is the time to consider that switch.

Before making the change, though, it is important to understand the consequences.

For instance, if you have been in a Medicare Advantage plan for at least a year and then switch to Original Medicare, you may not have guaranteed-issue rights. That means you could face a higher premium or even be denied coverage.

There are exceptions, such as when a plan leaves your area.

Bottom line

Cuban has repeatedly argued that Medicare is becoming more expensive because of a lack of transparency. Seniors cannot fix that systemwide problem on their own.

Still, there are plenty of ways to lower personal coverage costs and make retirement dollars go further. With open enrollment running through Dec. 7, this is the time to make changes that can reduce bills and improve coverage.

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