The new year brings new Medicare costs for 2026. Here are some of the changes to your coverage.
Medicare Part A changes
Medicare Part A covers your hospital costs, such as: hospital care, skilled nursing facility care, home health care, hospice care, and other services. Most beneficiaries do not pay a premium for Part A if they have 40 quarters of work history. Roughly 1% of beneficiaries pay Part A premiums. Depending on their work history for 2026 they will pay either $311/month or $565/month.
The Part A deductible will increase from $1,632 to $1736. This deductible is the beneficiary’s only cost for up to 60 days of Medicare-covered inpatient hospital services. The 61st to the 90th day has increased from $408 to $434 a day, and beyond the 90th day has increased from $816 to $868 a day. For beneficiaries who have a Medigap Supplement 1 or 1A plan, these costs are covered by that supplemental insurance coverage.
Medicare Part A covers the first 20 days in a skilled nursing facility, after a three-day-qualifying stay in a hospital. The skilled nursing facility coinsurance has increased from $204 to $217 for the 21st to the 100th day.
Medicare Part B changes
Medicare Part B covers your outpatient costs, such as doctors’ services, x-rays and tests, outpatient hospital care, ambulance service, medical supplies, and other medical equipment. When a beneficiary receives covered care they will have an annual deductible which in 2026 will be $283, up from $257. The Part B deductible is annual; once you have incurred $283 of expenses for Medicare-covered services in any year, the Part B deductible does not apply for the rest of the year. You will also be responsible for a 20% co-insurance on Medicare-covered services.
The standard monthly premium for Medicare Part B in 2026 is $202.90, up from $185 in 2025. The cost of this premium is normally taken out of your Social Security direct deposit; however, if you are not collecting Social Security yet, you will receive a premium bill in the mail.
Medicare beneficiaries whose individual income is above $109,000 annually or a couple’s joint income above $218,000 annually will pay an increased amount for their Part B and Part D, called an income-related monthly adjustment amount, also known as “IRMAA.” This affects 7% of people with Medicare. The Federal Government bases the 2026 adjustments on the beneficiaries’ 2024 Federal Income taxes. You may request a new initial determination through Social Security if you believe your IRMAA is incorrect by contacting your local Social Security office. This is especially important if your income has changed after 2024 due to various reasons, for instance, you retire and are no longer working.
Many Medicare beneficiaries purchase additional insurance, including Medicare Supplemental Plans or Medicare Advantage Plans, to cover the gaps of Medicare in order to help reduce out-of-pocket expenses.
Medicare Part D changes
Medicare Part D is private prescription drug coverage offered by stand-alone plans or integrated within a Medicare Advantage plan. Original Medicare does not cover outpatient prescription drugs so beneficiaries will need a Part D plan unless they have creditable coverage from another source such as an employer, or retiree or Veterans coverage. Not enrolling in a Part D plan could lead to life-long penalties.
Costs for plan premiums vary by plan as do costs for medications. However, starting in 2025, the Inflation Reduction Act implemented a $2000 cap on out-of-pocket costs for drugs covered by Part D plans. This will increase to $2100 in 2026. Other changes to Part D benefits include elimination of the donut hole, no costs for recommended vaccines, and copays for covered insulin products are now capped at $35/month. The maximum Part D deductible is $615 in 2026, however, plans can have lower or no deductible.
Help paying for premiums is available.
Medicare Savings Programs (MSPs) help low-income beneficiaries pay for premiums and, depending on the level of coverage, deductibles, coinsurance, and copays.
In Massachusetts MSPs are administered by MassHealth, however, MSPs are not insurance plans. They are programs designed to help lower the costs of your Medicare insurance coverage but do not offer coverage outside of services that Medicare doesn’t provide.
To qualify for these programs, your income must be at or below $2935/month for a single individual or $3966/month for a married couple. The short application asks for your gross monthly income but there is no asset test for the MSP benefits.
There are three levels of MSPs:
The Qualified Medicare Beneficiaries (QMB) level pays for Medicare A premium, Medicare B premium, and cost sharing (paying some of the costs like copays, deductibles, and/or premiums). Your providers cannot bill you for Medicare copays and deductibles if you have the QMB. You may still have copays at the pharmacy.
Specified Low-Income Medicare Beneficiary (SLMB) and Qualifying Individual (QI) levels pay for your Part B Premium.
These programs, previously known as the “Buy-In Program,” automatically enroll a beneficiary in Extra Help, the Part D low‑income subsidy (LIS) which helps pay for the Part D premium and lowers the cost of prescription drugs. Beneficiaries who qualify for MSP will also receive Health Safety Net, which pays acute care hospitals and community health centers for certain services to low-income Massachusetts residents that are not paid by other coverage. To qualify for this benefit patients must have income of 225% Federal Poverty Level or less.
Don’t miss out on significant savings on your Medicare costs. SHINE counselors can check your eligibility and assist you with applying for this program.
LifePath’s SHINE Program provides confidential and unbiased health insurance counseling for Medicare beneficiaries through its highly-trained staff and 45 certified counselors volunteers. This is a free service, though contributions are welcome and will go a long way to help support this vital program. For further assistance with Medicare questions, you may request an appointment with a certified SHINE counselor by contacting the LifePath SHINE Regional Office at 1-800-498-4232 or 413-773-5555, Ext. 1220; or by contacting your local Council on Aging.
