Each year, the Centers for Medicare and Medicaid Services (CMS) updates cost-sharing requirements for the various parts of Medicare. On November 14, 2025, CMS released the updated figures for 2026. Here’s what beneficiaries and agents/brokers need to know.
Medicare Part A cost-sharing increased
99% of Medicare beneficiaries pay no Part A premium, due to them having paid FICA taxes for over 40 quarters. For those who have not met that requirement, they will see moderate increases in their monthly premium payments. See the table below.
| Medicare Part A Premium (per month) |
|
|
|
| |
2025 |
2026 |
|
|
|
|
Enrollees over age 65, contributed to FICA for 40+ quarters
|
$0
|
$0 |
|
|
|
|
Enrollees over age 65, contribute to FICA for 30-39 quarters
|
$285
|
$311 |
|
|
|
|
Enrollees over age 65, contributed to FICA for fewer than 30 quarters
|
$518
|
$565 |
|
|
|
Regardless of what they pay (or not!) in premium, all Part A beneficiaries are subject to cost-sharing for inpatient care – whether it occurs in a hospital or a skilled nursing facility. Cost sharing for Part A is based on benefit periods. The table below details what beneficiaries can expect to pay for each type of service.
| Medicare Part A Deductible and Coinsurance Amounts for Calendar Years 2025 and 2026 by type of cost-sharing |
| |
2025
|
2026 |
|
Inpatient hospital deductible
|
$1,676
|
$1,736 |
|
Daily coinsurance for days 61-90
|
$419
|
$434 |
|
Daily coinsurance for lifetime reserve days
|
$838
|
$868 |
|
Skilled nursing facility coinsurance for days 21-100
|
$209.50
|
$217 |
Increase in Part B premium, Deductible; IRMAA Brackets Adjusted
The base premium for full Part B will increase from $185 per month to $202.90 per month. The change is a result of a projected increase in healthcare spending. The Part B deductible will also increase from $257 to $283.
Since 2007, a beneficiary’s monthly part B premium has depended on income and tax filing status. Income-related monthly adjustment amounts impact about 8% of enrollees. Total premiums for various income brackets and filing statuses are shown in the tables below. Note these brackets have shifted some due to inflationary pressures.
| Full Part B Coverage |
|
Beneficiaries who file individual tax returns with modified adjusted gross income:
|
Beneficiaries who file joint tax returns with modified adjusted gross income:
|
Income-Related Monthly Adjustment Amount
|
Total Monthly Premium Amount
|
|
Less than or equal to $109,000
|
Less than or equal to $218,000
|
$0.00
|
$202.90
|
|
Greater than $109,000 and less than or equal to $137,000
|
Greater than $218,000 and less than or equal to $274,000
|
$81.20
|
$284.10
|
|
Greater than $137,000 and less than or equal to $171,000
|
Greater than $274,000 and less than or equal to $342,000
|
$202.90
|
$405.80
|
|
Greater than $171,000 and less than or equal to $205,000
|
Greater than $342,000 and less than or equal to $410,000
|
$324.60
|
$527.50
|
|
Greater than $205,000 and less than $500,000
|
Greater than $410,000 and less than $750,000
|
$446.30
|
$649.20
|
|
Greater than or equal to $500,000
|
Greater than or equal to $750,000
|
$487.00
|
$689.90
|
| Full Part B Coverage |
|
Beneficiaries who are married and lived with their spouses at any time during the year, but who file separate tax returns from their spouses with modified adjusted gross income:
|
Income-Related Monthly Adjustment Amount
|
Total Monthly Premium Amount
|
|
Less than or equal to $109,000
|
$0.00
|
$202.90
|
|
Greater than $109,000 and less than $391,000
|
$446.30
|
$649.20
|
|
Greater than or equal to $391,000
|
$487.00
|
$689.90
|
Some Medicare beneficiaries who are 36 months post-kidney transplant and are no longer eligible for full Medicare coverage can choose to have Part B cover their immunosuppressive drugs. This coverage comes with a reduced premium, but that premium is still based on income and tax filing status. A variety of income brackets and tax filing statuses are shown below.
| Part B Immunosuppressive Drug Coverage Only |
|
Beneficiaries who file individual tax returns with modified adjusted gross income:
|
Beneficiaries who file joint tax returns with modified adjusted gross income:
|
Income-Related Monthly Adjustment Amount
|
Total Monthly Premium Amount
|
|
Less than or equal to $109,000
|
Less than or equal to $218,000
|
$0.00
|
$121.60
|
|
Greater than $109,000 and less than or equal to $137,000
|
Greater than $218,000 and less than or equal to $274000
|
$81.10
|
$202.70
|
|
Greater than $137,000 and less than or equal to $171,000
|
Greater than $274,000 and less than or equal to $342,000
|
$202.70
|
$324.30
|
|
Greater than $171,000 and less than or equal to $205,000
|
Greater than $342,000 and less than or equal to $410,000
|
$324.30
|
$445.90
|
|
Greater than $205,000 and less than $500,000
|
Greater than $410,000 and less than $750,000
|
$445.90
|
$567.50
|
|
Greater than or equal to $500,000
|
Greater than or equal to $750,000
|
$486.50
|
$608.10
|
| Part B Immunosuppressive Drug Coverage Only |
|
Beneficiaries who are married and lived with their spouses at any time during the year, but who file separate tax returns from their spouses with modified adjusted gross income:
|
Income-Related Monthly Adjustment Amount
|
Total Monthly Premium Amount
|
|
Less than or equal to $109,000
|
$0.00
|
$121.60
|
|
Greater than $109,000 and less than $391,000
|
$445.90
|
$567.50
|
|
Greater than or equal to $391,000
|
$486.50
|
$608.10
|
Part D IRMAA brackets have also changed
While Part D plan premiums are determined by private insurers, high-income earners may also be subject to an income-related monthly adjustment amount. This adjustment is deducted from an enrollee’s Social Security benefit. Figures for a variety of income brackets and tax filing statuses are displayed below.
| Medicare Part D Income-Related Monthly Adjustment Amounts |
|
Beneficiaries who file individual tax returns with modified adjusted gross income:
|
Beneficiaries who file joint tax returns with modified adjusted gross income:
|
Income-related monthly adjustment amount
|
|
Less than or equal to $109,000
|
Less than or equal to $218,000
|
$0.00
|
|
Greater than $109,000 and less than or equal to $137,000
|
Greater than $218,000 and less than or equal to $274,000
|
$14.50
|
|
Greater than $137,000 and less than or equal to $171,000
|
Greater than $274,000 and less than or equal to $342,000
|
$37.50
|
|
Greater than $171,000 and less than or equal to $205,000
|
Greater than $342,000 and less than or equal to $410,000
|
$60.40
|
|
Greater than $205,000 and less than $500,000
|
Greater than $410,000 and less than $750,000
|
$83.30
|
|
Greater than or equal to $500,000
|
Greater than or equal to $750,000
|
$91.00
|
|
Medicare Part D Income-Related Monthly Adjustment Amounts
|
|
Beneficiaries who are married and lived with their spouses at any time during the year, but file separate tax returns from their spouses with modified adjusted gross income:
|
Income-related monthly adjustment amount
|
|
Less than or equal to $109,000
|
$0.00
|
|
Greater than $109,000 and less than $391,000
|
$83.30
|
|
Greater than or equal to $391,000
|
$91.00
|
What it means for beneficiaries
While the price jumped in 2025, the jump is even higher for beneficiaries in 2026. This is particularly difficult to swallow when paired with the disruption to $0 premium plans and the shrinking number of plans paying a Part B giveback. While you can't make the premiums lower for your clients, you can ensure you explore every option available so your clients can make choices that make good sense to them.
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Action Benefits : Nov 11, 2024 9:49:43 AM
Action Benefits