If you are one of the millions of Americans who rely on Medicare, it is time to mark your calendar and check your budget. The Centers for Medicare & Medicaid Services (CMS) recently released the new premiums, deductibles, and coinsurance amounts for 2026. While the core benefits remain strong, the costs associated with your coverage are shifting upward.

Whether you are already enrolled or planning to sign up soon, understanding these changes is vital for avoiding financial surprises in the coming year. Here is a breakdown of the key updates for Medicare Parts A, B, and D in 2026.

 

Part A: Hospital Insurance Costs Are Climbing

Medicare Part A covers inpatient hospital stays, care in skilled nursing facilities, hospice care, and some home health care. For most beneficiaries (about 99%), there is no monthly premium for Part A because they paid Medicare taxes while working. However, the costs when you use these services are increasing.

The 2026 Numbers:

  • Inpatient Hospital Deductible: If you are admitted to the hospital, you will pay a deductible of $1,736 per benefit period. This is an increase of $60 from 2025.
  • Daily Coinsurance:
  • Days 61-90: You will pay $434 per day (up from $419).
  • Lifetime Reserve Days: After day 90, you will pay $868 per day (up from $838).
  • Skilled Nursing Facilities: For days 21 through 100, the daily coinsurance is rising to $217.

What This Means for You:
If you have a planned surgery or anticipate a hospital stay, expect your initial out-of-pocket cost to be higher. The deductible resets for each new benefit period, meaning you could pay this amount more than once in a year if you have multiple unrelated hospitalizations separated by at least 60 days.

Part B: Medical Insurance Premiums on the Rise

Medicare Part B covers doctor visits, outpatient care, medical supplies, and preventive services. Unlike Part A, Part B requires a monthly premium.

The 2026 Numbers:

  • Standard Monthly Premium: The standard premium will be $202.90, an increase of $17.90 from the 2025 rate.
  • Annual Deductible: The annual deductible for Part B is increasing by $26 to $283.

Why the Increase?
According to CMS, the rise in premiums is largely due to projected price changes and expected increases in healthcare utilization. Interestingly, the increase could have been higher. Policy changes regarding spending on “skin substitutes” (often used for wound care) helped curb what would have been an even sharper price hike.

Income-Related Adjustments (IRMAA):
If you have a higher income, you will pay more than the standard premium. These extra charges, known as the Income-Related Monthly Adjustment Amount (IRMAA), affect about 8% of beneficiaries.

  • Individual Filers earning > $109,000: Premiums start at $284.10 and go up to $689.90 per month depending on income bracket.
  • Joint Filers earning > $218,000: The same sliding scale applies.

Part D: Prescription Drug Coverage Adjustments

Medicare Part D helps cover the cost of prescription drugs. While base premiums vary significantly by the private plan you choose, high earners must also pay an extra adjustment on top of their plan premium.

High-Income Earners Pay More:
Just like Part B, Part D has an IRMAA surcharge for high-income beneficiaries.

  • If you file individually and earn over $109,000 (or jointly over $218,000), you will pay an additional monthly amount ranging from $14.50 to $91.00, depending on your income tier.
  • This amount is usually deducted directly from your Social Security check.

Action Steps: How to Prepare for 2026

With costs rising across the board, proactive planning is essential. Here are three steps you can take today:

  1. Review Your Current Coverage: Open enrollment is the best time to review your Part D or Medicare Advantage plan. Make sure your current medications are still on the formulary and that your doctors are still in-network. Sometimes switching plans can offset the premium increases in original Medicare.
  1. Budget for the Part B Hike: If your Part B premium is deducted from your Social Security payment, your net check might look different in 2026. Ensure your monthly budget accounts for the nearly $18 increase in premiums.
  1. Check Your Tax Returns: Because IRMAA surcharges are based on tax returns from two years prior (your 2024 return determines your 2026 rates), review your income. If you have had a life-changing event—like retirement, divorce, or the death of a spouse—that reduced your income significantly, you can file an appeal with Social Security to request a reduction in your IRMAA surcharge.

Healthcare costs are a significant part of retirement planning. By staying informed about these 2026 updates, you can make smarter decisions about your coverage and keep your financial health in check.

 

# ACA Updates 2025-2026: Brace for Higher Costs and Stricter Enrollment Rules

For over a decade, the Affordable Care Act (ACA), often called Obamacare, has been a reliable source of health coverage for millions. However, significant legislative changes are on the horizon for 2025 and 2026 that will alter how you enroll, what you pay, and even who qualifies for financial help.

If you purchase your own health insurance through the Marketplace (Healthcare.gov or your state exchange), the landscape is shifting. Here is a breakdown of the critical updates you need to know to keep your coverage and manage your budget.

The End of “Set It and Forget It”

One of the most convenient features of the ACA Marketplace has been automatic re-enrollment. In the past, if you liked your plan, you could simply do nothing, and the system would renew your coverage for the next year.

The Change:
New legislation effectively ends automatic re-enrollment for many users. Starting with the upcoming enrollment cycles:

  • Manual Action Required: You will likely need to log in, update your application, and actively select a plan every year.
  • Stricter Verification: There are new pre-enrollment verification requirements for receiving premium tax credits. You will need to verify your income, family size, and other eligibility details upfront before subsidies are applied to your monthly bill.

The Risk:
If you assume your plan will auto-renew and you miss the deadline, you could find yourself uninsured for the new year.

Premium Tax Credits Are Expiring

For the last few years, “enhanced” premium tax credits (subsidies) have made ACA plans more affordable than ever, capping premiums at a certain percentage of income and expanding help to middle-income families who previously earned too much to qualify.

The Change:
Unless Congress acts to extend them, these enhanced credits are set to expire at the end of 2025.

The Financial Impact:

  • Higher Premiums in 2026: Without these enhanced credits, many enrollees will see their monthly premiums jump significantly—some estimates suggest an average increase of 75%.
  • Subsidy Cliff Returns: The “subsidy cliff” may return, meaning if you earn just one dollar above the income limit (400% of the federal poverty level), you could lose all financial assistance and be responsible for the full sticker price of your plan.

Shorter Enrollment Windows

Flexibility is also being dialed back regarding when you can sign up.

The Change:

  • Shorter Open Enrollment: The open enrollment period is being shortened by a month. Instead of running through mid-January, the window will now generally close on December 15.
  • Stricter Special Enrollment: If you need to sign up outside of the standard window (due to a life event like marriage or job loss), you may face tougher scrutiny to prove your eligibility before coverage begins. Previously, consumers often had a 90-day grace period to provide documentation; this flexibility is being removed or tightened.

Action Plan: How to Navigate the Changes

The upcoming enrollment seasons will require more attention to detail than in previous years. Here is how to protect yourself:

  1. Mark Your Calendar for November 1: Open enrollment typically begins on November 1. Do not wait until January to think about health insurance, as the deadline will likely be December 15.
  1. Prepare Your Documents Early: Because verification is getting stricter, have your pay stubs, tax returns from the previous year, and identification documents ready before you log in to apply.
  1. Watch Your Mail and Email Closely: The Marketplace will send notices regarding your eligibility. With the end of auto-renewal, these notices are critical reminders. Ignoring them could result in a lapse of coverage.
  1. Shop Around: Even if you manage to keep your current plan, the price might change drastically. With the potential expiration of tax credits, “shopping” the Marketplace to compare premiums and deductibles is the only way to ensure you are getting the best deal for your budget.

The era of passive enrollment is ending. By staying proactive and understanding these new administrative hurdles, you can ensure that you and your family remain covered through 2026 and beyond.

Medicare, key dates are your Initial Enrollment Period (IEP) around turning 65 (7 months starting 3 months before your birthday), the Annual Enrollment Period (AEP) (Oct 15-Dec 7) for plan changes, the Medicare Advantage Open Enrollment (Jan 1-Mar 31) for MA/Drug plan swaps, and receiving your Annual Notice of Change (ANOC) around October 1st to review next year’s benefits. 

Key Enrollment Periods

Important Annual Dates

  • September: Annual Notice of Change (ANOC) and Explanation of Benefits (EOB) mailed.
  • October 1: New plan benefits and costs for the next year are announced, and you can review them.
  • January 1: New plan coverage begins for changes made during AEP or OEP. 

Special Situations

  • Special Enrollment Periods (SEPs): Available if you lose employer coverage or move, allowing enrollment outside standard periods.
  • 5-Star Special Enrollment Period: December 8 – November 30 allows switching to a 5-star MA or Part D plan. 

Action Items for NC Residents

  • Review ANOC: Understand changes in your current plan’s costs, benefits, and drug formulary for the upcoming year.
  • Compare Plans: Use Medicare.gov to compare plans available in your North Carolina county during AEP.
  • Check for 5-Star Plans: See if a 5-star plan is available for a special enrollment period.