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Medicare Agents as TPMOs: Compliance and Best Practices for Medicare Agents

As a Medicare agent, you are more than just a licensed professional helping beneficiaries find the right coverage; you are officially recognized by CMS as a Third-Party Marketing Organization (TPMO). Understanding Medicare agents as TPMOs is crucial to protecting your business and staying compliant.

What Is a TPMO

CMS defines a TPMO as any organization or individual compensated to perform lead generation, marketing, or enrollment activities for Medicare Advantage (MA) or Part D plans. That means independent agents and brokers fall under the TPMO umbrella whenever they market or sell these plans.

Why It Matters

The TPMO designation exists to ensure transparency, accountability, and consumer protection. CMS tightened these rules in response to misleading advertisements and beneficiary confusion. As a result, every agent who sells MA or Part D plans must meet strict communication and documentation requirements.

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Key Compliance Requirements

Here are the most important rules every TPMO must follow:

• Mandatory Disclaimer: Every piece of marketing material, website, or verbal outreach must include the approved CMS disclaimer: “We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all your options.”
• Call Recording: Any phone call that discusses MA or Part D benefits; even informational calls must be recorded and securely stored for at least 10 years.
• Scope of Appointment (SOA): Always obtain an SOA before discussing plan details. Electronic and paper SOAs are acceptable but must be saved for recordkeeping.
• Avoid Misleading Language: Never imply government affiliation or say you offer “every plan” unless that is true. Be careful with phrasing on social media, websites, and mailers.

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Best Practices for Sales and Marketing

To remain compliant and build trust with clients:

• Lead with education, not sales. Help beneficiaries understand their options before recommending a plan.
• Use CMS-approved materials. Avoid customizing carrier pieces unless approved for agent use.
• Document everything. Keep records of calls, SOAs, and marketing pieces.
• Stay current on CMS updates. Rules can change annually; follow your FMO and carrier training closely.

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Being classified as a TPMO isn’t just a compliance label; it’s a reminder that agents play a critical role in maintaining Medicare integrity. By following CMS rules, staying transparent, and putting client education first, you protect both your license and your reputation in the Medicare marketplace.

Why Medicare Star Ratings Matter – Understanding Their Importance

When comparing Medicare Advantage or Part D prescription drug plans, you’ll see a “star rating” next to each one. These ratings aren’t just numbers; they reflect the overall quality and performance of a plan. Knowing why Medicare star ratings matter can help beneficiaries make a more confident, informed choice.

What Are Medicare Star Ratings

Each year, the Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (MA) and Part D plans on a 1-to-5-star scale, with 5 stars being excellent and 1 star being poor.

CMS evaluates plans based on key measures such as:

• Preventive care and managing chronic conditions
• Member satisfaction and customer service
• Medication safety and accuracy of drug pricing
• Handling of complaints and appeals

These ratings help beneficiaries compare plan quality; not just costs.

Why Star Ratings Matter to Beneficiaries

1. Quality Over Cost
   A low monthly premium might look appealing, but a lower-rated plan could have poorer customer service or fewer care management programs. Star Ratings help you see the bigger picture.
2. Better Health Outcomes
   High-rated plans generally perform better in preventive care, chronic condition management, and prescription safety leading to improved member health.
3. Special Enrollment Advantage
   If a 5-star plan is available in your area, you can use the 5-Star Special Enrollment Period to switch once a year, even outside regular enrollment periods.

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Why Star Ratings Matter to Carriers

For insurance carriers, these ratings are more than just feedback — they directly affect their business.

• Financial Rewards: CMS provides quality bonus payments to plans with ratings of 4 stars or higher. These bonuses can help carriers enhance benefits, reduce premiums, and remain competitive.
• Reputation and Market Growth: A higher-rated plan attracts more enrollees. Consumers often view Star Ratings as a trusted indicator of quality and satisfaction.
• Compliance and Accountability: Consistently low ratings can lead to penalties or even removal from the Medicare program. This motivates carriers to continuously improve service, communication, and care coordination.

In short, the Star Rating system drives both accountability and quality improvement for carriers and members alike.

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The Bottom Line

Medicare Star Ratings serve an important purpose for everyone involved. They help beneficiaries choose better plans, encourage carriers to maintain high standards, and ensure that Medicare funds support quality care.

When reviewing plans, remember; the stars tell a story about value, performance, and member experience. Taking time to understand them can make an important difference in satisfaction with healthcare coverage.

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Reasons for MA Plan Cuts – What’s going on

Recently, many insurers are pulling back or dropping Medicare Advantage plans in certain counties. Many Medicare advantage carriers are reducing offerings. This is especially true for PPO plans, which tend to be less restrictive for patients, but also costlier/riskier for insurers. Here’s a breakdown of the reasons for MA plan cuts and why some Medicare Advantage (MA) plans are leaving the market, what it means for enrollees, and how to prepare.

Why Some Medicare Advantage Plans Are Leaving the Market

In 2025 and beyond, several major insurers are scaling back or exiting certain Medicare Advantage (MA) markets. Companies like UnitedHealthcare, Humana, and Aetna are discontinuing specific plans or leaving select counties, affecting hundreds of thousands of beneficiaries. So, what’s driving these exits and what does it mean for Medicare enrollees?

Rising Costs and Slower Reimbursements

The main driver behind these exits is financial pressure. Health care costs; doctor visits, hospital stays, and prescription drugs continue to rise. Meanwhile, the Centers for Medicare & Medicaid Services (CMS) has limited how much funding increases for MA plans each year.

When reimbursement rates don’t keep pace with actual medical spending, insurers are forced to make tough decisions. Some reduce coverage areas; others leave markets entirely. The challenge is even greater in rural counties, where fewer enrollees mean higher per-member costs and less opportunity to spread financial risk.

Increased Regulation and Administrative Burdens

Medicare Advantage plans are subject to strict federal oversight. CMS star ratings, which measure quality and satisfaction, directly affect plan payments and bonuses. Plans with low ratings can face penalties or reduced funding.

New rules around prior authorization, marketing practices, and network adequacy have also added administrative costs. While these policies aim to protect consumers, they make operating certain plans more expensive and complex; especially for smaller carriers.

Shrinking Margins and Risky Plan Types

Preferred Provider Organization (PPO) plans, which allow greater provider flexibility, are especially expensive for insurers to run. In response, many companies are narrowing their focus to Health Maintenance Organization (HMO) plans with tighter networks and lower costs.

However, even with these adjustments, many insurers report that the combination of higher utilization, slower reimbursements, and increased regulation has made some plans unsustainable. As a result, certain counties are seeing fewer plan options for 2026.

Cutting Back on Benefits

To stay competitive and manage costs, insurers are also reducing extra benefits that have become popular selling points for Medicare Advantage plans.

Perks such as dental, vision, hearing, over-the-counter allowances, and fitness memberships are being scaled back or dropped altogether. Some plans have increased copays for specialists, raised out-of-pocket maximums, or restricted drug formularies.

While these changes help insurers control spending, they can leave beneficiaries with fewer incentives to stay on a plan—prompting more people to explore other options like Original Medicare with a Medigap supplement.

What This Means for Beneficiaries

If your Medicare Advantage plan is ending or changing benefits, you’ll receive an Annual Notice of Change (ANOC) this fall. It’s important to read this document carefully. You may find that your premiums, networks, or covered benefits are changing even if your plan remains available.

Here’s what to watch for:

• Fewer local plan options—especially in smaller or rural markets.
• Higher out-of-pocket costs due to benefit reductions or network changes.
• Provider access changes as plans narrow their networks.
• Reduced extra benefits, such as dental, vision, and wellness perks.

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If your plan is leaving your area entirely, you’ll qualify for a Special Enrollment Period (SEP) to choose a new plan or return to Original Medicare.

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What You Can Do

1. Review your ANOC early to understand all upcoming changes.
2. Compare new plans on Medicare.gov or with a licensed agent to see what’s available in your ZIP code.
3. Look beyond the premium. Consider total out-of-pocket costs, copays, and your provider network.
4. Verify your prescriptions. Ensure your medications are still covered under the plan’s formulary.
5. Explore Medigap and Part D options if you want more stability or broader provider access.

The Bottom Line

Medicare Advantage remains a strong and growing program, but rising costs and tighter reimbursement rules are forcing insurers to reassess their participation. Many are choosing to leave certain counties or reduce extra benefits to stay financially viable.

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For beneficiaries, staying informed is key. Review your plan each year, compare options carefully, and don’t assume your current benefits will stay the same. A little preparation can help avoid surprises and ensure you continue to get the coverage and care you need.

Medicare Sales Compliance Rules – What Not to Say During a Medicare Sale

When you with meet with Medicare beneficiaries, the words you choose matter. CMS has strict marketing guidelines, and violating them can lead to serious issues, this includes fines or even loss of contracts. To protect your clients and your business; we will go over some Medicare Sales Compliance Rules regarding things Medicare agents cannot say or do during a sales appointment.

“We offer every Medicare plan available”

This statement is misleading. Not all plans contract with independent agents, and no agent can truly offer every plan. You may represent several excellent plans, but accuracy is essential. Always choose wording carefully on printed materials and in conversations.

Remember: CMS requires TPMOs (Third-Party Marketing Organizations) to include a disclaimer on all marketing materials, communications, and even phone calls with prospective clients.

“This plan is free”

CMS marketing guidelines prohibit agents from using the word free to describe any plan.

• A $0 premium does not mean the plan has no costs.
• Enrollees are still responsible for deductibles, co-pays, and coinsurance.
• Network restrictions often apply.

The word free is misleading and should never be used when describing Medicare plans, premiums, deductibles, or cost-sharing.

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“This plan covers everything you need”

There is no Medicare plan that covers all of someone’s health needs. The agent’s role is to help clients compare options and choose what best fits their personal situation. Present the pros and cons, but never promise that a plan will meet 100% of their needs.

“This is the best plan”

Superlatives like “best” are not allowed unless supported by verifiable, CMS-approved data. What’s best for one client may not be best for another. Always focus on what meets that client’s needs, not a blanket claim.

“Medicare approves this plan’s benefits”

You cannot say or imply that Medicare endorses, approves, or recommends a plan. While Medicare Advantage and Part D plans must meet CMS standards, they are offered by private companies; not by Medicare itself.

Talking about non-Medicare products during an SOA

Stick to the Scope of Appointment (SOA). If the SOA only covers Medicare Advantage, you cannot bring up Medigap, Part D, or life insurance. If a client asks about other products, suggest scheduling another appointment.

Asking for friends’ or family contact info

You cannot request phone numbers or addresses of potential referrals. What you can do is hand clients extra business cards so they can share your information with others who may be interested.

Offering gifts or money for enrollment

Agents cannot provide financial incentives or high-value gifts in exchange for signing up. CMS allows small promotional items (worth $15 or less per item, up to $75 per year per person).

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Scare tactics or misinformation

Do not tell clients their current coverage will change just to push a new plan. You may compare benefits factually but avoid scare tactics. Clients must feel educated, not pressured.

Medicare compliance is about accuracy, transparency, and respect. Stick to CMS-approved language, avoid misleading claims, and always tailor your advice to the individual client. Doing so not only keeps you compliant; it builds lasting trust.

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Medicare Part B Costs 2026

Medicare Part B helps cover medically necessary outpatient services, doctor visits, preventive services, medical equipment, and more. Because like many aspects of health care, its costs change annually, We will discuss the Medicare Part B costs 2026. beneficiaries and future enrollees need to know what’s ahead.

Below, we explore the projected premiums, deductibles, income-based surcharges (IRMAA), and strategies for planning.

What’s Covered by Part B & Basic Costs

Before diving into 2026, here’s a quick recap of how Part B costs typically work:

• You pay a monthly premium for Part B (unless you qualify for assistance).
• You also pay a yearly deductible before Medicare pays (for most services).
• After meeting the deductible, Medicare generally covers 80% of approved costs for covered outpatient services; you’re responsible for the remaining 20% coinsurance (unless another plan helps).
• If your income is above certain thresholds, you may pay an extra surcharge (IRMAA).
• Costs can vary based on where you live, your coverage options (like Medigap or Medicare Advantage), and your income.

These rules remain consistent, even as dollar amounts shift over time.

Projected Part B Premium in 2026

According to the Medicare Trustees’ projections and other financial analysts, the standard Part B monthly premium is expected to rise from $185 in 2025 to $206.50 in 2026 an increase of $21.50, or roughly 11.6%.

That jump would be the largest single-year dollar increase in recent years.

It’s crucial to note: this “standard” premium applies to beneficiaries without additional income-based surcharges (i.e. those whose incomes fall under the IRMAA thresholds). Those with higher incomes will pay more.

Expected Part B Deductible in 2026

While the exact deductible for 2026 will not be finalized until closer to year-end 2025, current projections suggest it may rise from $257 in 2025 to $288 in 2026.

That would be a roughly 12% increase in the amount beneficiaries pay out of pocket before Medicare starts covering your outpatient services.

Some Medigap (supplemental) plans cover the deductible; others require you to pay it yourself, so an increase could matter more to those on certain Medigap plans.

Income-Related Monthly Adjustment Amount (IRMAA) for 2026

One of the most significant cost levers in Medicare is the IRMAA surcharge: higher-income beneficiaries pay extra on top of the base premium. Here’s what’s projected for 2026:

• The 2026 IRMAA brackets and surcharge amounts are based on modified adjusted gross income (MAGI) from your 2024 tax return.
• The income thresholds (for moving among surcharge tiers) are expected to be indexed upward (adjusted for inflation) for 2026.
• The average surcharge increases for Part B are projected to be modest; around 1.04%.

Because of IRMAA, two people in the same city with different incomes might pay very different Part B amounts.

Why Are Costs Rising

Several forces contribute to rising Medicare Part B costs:

1. Medical inflation and utilization – Outpatient services, physician-administered drugs, diagnostics, and usage of health services often rise faster than general inflation.
2. Aging population / higher demand – As more retirees enter Medicare and health care needs grow, the burden on the system increases.
3. Cost shifting – Higher-income beneficiaries absorb more of the cost via IRMAA, but base premiums still have to cover a portion of system-wide costs.
4. Policy adjustments & fund dynamics – Adjustments to how much premiums are allowed to cover, budget pressures, and funding decisions all play a role.
5. Legislative changes – New laws affecting drug pricing, Medicare rules, and benefit design indirectly affect Part B costs over time.

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What It Means for Beneficiaries

• Budget impact: That extra $21.50 per month may absorb a significant chunk of any Social Security cost-of-living adjustment (COLA). Indeed, projections show much of retirees’ COLA gains may be eaten by higher health costs.
• Planning ahead: If your income is near an IRMAA threshold, small changes (e.g. capital gains, extra work income, withdrawals) could push you into a higher bracket.
• Review your coverage: Supplemental (Medigap) or Medicare Advantage plans may mitigate some out-of-pocket costs. If your Medigap plan covers the Part B deductible, the increase matters more.
• Appeal or exemption: If your income decreases substantially due to life events (e.g. retirement, widowhood), you may be able to appeal IRMAA adjustments.
• Stay informed: Final Medicare pricing is announced in late 2025. Propose your budget accordingly but expect adjustments.

Tips to Manage the Cost Increase

1. Estimate your 2024 MAGI now — knowing whether you might cross an IRMAA threshold will help with tax planning or withdrawals.
2. Delay or stagger income where possible — if legally and financially feasible, deferring income from 2024 may help you stay lower in the IRMAA tiers.
3. Choose the right supplemental plan — some Medigap policies cover the Part B deductible or reduce your coinsurance burden.
4. Stay within the initial enrollment windows — avoid late enrollment penalties, which add to cost burdens.
5. Appeal IRMAA where applicable — if you experience life-changing events, you may qualify for exceptions.
6. Watch your investments and gains — high capital gains or distributions in 2024 could unexpectedly push your MAGI upward.

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Bottom Line

Based on current projections:

• The standard Part B premium in 2026 may reach $206.50 per month, up from $185 in 2025.
• The deductible is expected to rise to about $288.
• Income-based surcharges (IRMAA) may add considerably more for higher earners.
• The increase is sizable and could erode a portion of any Social Security increase.
• Planning ahead; particularly regarding your 2024 income, can help reduce the surprise.

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Which Vaccines Does Medicare Cover

Vaccinations are an important part of preventive healthcare, especially for older adults who may be at higher risk of serious illness. Fortunately, Medicare provides coverage for many common vaccines, but which vaccines does Medicare cover? Additionally, knowing which part of Medicare covers what can help beneficiaries avoid surprise costs.

Vaccines Covered by Medicare Part B

Medicare Part B covers certain vaccines that are considered medically necessary for disease prevention. These include:

• Flu shot (Influenza vaccine): Covered once per flu season, and sometimes more if medically necessary.
• Pneumococcal vaccine: Helps prevent pneumonia and other infections. Medicare covers two different pneumococcal shots at no cost when given at least one year apart.
• Hepatitis B vaccine: Covered for beneficiaries at medium or high risk (such as those with diabetes, liver disease, or certain occupational exposures).
• Vaccines needed due to injury or exposure: For example, if you’re exposed to rabies or step on a rusty nail and need a tetanus shot, Medicare Part B covers it.

There’s no deductible or copayment for these vaccines if you receive them from a provider who accepts Medicare assignment.

Vaccines Covered by Medicare Part D

Medicare Part D (prescription drug coverage) handles most other commercially available vaccines that are not covered by Part B. This includes:

• Shingles (Herpes Zoster) vaccine
• Tetanus, Diphtheria, and Pertussis (Tdap) vaccine when not related to an injury
• RSV (Respiratory Syncytial Virus) vaccine for older adults
• Travel vaccines, such as those for hepatitis A or typhoid, depending on your plan

Part D plans must cover all vaccines recommended by the Centers for Disease Control and Prevention (CDC) that aren’t already covered by Part B. Since 2023, beneficiaries pay no out-of-pocket costs for these recommended vaccines under Part D.

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Why Staying Up to Date Matters

Getting the right vaccines can help prevent hospitalizations and serious illness. With Medicare’s expanded coverage, beneficiaries can stay current on vaccinations at little to no cost. It’s always best to check with your provider or Part D plan to confirm coverage before receiving any vaccine

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Medicare makes it easier than ever to stay protected. Part B covers flu, pneumonia, Hepatitis B (for those at risk), and vaccines needed due to injury, while Part D covers all other recommended vaccines; often at no cost.

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Common Medicare Beneficiary Mistakes

Medicare can be confusing, especially with its many rules and enrollment periods. Unfortunately, even small mistakes can lead to coverage gaps or lifetime penalties. Here are some of the most common Medicare beneficiary mistakes and missteps to avoid.

Missing Your Initial Enrollment Period

Your Initial Enrollment Period (IEP) is your first chance to enroll in Medicare. It starts three months before your 65th birthday, includes your birthday month, and ends three months after. Waiting too long to sign up can delay your coverage and lead to permanent late enrollment penalties — especially if you don’t have other creditable insurance.

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Assuming COBRA or Retiree Coverage Lets You Delay Medicare

If you have COBRA or retiree insurance, don’t assume it allows you to postpone Medicare. COBRA is not creditable coverage for delaying Part B or Part D. Failing to enroll when first eligible can leave you uninsured and subject to lifetime penalties once you do sign up.

Not Enrolling While Working for a Small Employer

If you’re still working and your company has 20 or fewer employees, Medicare becomes your primary insurance, not your employer plan. Failing to enroll in Medicare on time could mean denied claims and unexpected bills.

Ignoring the Need for a Part D Drug Plan

Even if you don’t take prescriptions, you should enroll in a Part D plan when first eligible. Without it, you’ll face a permanent late enrollment penalty once you do sign up, and you’ll have to wait until the next enrollment period for your coverage to start. Many beneficiaries choose an inexpensive plan simply to avoid future penalties.

Confusing Medigap Enrollment Rules

Unlike Medicare Advantage or Part D, Medigap doesn’t have an annual election period. Your one-time Medigap Open Enrollment Period begins when you enroll in Part B. During these six months, you can get a Medigap plan with no health questions — miss it, and medical underwriting could apply later.

Paying the Part B Deductible Too Soon

Some providers mistakenly request the Part B deductible before Medicare processes your claim. Always wait until Medicare applies the deductible to the correct bill to avoid confusion or overpayment.

Bottom Line

Understanding Medicare’s timelines and coverage rules can save you from penalties, gaps and unnecessary stress. Taking the time to review coverage options and asking your agent questions before you enroll helps you get the most out of your benefits.

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Social Security COLA 2026: What to Expect

Each year, Social Security adjusts benefits through a Cost-of-Living Adjustment (COLA) to help offset the impact of inflation. The COLA is tied to the Consumer Price Index for Urban Wage Earners and Clerical Workers (CPI-W). It compares inflation from July through September of one year to the same period in the previous year. The official announcement for the Social Security COLA 2026 is usually released in October 2025.

2026 COLA Projections

The Senior Citizens League and other analysts are projecting a 2.7% COLA for 2026. That’s a slight bump compared to 2025’s 2.5% increase and marks the fifth consecutive year with an adjustment above 2.5%.

For the average Social Security retirement benefit of about $2,007 per month, a 2.7% increase means an extra $54 per month, or roughly $648 per year. For someone receiving $1,500 monthly, the raise would be closer to $40 per month.

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Medicare Premiums Could Offset Gains

While a COLA increase is welcome, retirees must also consider rising healthcare costs. WE expect to see an 11.6% rise in Medicare Part B premiums in 2026, jumping from $185 in 2025 to around $206.50 per month.

That increase could significantly cut into the COLA. For many retirees, instead of seeing the full $54 monthly boost, the actual net gain may be closer to $30–$40, depending on their income level and Medicare plan choices.

Why It Matters

A 2.7% COLA may help, but it doesn’t always reflect the real inflation retirees face. Seniors often spend a larger share of their budget on housing, utilities, and especially healthcare; areas where costs are rising faster than the CPI-W measures.

Preparing for 2026

• Budget carefully. Plan for only a modest increase after Medicare deductions.
• Review Medicare options. Choosing the right plan can help you preserve more of your COLA.
• Consider supplemental income. Investments, part-time work, or savings can provide an additional buffer against rising costs.

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Bottom Line

The 2026 Social Security COLA will provide a modest increase, but higher Medicare premiums will likely reduce the real benefit retirees see in their checks. By planning ahead and managing healthcare costs, beneficiaries can make the most of the adjustment.

2026 Medicare IRMAA Amounts 2026: What Beneficiaries Should Expect

If beneficiary income is above certain thresholds, they’ll pay more for Medicare Part B and Part D through an IRMAA; the Income-Related Monthly Adjustment Amount. Because IRMAA is based on your tax return from two years earlier, 2024 income will determine what you owe in 2026. It is important to understand Medicare IRMAA amounts 2026 to budget for the year.

What Is IRMAA

IRMAA adds a surcharge to your Part B and Part D premiums if your Modified Adjusted Gross Income (MAGI) exceeds the set limits. For Part B, it’s usually withheld from Social Security; for Part D, it’s billed directly. If your income has recently dropped due to retirement, marriage, divorce, or another life-changing event, you can request a reconsideration using SSA Form 44.

Projected 2026 Costs

The standard Part B premium is projected to rise to $206.50/month in 2026, up from $185 in 2025. Even those who don’t pay IRMAA will see higher costs.

For higher-income beneficiaries, surcharges are added in brackets. Here are projected 2026 totals for Part B:

• Income of up to $109,000 (single) / $218,000 (married): pay $206.50 (the standard monthly rate)
• Income levels from $109k–$137k (single)/ $218k–$274k (married): pay $289 for Part B
• Those with income levels $137k–$171k (single)/ $274k–$342k (married): pay $413 for Part B
• Income levels of $171k–$205k (single) / $342k–$410k (married): pay $537
• Beneficiaries who make $205k–$500k (single) / $410k–$750k (married): will pay $661
• Those with income levels over $500k (single) / $750k (married): must pay $702

Part D IRMAA surcharges will also rise, from about $14.50/month in the first bracket up to $91/month for the highest incomes. CMS adds these amounts to the beneficiaries plan premium.

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What This Means for Beneficiaries

• Premiums are climbing, as they do most years. Even without IRMAA, 2026 Medicare costs are higher.
• IRMAA is a “cliff.” Going just $1 over a threshold bumps you into a higher bracket.
• Tax planning matters. Roth conversions, investment sales, and IRA withdrawals can all affect your MAGI.
• Life changes can help reduce an IRMAA. If income drops, beneficiaries may appeal to reduce or eliminate an IRMAA.

Planning Ahead

• Review 2024 tax returns to gauge your 2026 bracket.
• Be aware of income timing; shifting taxable money can prevent reaching income thresholds.
• Keep documentation ready if you need proof for a reconsideration.
• Stay updated on Medicare’s official income release in late 2025 for confirmation of final numbers.

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The projected 2026 IRMAA increases could mean significantly higher Medicare costs for high-income beneficiaries. By planning around your 2024 income now, beneficiaries may avoid unnecessary surcharges and keep more of their retirement income.

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2026 Medicare Part B Costs: What to Expect

Medicare beneficiaries should prepare for higher Medicare Part B costs in 2026. Medicare Part B covers outpatient care such as doctor visits, lab work, preventive screenings, and durable medical equipment. While the official 2026 numbers will be officially released later in 2025, projections show some of the steepest increases in recent years for 2026 Medicare Part B costs.

Projected Premium & Deductible

• The 2025 standard Part B premium is $185/month. Estimates suggest it could rise to about $206.50/month in 2026; an increase of more than 11%.
• The Part B deductible, currently $257, may increase to around $288. After meeting the deductible, beneficiaries generally pay 20% of Medicare-approved amounts for most services.

Income-Related Surcharges (IRMAA)

Higher-income beneficiaries pay more through the Income-Related Monthly Adjustment Amount (IRMAA). These surcharges are based on tax returns from two years prior (2024 income for 2026 premiums). Depending on income, premiums could rise from the base $206.50 up to more than $700 per month. Beneficiaries experiencing major life changes such as retirement can appeal their IRMAA through Social Security.

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Why Costs Are Rising

Several factors drive these increases:

• Rising healthcare costs and higher use of outpatient services
• The aging U.S. population requiring more care
• Inflation adjustments to both premiums and income brackets

Preparing for 2026

• Budget ahead using the projected $206.50 premium and higher deductible.
• Consider supplemental coverage. Medigap policies and Medicare Advantage plans may reduce out-of-pocket costs.
• Manage income carefully. Since IRMAA is tied to taxable income, strategies such as Roth conversions or adjusting withdrawals may help avoid higher surcharges.
• Stay informed. CMS will announce final 2026 premiums and deductibles in late 2025, so review your plan options during Medicare’s open enrollment period.

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Final Thoughts

If these projections hold, 2026 Medicare Part B costs will rise significantly, with some retirees seeing most of their Social Security COLA consumed by the higher premium. The good news is that planning now; whether through financial adjustments or reviewing Medicare coverage, can help soften the impact.

Why Offer Assurity Life Products

When it comes to building a sustainable book of business, choosing the right carriers and product lines can make all the difference. Assurity Life Insurance Company has established itself as a trusted name in the industry, offering a wide range of products designed to meet clients’ needs while also supporting agents with tools for success. We will explain why offer Assurity life products.

A Diverse Product Line

Assurity offers an array of products that go beyond traditional life insurance. From term and whole life insurance to critical illness, disability income, and accidental death coverage, agents have multiple solutions to offer clients at every stage of life. This diversity not only makes it easier to meet client needs but also provides opportunities for cross-selling and deeper client relationships.

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Competitive Pricing and Flexibility

Assurity is known for affordable premiums and customizable options that fit a wide range of budgets. Flexible underwriting guidelines and product designs mean more clients can qualify for coverage, making it easier for agents to close sales and retain satisfied policyholders.

Strong Reputation and Financial Stability

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Agent-Friendly Technology and Support

Assurity provides streamlined e-applications, online quoting tools, and marketing resources that help agents work smarter, not harder. Their agent portal makes it easy to manage applications, track business, and access sales materials. This level of support can reduce time spent on paperwork and increase time spent with clients.

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Opportunities for Growth and Retention

By offering products like critical illness or disability income insurance (often overlooked by other agents), you can stand out from competitors. These coverage solutions can open doors to new clients and provide long-term growth opportunities for your business.

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These products not only bring in additional commission but also increase client loyalty. When clients know you can handle multiple needs, they’re far less likely to shop with another agent.

Preparing for AEP 2026: Boost Your Sales, Retain Clients, and Grow Your Book

The 2026 Annual Enrollment Period (AEP) isn’t just another enrollment season; it’s a golden opportunity to build stronger client relationships and grow your business. With more non–commissionable Prescription Drug Plans (PDPs) and Medicare Advantage (MA) plans in the market, preparing for AEP 2026 is more difficult than ever.

Here’s how you can maximize earnings, protect your clients, and position yourself as the go-to Medicare resource this AEP.

Turn Non-Commissionable Plans Into Revenue Opportunities

Yes, some PDPs and MA plans won’t pay you. But don’t let that stop you from helping your clients:

• Be the expert they trust. Walk them through all available options; even the ones you don’t get paid for. This honesty builds loyalty and keeps them coming back every year.
• Leverage the conversation. Once you’ve solved their drug plan or MA needs, introduce other solutions that can better protect them and generate income for you.
• Think lifetime value, not one commission. The client you help today (even for free) could be the one who buys a Medigap plan, final expense policy, or ancillary product tomorrow.

Promote Medicare Supplements

Medicare Supplements are a powerful tool for agents looking to grow their book with long-term, commissionable business.

• High Deductible Plan G (HDG): Sell the benefits of lower premiums, network freedom, and great cost protection once the deductible is met. Perfect for healthy, budget-conscious clients.
• Plan G or Plan N: Offer predictable out-of-pocket costs and peace of mind. Great for clients leaving MA plans or worried about networks shrinking.
• Target switching opportunities: Use the Medigap Open Enrollment period, guaranteed issue rights, and birthday rules where available to win new clients.

Cross-Sell Ancillary Products to Increase Income

Every client interaction is a chance to protect more of their health and finances. Cross-selling not only grows your revenue; it keeps competitors out of your book.

Products to focus on this AEP:

• Hospital Indemnity Plans – Cover MA plan hospital copays and reduce client financial stress.
• Cancer, Heart & Stroke Policies – Offer lump-sum protection for serious illness expenses.
• Dental, Vision & Hearing Plans – Fill in coverage gaps Original Medicare doesn’t touch.
• Final Expense Life Insurance – Help clients plan for end-of-life costs and leave a legacy.

Watch a YouTube video – Why and how to sell ancillary with Medicare in 5 minutes

Strengthen Client Retention with Education

AEP isn’t just about selling — it’s about proving you’re the trusted Medicare expert year-round.

• Send an AEP prep email or postcard to let clients know you’ll review their coverage.
• Host a quick webinar or local seminar on “What’s New for 2026.”
• Offer annual policy reviews to make sure they’re always in the best plan for their situation.

Education keeps your name top of mind and positions you as the advisor they call before making a move.

The agents who win this AEP will be those who combine client-first service with smart product recommendations. Help with the non-commissionable PDPs and MA plans, but don’t stop there; present Medigap, HDG, and ancillary products that protect your clients’ health and finances while boosting your bottom line.

If you are ready to join the team at Crowe; click here for online contracting.

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Your clients get better coverage, you get stronger renewals, and your book of business grows. That’s a win-win AEP strategy.