РусскийUpdated November 2025 — 2026 Official Figures
2026 Medicare & Social Security
Complete Reference Numbers
Every official cost, premium, deductible, IRMAA bracket, and Social Security figure for 2026 – sourced directly from CMS and SSA. Updated each November. Free consultation available year-round.
01
Medicare Part A – Hospital Insurance
CMS.gov 2026
Premium – 40+ Quarters
$0 / mo
Free for most people. Requires 40+ quarters (10+ years) of Medicare-taxed work for you or your spouse.
Premium – 30-39 Quarters
$311 / mo
If you or your spouse have 30-39 quarters of Medicare-covered work history.
Premium – Under 30 Quarters
$565 / mo
Fewer than 30 quarters. You must also enroll in Part B to purchase Part A.
Hospital Inpatient Costs Per Benefit Period (2026)
| Duration of Stay | What You Pay | Notes |
|---|---|---|
| Days 1-60 | $1,676 deductible | One deductible per benefit period, then $0 |
| Days 61-90 | $419 / day | Daily coinsurance |
| Days 91-150 (Lifetime Reserve) | $838 / day | 60 lifetime reserve days total – once used, cannot be replaced |
| Beyond 150 days | 100% of all costs | No Part A coverage; Medigap Plan G/N covers days 1-150 |
Skilled Nursing Facility (SNF) Costs Per Benefit Period (2026)
| Duration of Stay | What You Pay | Notes |
|---|---|---|
| Days 1-20 | $0 | Fully covered after a qualifying 3-day inpatient hospital stay |
| Days 21-100 | $209.50 / day | Medigap Plan G and N cover this in full |
| Beyond 100 days | 100% of all costs | No Part A SNF coverage beyond day 100 |
Observation Status Warning: SNF coverage requires a prior inpatient stay of at least 3 consecutive days. Observation status does NOT count even if you sleep in the hospital overnight. Always ask your doctor: “Am I admitted as inpatient or under observation?”
Benefit Period Rule: A new benefit period – and a new $1,676 deductible – begins each time you have been out of hospital and SNF for 60 consecutive days. You could owe this deductible more than once in a single year.
02
Medicare Part B – Medical Insurance
CMS.gov 2026
Standard Monthly Premium
$202.90
For individuals with 2024 MAGI of $109,000 or less; joint filers $218,000 or less.
Annual Deductible
$283
You pay the first $283 of Part B-covered services each calendar year before Medicare pays its share.
Coinsurance After Deductible
20%
Medicare pays 80% of approved amounts. No annual cap under Original Medicare alone.
No out-of-pocket maximum under Original Medicare alone. Without Medigap or Medicare Advantage, your 20% coinsurance is unlimited. A serious illness could cost tens of thousands out of pocket. This is why Medigap Plan G and N are so valuable.
Part B Coverage Summary
| Service | Your Cost (After Deductible) |
|---|---|
| Doctor visits and specialist consultations | 20% coinsurance |
| Outpatient hospital services and surgeries | 20% coinsurance |
| Diagnostic tests, lab work, and X-rays | 20% coinsurance |
| Durable medical equipment (wheelchairs, walkers) | 20% coinsurance |
| Mental health services (outpatient) | 20% coinsurance |
| Ambulance services | 20% coinsurance |
| Annual Wellness Visit | $0 (if provider accepts Medicare assignment) |
| Most USPSTF-recommended preventive screenings | $0 |
| Flu, pneumonia, and COVID-19 vaccines (Part B) | $0 |
Part B does NOT cover: routine dental, routine vision (glasses, contacts), hearing aids or fittings, long-term custodial care, cosmetic procedures, or most care outside the United States.
03
IRMAA – Income-Related Monthly Adjustment Amount
Based on 2024 tax return MAGI
How IRMAA works: If your Modified Adjusted Gross Income (MAGI) from 2 years ago (2024 for 2026 premiums) exceeds the thresholds below, you pay higher Part B and Part D premiums. If your income has dropped due to retirement, divorce, death of a spouse, or other qualifying event, appeal using Form SSA-44.
Married Filing Separately: If you lived with your spouse at any time during the year but filed separate returns, the highest IRMAA surcharge tiers begin at just $109,000 of individual income – one of the most punishing provisions in Medicare’s premium rules.
Part B Premium – Individual Filers (2026)
| 2024 Individual MAGI | Monthly Part B Premium |
|---|---|
| $109,000 or less | $202.90 |
| $109,001 – $137,000 | $284.10 |
| $137,001 – $171,000 | $405.80 |
| $171,001 – $205,000 | $527.50 |
| $205,001 – $500,000 | $649.20 |
| Above $500,000 | $689.90 |
Part B Premium – Joint Filers (2026)
| 2024 Joint MAGI | Monthly Part B Premium |
|---|---|
| $218,000 or less | $202.90 |
| $218,001 – $274,000 | $284.10 |
| $274,001 – $342,000 | $405.80 |
| $342,001 – $410,000 | $527.50 |
| $410,001 – $750,000 | $649.20 |
| Above $750,000 | $689.90 |
Combined Part B + Part D IRMAA (2026)
| Individual MAGI (2024) | Joint MAGI (2024) | Part B Premium | Part D IRMAA / mo | Total B + D surcharge |
|---|---|---|---|---|
| $109,000 or less | $218,000 or less | $202.90 | $0 | $202.90 |
| $109,001 – $137,000 | $218,001 – $274,000 | $284.10 | +$14.50 | $298.60 |
| $137,001 – $171,000 | $274,001 – $342,000 | $405.80 | +$37.50 | $443.30 |
| $171,001 – $205,000 | $342,001 – $410,000 | $527.50 | +$60.40 | $587.90 |
| $205,001 – $500,000 | $410,001 – $750,000 | $649.20 | +$83.30 | $732.50 |
| Above $500,000 | Above $750,000 | $689.90 | +$91.00 | $780.90 |
What Counts as Income for IRMAA (MAGI)
| Income Type | Included in MAGI? |
|---|---|
| Wages, salary, self-employment income | Yes |
| Capital gains (short- and long-term) | Yes |
| Traditional IRA withdrawals and Required Minimum Distributions (RMDs) | Yes |
| Pension and annuity income | Yes |
| Taxable portion of Social Security benefits | Yes |
| Tax-exempt interest (e.g., municipal bonds) | Yes – included in MAGI |
| Roth IRA withdrawals (qualified distributions) | No |
| Reverse mortgage proceeds | No |
| Roth IRA conversions | Yes – full converted amount is income |
| Home sale gains above $250K/$500K exclusion | Yes – can spike IRMAA 2 years later |
How to Appeal IRMAA: If your income dropped due to a qualifying life-changing event (retirement, divorce, death of spouse, loss of income-producing property), submit Form SSA-44 to SSA with documentation. SSA will use a more recent tax year to recalculate. Do not simply pay the surcharge if your income has since decreased.
04
Medicare Part D – Prescription Drug Coverage
Inflation Reduction Act fully in effect 2025-2026
Annual Out-of-Pocket Cap
$2,100
Once you spend $2,100 on covered drugs, you pay $0 for the rest of the year. No cap existed before 2025.
Maximum Deductible
$615
Plans may charge less or waive it. Tier 1-2 generic drugs are often exempt from the deductible.
Insulin Copay Cap
$35 / mo
No Part D plan may charge more than $35 for a one-month supply of any covered insulin.
ACIP Vaccines Under Part D
$0
All ACIP-recommended adult vaccines (Shingrix, RSV, Tdap, etc.) are $0 under Part D.
Part D Three-Phase Structure (2026)
| Phase | When It Applies | What You Pay |
|---|---|---|
| Phase 1: Deductible | Until plan deductible is met (max $615) | Full cost of drugs (Tier 1-2 often exempt) |
| Phase 2: Initial Coverage | After deductible until $2,100 out-of-pocket | Copays or coinsurance per plan’s drug tiers |
| Phase 3: Catastrophic | After $2,100 in out-of-pocket spending | $0 for all covered Part D drugs |
Drug Tier Structure
| Tier | Drug Type | Typical Copay Range |
|---|---|---|
| Tier 1 | Preferred generic drugs | $0 – $5 |
| Tier 2 | Generic drugs | $5 – $15 |
| Tier 3 | Preferred brand-name drugs | $35 – $50 |
| Tier 4 | Non-preferred brand-name drugs | $60 – $100+ |
| Tier 5 | Specialty drugs | Coinsurance up to $2,100 OOP cap/year |
Late Enrollment Penalty – Permanent: Skip Part D when first eligible without creditable drug coverage, and you owe 1% of the national base beneficiary premium per month without coverage – permanently added to your premium for life. Even if you take no medications, enroll in a basic plan. Plans start at just a few dollars per month.
Medicare Prescription Payment Plan (2025+): You can now spread Part D out-of-pocket costs across equal monthly payments throughout the year rather than paying large lump sums at the pharmacy. Contact your Part D plan to opt in.
05
Medicare Advantage (Part C)
CMS-mandated limits 2026
OOP Maximum – In-Network
$9,250
CMS maximum for in-network services. Many plans set a lower limit. Once hit, plan pays 100%.
OOP Maximum – Combined
$13,900
CMS maximum for combined in-network + out-of-network (applies to PPO plans).
Typical Monthly Premium
$0 – $50+
Many plans charge $0. You still pay Part B ($202.90). Some plans offer a Part B premium rebate.
2026 Warning – Leaner Benefits: Many Medicare Advantage plans reduced dental, vision, hearing, and OTC allowances for 2026. Industry projections suggest plans may add ~$23/month premium in 2027, and many plans may exit the market. Review your Annual Notice of Change every September.
Medicare Advantage Plan Types
| Plan Type | Network Rule | Referrals? | Best For |
|---|---|---|---|
| HMO | In-network only (emergencies excepted) | Yes | Lowest premium; concentrated local care |
| PPO | Lower cost in-network; higher cost out-of-network | No | More flexibility; some travel |
| D-SNP | For dual Medicare-Medicaid enrollees | Varies | Limited income; often $0 premium and $0 OOP |
| C-SNP | For specific chronic conditions | Varies | Diabetes, heart failure, ESRD management |
06
Medicare Supplement (Medigap) Plans
Federally standardized – same benefits regardless of insurer
2026 Rate Alert: Medicare Supplement premiums are increasing significantly – many carriers raising rates 10-20%+. Part of this is driven by healthy beneficiaries moving to Medicare Advantage. If your premium has risen and you are in good health, you may be able to switch to a lower-cost carrier with identical coverage. Call us to compare rates.
Typical Monthly Premium Range
$100 – $400+
Varies by plan letter, age, gender, ZIP code, and tobacco use. Plan G and N most popular for new enrollees.
Part A Deductible (Plans G & N cover)
$1,676
Both Plan G and N cover the full Part A deductible per benefit period.
SNF Coinsurance (Plans G & N cover)
$209.50/day
Plans G and N cover days 21-100 in full – $209.50/day otherwise left to you.
Plan G vs. Plan N – Side by Side (2026)
| Benefit | Plan G | Plan N |
|---|---|---|
| Part A deductible ($1,676 per benefit period) | Covered 100% | Covered 100% |
| Part A coinsurance – hospital days 61-90 ($419/day) | Covered 100% | Covered 100% |
| Part A lifetime reserve days 91-150 ($838/day) | Covered 100% | Covered 100% |
| SNF coinsurance days 21-100 ($209.50/day) | Covered 100% | Covered 100% |
| Hospice care coinsurance | Covered 100% | Covered 100% |
| First 3 pints of blood | Covered 100% | Covered 100% |
| Foreign travel emergency (80%, up to plan limits) | Covered | Covered |
| Part B annual deductible ($283) | Not covered | Not covered |
| Part B coinsurance (20% after deductible) | Covered 100% | Covered 100%* |
| Part B excess charges | Covered 100% | NOT covered |
*Plan N pays 100% of Part B coinsurance except for up to $20 copay for office visits and up to $50 copay for ER visits that do not result in inpatient admission. Plans C and F not available to those eligible for Medicare on or after January 1, 2020.
Medigap Guaranteed Issue Rights
| Situation | States / Rule | What It Means |
|---|---|---|
| Medigap Open Enrollment Period | All states | 6 months starting when you have Part B at 65 – guaranteed issue, no health questions, one-time right |
| Year-round guaranteed issue | NY, MA, CT | Can enroll any time with guaranteed acceptance |
| Birthday rule states | CA, OR, ID, IL, LA, MO, NV | Can switch plans around your birthday without underwriting |
| Prior authorization pilot (6-year CMS trial) | AZ, NJ, OH, OK, TX, WA | Medigap holders may need prior approval for 13 targeted procedures – AI-assisted review |
07
Medicare Enrollment Periods
All Medicare Enrollment Periods at a Glance
| Period | When | What You Can Do | Miss It and… |
|---|---|---|---|
| Initial Enrollment Period (IEP) | 7 months around 65th birthday (3 before, birthday month, 3 after) | Enroll in Parts A, B, D; Medigap with guaranteed issue | Late enrollment penalties + coverage delays |
| Annual Election Period (AEP) | Oct 15 – Dec 7 (changes effective Jan 1) | Switch MA plans; switch between MA and Original Medicare; change Part D plan | Stuck in current plan for the year |
| MA Open Enrollment (MA OEP) | Jan 1 – Mar 31 (changes effective 1st of following month) | Switch MA plans; return to Original Medicare – one time only | Must wait for next AEP |
| Medigap Open Enrollment | 6 months starting month you have Part B at age 65 | Any Medigap plan – guaranteed acceptance, no health questions | Medical underwriting; possible denial |
| General Enrollment Period (GEP) | Jan 1 – Mar 31; coverage begins July 1 | Late Part A/B enrollment for those who missed IEP | Months without coverage + permanent late penalties |
| Special Enrollment Period (SEP) | Triggered by qualifying life event | Part B: 8 months from job loss / Part D: 63 days from losing drug coverage | Must use GEP; penalties apply |
Late Enrollment Penalties
| Part | Penalty Formula | Duration |
|---|---|---|
| Part B | 10% of Part B premium for each full 12-month period without coverage | Permanent – for life |
| Part D | 1% of national base beneficiary premium per month without creditable coverage | Permanent – for life |
| Part A (if you pay a premium) | 10% of Part A premium for twice the number of years delayed | Permanent – for life |
Working past 65? You can delay Medicare without penalty only with active employer-sponsored group coverage from a company with 20+ employees. COBRA, retiree coverage, Marketplace plans, and coverage through employers with fewer than 20 employees do NOT qualify as creditable coverage for delay purposes.
09
Important 2026 Policy Updates
Confirmed changes vs. proposed changes
Most news coverage of Medicare and Social Security involves proposed changes, not enacted law. The updates below reflect confirmed policy as of 2026. Always verify with a licensed broker before adjusting coverage or financial plans based on news reports.
Social Security is Still Taxable – No Change in Law
No law has passed to eliminate federal taxation of SS benefits. The proposed “Big Beautiful Bill” does not include full SS tax elimination. It proposes a $6,000 exemption for individuals age 65+ with income under $75,000 (doubled for couples), but this is temporary (3 years) and not yet finalized law. Plan assuming SS benefits remain taxable at current thresholds.
SSA Overpayment Recovery – Reinstated at 50%
SSA reinstated its policy to withhold 50% of monthly benefits (not 100%) to recover overpaid amounts. SSA can also intercept your federal tax refund. If your spouse receives benefits based on your record, your spouse’s payments are also affected until the debt is repaid.
Applying for Medicare – Phone Applications Still Available
Enhanced identity verification for SS benefit applications only if you cannot use ssa.gov AND cannot pass identity questions by phone. If applying only for Medicare, call 800-772-1213 – phone applications are still accepted. You are not required to visit a local SSA office unless flagged for fraud. Apply early – processing times are longer due to staffing transitions.
WEP/GPO Retroactive Payments – Most People Are Not Eligible
Some beneficiaries affected by WEP/GPO are receiving retroactive payments. Most people are not eligible. Any email, text, or call offering to help you “claim your check” is almost certainly a scam. Check ssa.gov directly.
Prior Authorization Pilot for Medigap Holders – 6 States
A 6-year CMS pilot program requires prior authorization for certain services for Medigap holders in AZ, NJ, OH, OK, TX, and WA. Only 13 specific procedures are targeted. An AI-assisted review process makes approval decisions. Care could be delayed or denied – request prior authorization proactively before scheduled procedures.
Weight-Loss Drugs – Not Covered for Weight Loss Alone
Medicare will not cover anti-obesity medications (Wegovy, Zepbound, etc.) solely for weight loss. Coverage available only when prescribed for Type 2 diabetes, cardiovascular risk, or obstructive sleep apnea. Even when Medicare allows the drug category, your Part D plan is not required to include it – always check your formulary.
Telehealth Extended Through December 31, 2027
Medicare telehealth services – including virtual visits with physicians, mental health providers, and other practitioners – extended through end of 2027. Includes both audio-video and audio-only visits where appropriate.
Medicare Advantage – Slimmer Benefits in 2026, More Changes Ahead in 2027
Many MA plans reduced dental, vision, hearing, and OTC allowances for 2026. Industry projections suggest plans may add ~$23/month premium in 2027, and millions of plan slots may exit the market. Review your Annual Notice of Change every September and compare options during AEP (Oct 15 – Dec 7).
Medicaid – Major Changes Coming January 1, 2027
If enacted, the One Big Beautiful Bill would require twice-per-year Medicaid eligibility recertification. People who cannot navigate the paperwork may lose coverage. Dual-eligible (Medicare + Medicaid) beneficiaries would also be affected. Begin preparing now.
Electronic Payment Requirement for Social Security
All Social Security beneficiaries must receive payments via direct deposit, prepaid debit card, or other approved digital method. Paper checks are being phased out. If you or a family member still receives paper checks, contact SSA to set up direct deposit promptly.
Questions About Your Specific Situation?
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Social Security – 2026 Key Figures
SSA.gov 2026