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What Medicare Part D Covers: A Clear Guide for Medicare Beneficiaries

Medicare Part D is essential for millions of beneficiaries who rely on prescription medications to manage chronic conditions and maintain their health. Understanding what Medicare Part D covers can help you choose the right plan, avoid unexpected costs, and make the most of your Medicare benefits. This guide breaks down the key features of Part D coverage so you know exactly what to expect.

What Is Medicare Part D

Medicare Part D is prescription drug coverage offered by private insurance companies approved by Medicare. Beneficiaries can enroll in a stand-alone Prescription Drug Plan (PDP) with Original Medicare or choose a Medicare Advantage plan (MA-PD) that includes drug benefits. Every plan must follow Medicare’s minimum coverage rules, but formularies and pricing vary.

What Medicare Part D Covers

Prescription Drugs in Essential Categories

All Medicare Part D plans must cover drugs across major therapeutic classes, including medications for:

• Diabetes
• High blood pressure
• High cholesterol
• COPD and asthma
• Depression and anxiety
• Osteoporosis

This ensures beneficiaries have access to commonly used medications for chronic conditions.

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Protected Class Medications

Medicare Part D also requires plans to cover “protected class” drugs, which include:

• Antidepressants
• Antipsychotics
• Anticonvulsants
• Antiretrovirals
• Immunosuppressants
• Certain cancer medications

These protections ensure that people with serious or complex health needs can access the full range of necessary treatments.

Vaccines Not Covered by Part B

Part D covers many important vaccines, including the shingles (Shingrix) vaccine, RSV vaccines, and most travel immunizations. Under current Medicare rules, beneficiaries typically pay $0 out of pocket for recommended vaccines.

Insulin and Diabetic Supplies

Thanks to recent updates, Medicare Part D limits monthly insulin costs to $35 for covered insulin products. Many plans also cover diabetic supplies such as test strips, lancets, and pen needles.

Specialty and High-Cost Medications

Part D covers a wide range of specialty drugs used for conditions like multiple sclerosis, rheumatoid arthritis, and autoimmune disorders. These medications may fall into higher cost tiers but are included in most formularies.

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What Medicare Part D Does Not Cover

Medicare Part D does not cover over-the-counter drugs, vitamins and supplements, cosmetic medications, fertility treatments, or drugs for weight loss.

Medicare Part D provides comprehensive, affordable access to prescription medications. By reviewing your plan’s formulary, comparing costs, and choosing a plan that matches your medication needs, you can maximize your coverage and save money throughout the year.

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Medicare Advantage OEP 2026: What Beneficiaries Need to Know

As in previos years, the Medicare Advantage OEP 2026 runs from January 1 to March 31, giving Medicare beneficiaries a valuable second chance to fine-tune their health coverage. While the Annual Enrollment Period (AEP) in the fall gets the most attention, OEP is just as important; especially with the growing number of changes expected in Medicare Advantage benefits, Star Ratings, utilization management, and supplemental offerings in 2026.

Here’s an overview of what OEP is, how it works, and why 2026 may be an especially important year to review plan choices.

What Is the Medicare Advantage OEP

The Medicare Advantage OEP is a once-per-year enrollment window designed specifically for people already enrolled in a Medicare Advantage plan. It allows beneficiaries to:

• Switch to a different Medicare Advantage plan (with or without drug coverage)
• Drop Medicare Advantage and return to Original Medicare
• Enroll in a stand-alone Part D prescription drug plan if switching back to Original Medicare

However, OEP does not allow someone on Original Medicare to join a Medicare Advantage plan. It is strictly for current MA members who want to make a change.

Why OEP Matters in 2026

Medicare Advantage plans are expected to see continued adjustments in 2026, including:

More Care Management Controls

Many carriers are tightening prior authorization, utilization management, and cost-sharing rules. Some beneficiaries may find their 2026 MA plan more restrictive than expected once the new year begins.

Shifts in Supplemental Benefits

Non-medical extras like dental, vision, hearing, transportation, and OTC allowances are being closely reviewed by CMS. Some plans reduced benefits for 2026 to balance rising medical costs.

Watch a quick video on the differences between Medicare Advantage vs Medicare Supplements

Star Rating Modifications

With CMS proposing changes to the Star Ratings program, some plans entered 2026 with lower ratings than previous years. Lower ratings can mean reduced rebates, resulting in trimmed benefits or higher out-of-pocket costs for members.

Provider Network Adjustments

Every year brings hospital and physician network changes. Beneficiaries often don’t notice these changes until January, making OEP their opportunity to switch to a plan with more compatible providers.

With these shifts, OEP 2026 will be especially important for those who discover their new coverage doesn’t meet their expectations.

Who Should Consider Making a Change

A Medicare Advantage member may want to explore options during OEP if:

• Their plan dropped key doctors or specialists for 2026
• Prescription costs or formularies changed
• Supplemental benefits were reduced or removed
• Prior authorization requirements increased
• Their total out-of-pocket costs are higher than anticipated
• They enrolled in a new plan during AEP but are experiencing “buyer’s remorse”

Even a small change; like a different tier placement for a medication can significantly impact annual healthcare expenses.

How to Review Medicare Advantage Options During OEP

During OEP, beneficiaries should:

1. Review their 2026 Evidence of Coverage (EOC) to understand changes.
2. Compare local plan alternatives, focusing on doctors, drug coverage, and copays.
3. Check Star Ratings, but also evaluate real-world factors like provider access.
4. Consider switching back to Original Medicare if they prefer provider flexibility; though Medigap underwriting rules may apply depending on the state.

Working with a licensed Medicare agent is the quickest way to compare plans side-by-side and avoid unexpected coverage gaps.

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The Medicare Advantage Open Enrollment Period is a valuable opportunity for beneficiaries to correct course after the new plan year begins. With ongoing regulatory changes and shifting benefits in 2026, OEP gives Medicare members the flexibility to ensure their plan still aligns with their healthcare needs, budget, and preferred providers.

Whether it’s a minor adjustment or a full switch, the OEP helps ensure beneficiaries start the rest of 2026 with confidence in their coverage.

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Using Annuities for Retirement Income: A Simple, Reliable Strategy

For many Americans nearing retirement, one fear rises above all others: outliving their savings. With people living longer and traditional pensions becoming rare, retirees need income sources they can count on. That’s why using annuities for retirmenet income is gaining attention as a dependable way to create steady retirement income.

An annuity is a contract with an insurance company. You contribute a lump sum or make periodic payments, and in return, the insurer provides growth, protection, or guaranteed income. While annuities come in several forms, their main purpose is simple; turning savings into predictable income.

Types of Annuities

Fixed Annuities

Fixed annuities offer a guaranteed interest rate for a set term. They work like a secure, tax-deferred CD alternative and can later be converted into income.
Best for: Retirees who want stable, predictable returns.

Fixed Indexed Annuities

These annuities earn interest tied to a market index, such as the S&P 500, but protect your principal from market losses. Many include optional riders that provide guaranteed lifetime income.
Best for: People who want growth potential without risking their savings.

Immediate or Lifetime Income Annuities

These convert your investment into guaranteed monthly income that can last for life. They function like a personal pension.
Best for: Anyone who wants dependable, never-ending income.

Variable Annuities

Variable annuities invest in market-based subaccounts. They offer more growth potential but also market risk. Some add income riders for future stability.
Best for: Investors comfortable with market swings.

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Why Use Annuities for Retirement Income

Guaranteed Lifetime Income

Few financial products can provide income you cannot outlive. Annuities help create a reliable foundation for retirement.

Protection from Market Declines

For retirees, early losses can severely reduce long-term income. Many annuities protect your principal, which helps preserve your savings during downturns.

Tax-Deferred Growth

Earnings inside an annuity grow tax-deferred, making it easier for your funds to compound over time.

Complements Other Income Sources

Annuities can fill income gaps by working alongside Social Security, pensions, or withdrawals from retirement accounts.

Are Annuities Right for Everyone

Annuities may not be ideal for people who need high liquidity or want full access to their funds. They are best suited as part of a diversified retirement plan; not a replacement for all other investments.

In today’s retirement landscape, steady income matters more than ever. Annuities help retirees create predictable, long-lasting income while reducing risk. Whether you want stability, lifetime payments, or protection from market volatility, annuities can be an effective tool for building long-term financial security. A licensed agent can provide important guidance to create a long term strategy to secure your future income.

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Proposed Medicare Advantage Changes 2027

The Centers for Medicare & Medicaid Services (CMS) recently released a proposed rule for the 2027 contract year that could reshape Medicare Advantage (MA) and Part D prescription drug coverage. The agency aims to “strengthen quality, improve access, and modernize benefits” while reducing administrative burdens on plans.

Here’s what beneficiaries, providers, and policymakers need to know.

Star Ratings Overhaul

CMS proposes removing 12 Star Rating measures that are largely administrative or show little variation between plans. The focus will shift to meaningful metrics, including clinical outcomes, preventive care, and patient experience.

• New focus on outcomes: Plans will be evaluated more on health results than paperwork.
• Mental health measure: CMS plans to introduce a “Depression Screening and Follow-Up” measure for future cycles.
• Health equity bonuses paused: The previously planned “Excellent Health Outcomes for All” bonus is postponed, though CMS invites feedback on equity initiatives.

Impact: Beneficiaries may find it easier to identify high-quality plans, while insurers may redirect resources toward improving actual care.

Enrollment Flexibility

The proposed rule adds a new Special Enrollment Period (SEP) for beneficiaries whose providers leave a plan’s network. This allows mid-year plan changes without waiting for the regular enrollment window. CMS also codifies other existing SEP policies, making the system more consistent.

Impact: This change ensures continuity of care for people with chronic conditions or preferred providers.

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Part D and Drug Coverage Updates

The rule formalizes Part D reforms started under prior legislation, including:

• Eliminating the coverage gap (donut hole) phase.
• Maintaining reduced out-of-pocket thresholds.
• Removing cost-sharing in the catastrophic phase.
• Adjusting how True Out-of-Pocket (TrOOP) costs are calculated.

Impact: Beneficiaries gain more predictable and affordable prescription drug coverage.

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Reducing Administrative Burden

CMS proposes measures to reduce paperwork and regulatory complexity, such as:

• Exempting certain account-based plans from creditable coverage disclosures.
• Lifting requirements for mid-year notices about unused supplemental benefits.
• Removing some health-equity reporting mandates for plans.

Impact: Plans may operate more efficiently, but some transparency and oversight could be reduced.

Why It Matters

1. Patient-focused quality: More emphasis on outcomes and experience could improve care.
2. Drug cost protection: Part D reforms continue to protect beneficiaries from high out-of-pocket expenses.
3. Flexible enrollment: The new SEP enhances access to care when providers leave networks.
4. Efficiency vs. oversight: Streamlined administration may improve plan operations but reduce some accountability.
5. Future reform: CMS is constantly making changes to improve MA plans, and stakeholders have the chance to provide input.

CMS’s 2027 proposed rule could bring meaningful improvements for beneficiaries while easing administrative burdens for insurers. The Star Ratings overhaul, enrollment flexibility, and Part D updates are poised to enhance care and reduce costs. However, reduced oversight and postponed equity initiatives highlight areas to watch as the public-comment process unfolds.

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What to Know About Medicare Deductibles in 2026

Each year, Medicare updates its premiums, coinsurance, and deductibles. Understanding Medicare deductibles for 2026 is very important for beneficiaries. There are some important changes; especially for Medicare Part A and Medicare Part B.

Medicare Part A (Hospital Insurance)

Part A helps cover inpatient hospital stays, skilled nursing facility care, hospice, and some home-health services. In 2026, the inpatient hospital deductible for Part A is $1,736 per benefit period.
A “benefit period” begins at admission to the hospital and ends when you’ve been out of inpatient care (hospital or skilled nursing) for 60 consecutive days. That means every time a new benefit period starts, the deductible resets.

If your hospital stay extends past 60 days, daily coinsurance for days 61–90 (and beyond) will apply. These additional costs can add up underscoring why understanding the deductible is important for budgeting.

Medicare Part B (Medical Insurance)

Part B covers doctor visits, outpatient services, durable medical equipment, and more. For 2026:

• The standard monthly premium is $202.90.
• The annual deductible is $283.00.

You only pay the Part B deductible once per calendar year (if you receive Part B-covered services). After that, Medicare generally covers 80% of approved costs; you pay the remaining 20% (assuming your provider accepts Medicare assignment).

Learn the differences between Medicare Advantage vs Medicare Supplements

What This Means in Practice

• If you’re admitted to the hospital under Part A in 2026, you’ll need to pay $1,736 before Medicare begins to pay (for up to the first 60 days of a stay).
• If you use outpatient services or see a doctor under Part B, you’ll first need to meet the $283 annual deductible; once met, most services are covered at 80%.
• Because Part A’s deductible applies per benefit period (not per calendar year), multiple hospitalizations in one year could mean paying more than once.

Why You Should Care

Understanding Medicare deductibles is key to predicting out-of-pocket costs. For someone watching their budget, a hospital stay could require a substantial lump sum before coverage kicks in; for routine care under Part B, costs are more manageable, but still meaningful, especially for those on fixed incomes.

These 2026 changes also underscore the importance of evaluating supplemental coverage (like Medigap) or alternative plans to mitigate risk.

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Part B IRMAA Brackets 2026: What You Need to Know

Medicare Part B is a cornerstone of health coverage for many retirees, but for higher-income beneficiaries, there’s an additional cost: the Income-Related Monthly Adjustment Amount, better known as IRMAA. Understanding the Part B IRMAA brackets 2026 and how those adjustments work can help you plan your income, taxes, and healthcare costs.

What Is IRMAA — and Why It Matters

IRMAA is a surcharge added to Medicare Part B (and Part D) premiums for people whose income exceeds certain thresholds. Rather than base your premium solely on your age or election timing, IRMAA considers your Modified Adjusted Gross Income (MAGI) from two years earlier. In other words: your 2024 tax return determines what you pay for Medicare in 2026,

MAGI for Medicare includes your AGI (Adjusted Gross Income) plus certain tax-exempt sources like municipal bond interest.

Because of this “look-back,” proper planning in advance is critical; a one-time income spike (for example, a large capital gain or Roth conversion) in 2024 could significantly increase your 2026 Medicare premiums.

The 2026 IRMAA Brackets for Medicare Part B

Here’s a breakdown of the 2026 IRMAA income brackets (based on 2024 MAGI) and what they mean for your monthly Medicare Part B premium.

For couples filing jointly, the thresholds roughly double (e.g., up to $218,000 for no surcharge).

Why 2026 Premiums Are Rising

• The base Part B premium is increasing significantly: for 2026, it’s $202.90/month; up from $185 in 2025.
• Surcharges (IRMAA) are also escalating. The top surcharge for Part B is projected around $487/month, putting the total premium at $689.90 for the highest bracket.
• These adjustments are not just about inflation: the IRMAA brackets themselves are being re-indexed, which will pull more people into higher tiers over time.

Putting that in perspective: many beneficiaries on fixed incomes could face a bigger Medicare burden and it’s especially important for those with variable or investment income.

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Strategies to Manage or Reduce IRMAA

Because IRMAA hinges on reported MAGI from two years prior, you may have opportunities now (for your 2024 tax year) to influence your 2026 Medicare costs. Here are some strategies:

1. Mind your MAGI
   • Prioritize tax-efficient withdrawals in retirement (e.g., Roth conversions, IRA/401(k) distributions) to control your AGI.
   • Consider timing of capital gains: if you realize large gains in 2024, you may push yourself into a higher IRMAA bracket.
2. Use strategic charitable giving
   • Qualified Charitable Distributions (QCDs) from your IRA can lower your taxable income without affecting your MAGI in the same way as other income sources.
3. File an SSA-44 (Life-Changing Event)
   • If your income drops significantly (due to retirement, unemployment, or other life events), you can file a Form SSA-44 to request a re-determination of IRMAA.
   • But note: you need documentation, like proof of reduced income, to support your case when submitting.
4. Plan ahead for Medicare Advantage vs Medigap
   • Higher IRMAA could make certain Medigap (supplement) plans less attractive; it may also influence whether Part D surcharges make a zero-premium Medicare Advantage plan more favorable.

Things to Consider

• Your 2024 income matters – a lot. What you earned (or didn’t) in 2024 directly impacts your 2026 Medicare Part B costs.
• IRMAA is rising. Even modest increases in MAGI could push you into a higher surcharge bracket.
• You have agency. With smart tax planning and proactive strategies, you may be able to mitigate how much IRMAA you pay, but timing and strategy matter.

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Stand-Alone Dental Plans – Why Medicare Agents Should Offer Them

Stand-alone dental coverage has become one of the most valuable add-ons for Medicare beneficiaries and a smart cross-sell opportunity for agents. Because Original Medicare does not cover routine dental care, seniors face steep out-of-pocket costs for services they use frequently. Offering stand alone dental plans fills this gap and strengthens your overall product portfolio.

Medicare Leaves a Major Dental Gap

Original Medicare excludes cleanings, exams, fillings, crowns, dentures, implants, and more. Beneficiaries often don’t realize this until they get the bill. Dental plans help you address this common pain point and provide solutions your clients genuinely need.

High Demand Among Seniors

Dental needs increase with age; gum disease, decay, cracked teeth, and periodontal issues. Stand-alone plans offer predictable costs and access to affordable care, making them an easy sell to clients on fixed incomes.

Preventive Care = Better Health

Most plans cover routine cleanings and X-rays at 100%. This encourages regular checkups and helps prevent expensive problems later. Clients appreciate plans that improve long-term health and reduce medical complications.

Affordable Premiums and Strong Benefits

Stand-alone dental plans typically offer:

• Low monthly premiums
• Basic and major service coverage
• Large provider networks
• Options to keep their current dentist

These features make dental plans simple to explain and highly attractive during enrollment discussions.

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A Reliable Cross-Sell Opportunity

Dental plans pair easily with Medicare Supplement, Medicare Advantage, and stand-alone Part D coverage. Adding dental boosts client satisfaction, increases retention, and creates additional commission opportunities; all while genuinely improving your clients’ coverage.

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Offering stand-alone dental coverage helps you close Medicare’s biggest gap, deliver real value, and grow your book of business. With strong consumer demand and affordable pricing, dental plans remain one of the easiest and most impactful products to present in every client conversation.

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Medicare Part B in 2026: What to Expect

Medicare beneficiaries will see several important changes to Medicare Part B 2026. Costs are rising again, and many retirees will feel the impact. Here is a simple breakdown of what’s changing and why it matters.

Key Cost Changes for 2026

The standard monthly Part B premium increases to $202.90 in 2026. This is a noticeable jump from the 2025 premium of $185.00. The annual deductible also rises. It increases to $283, up from $257 in 2025.

After you meet the deductible, you still pay 20% coinsurance for most Part B services. This includes doctor visits, outpatient care, therapy, lab work, and durable medical equipment. These basic cost-sharing rules do not change.

Why These Costs Are Going Up

Medicare adjusts Part B premiums each year. These changes reflect the rising cost of healthcare. More people are using outpatient services. Physician-administered drugs also continue to drive spending.

CMS noted that the increase could have been even higher. Cost-saving steps helped reduce the size of the jump. One example is new rules designed to slow spending on certain high-priced items, such as skin substitutes. Still, higher medical costs overall mean higher premiums for beneficiaries.

Click here to watch our YouTube video on Medicare Part B IRMA and IEP, SEP rules

What This Means for You

Higher premiums and a higher deductible mean higher yearly expenses. The extra $18 per month adds up. Over the course of a year, it is more than $200. This does not include the out-of-pocket costs you may pay when you receive care.

Budgeting becomes even more important in 2026. If you expect frequent doctor visits or outpatient treatments, you may face additional costs throughout the year.

For many people, supplemental coverage can help. Medigap plans can reduce out-of-pocket expenses. Medicare Advantage may also offer lower upfront costs. However, each option has different benefits and limits. It is important to compare them carefully.

Check Your Income Level

Some people will pay more than the standard premium. If your income is above certain thresholds, you may owe an Income-Related Monthly Adjustment Amount (IRMAA). This surcharge increases your monthly cost. It is based on your tax return from two years prior.

Medicare Part B costs will increase again in 2026. These changes affect almost every beneficiary. Reviewing your coverage now can help you avoid surprises later. Look at your budget, your health needs, and your income level. Then decide whether Original Medicare alone is enough or if a supplemental option makes sense for you.

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2026 Social Security COLA: What the 2.8% Increase Means for Beneficiaries

The Social Security Administration (SSA) has officially announced the 2026 Social Security COLA; beneficiaries will receive a 2.8% increase beginning in January 2026. This annual Cost-of-Living Adjustment is designed to help SSI recipients keep pace with inflation. Here’s a clear breakdown of what the new COLA means and how it affects monthly benefits.

How Much Will Social Security Benefits Increase in 2026

Thanks to the 2.8% COLA, millions of Americans will see higher monthly payments. Here are some average 2026 Social Security benefit amounts after the increase:

• Retired worker: Rises from about $2,015 to $2,071 (+$56 per month)
• Medicare aged couple (both receiving benefits): Increases to $3,208
• Widow(er) living alone: Goes up to $1,919
• Widowed parent with two children: Increases to $3,898

For SSI recipients, the 2026 federal benefit rate climbs to $994 per month for an individual and $1,491 for couples. In total, the COLA affects roughly 75 million beneficiaries nationwide.

These updated numbers are among the most searched details about the 2026 COLA, and they reflect the real-dollar impact on everyday retirees.

Understanding Other Social Security Changes in 2026

Beyond the COLA increase, beneficiaries should be aware of several important 2026 Social Security updates:

• The maximum taxable earnings limit will rise to $184,500.
• The 2026 earnings limit for individuals collecting benefits before full retirement age increases to $24,480.
• For those reaching full retirement age in 2026, the earnings limit will be $65,160.

These figures matter for anyone still working while collecting Social Security, as well as future retirees planning ahead.

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Why the 2026 COLA May Not Feel Like a Big Raise

Although the 2.8% COLA is larger than last year’s adjustment, many retirees may not feel the full benefit. That’s because:

• Medicare Part B premiums are rising in 2026, reducing take-home Social Security checks.
• Seniors face higher inflation in areas not reflected fully in the CPI-W, such as healthcare, housing, and utilities.
• For retirees who rely heavily on Social Security, a $56 monthly increase may provide only modest relief.

What Beneficiaries Should Do Now

To prepare for the new year, beneficiaries should:

• Review their 2026 net Social Security payment after Medicare deductions
• Update household budgets to account for higher costs of living
• Understand how the 2026 earnings limits may affect working retirees

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The 2026 Social Security COLA provides helpful income protection, but rising expenses mean beneficiaries should plan carefully

CMS Proposes Star Ratings Change for Medicare Advantage & Part D Plans

Federal regulators are moving to revamp the Medicare Advantage Star Ratings program, signaling a shift in how insurers’ performance is measured and rewarded. The Centers for Medicare and Medicaid Services CMS Proposes Star Ratings Change; they issued a draft regulation, opening the door for public input on potential changes to Medicare Advantage policies, risk adjustment, and even the Medicare Part D prescription drug program.

The proposed overhaul comes as insurers face mounting pressure from prior authorization requirements, audits, and marketing restrictions. By streamlining the Star Ratings system, CMS may offer plans some relief while keeping the focus on high-quality patient care.

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What’s Changing in Star Ratings

The Star Ratings program has significant financial implications for insurers. CMS awards Medicare Advantage and Part D plans that score at least four stars with a 5% payment bonus. Under the draft rule, the agency proposes removing a dozen measures that focus on operational performance or administrative processes rather than clinical outcomes.

Of the changes, eight measures would affect only Medicare Advantage plans, two would apply only to Part D, and two would apply to both programs. Examples include removing metrics tied to appeal decision timeliness, customer service, and members’ decisions to leave a plan. CMS notes that these measures “don’t sufficiently convey variations in quality among plans.” Most of the changes would take effect for the 2029 plan year.

Health Equity Index Eliminated

CMS also proposes ending its Health Equity Index, a 2024 initiative that rewarded plans for improving care for marginalized populations. Instead, the agency would continue the existing reward factor that incentivizes high performance across measures.

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New Focus on Clinical Care

The draft regulation highlights CMS’s intent to refocus Star Ratings on meaningful clinical outcomes. For example, the agency plans to add a depression screening follow-up measure to Medicare Advantage, reflecting an emphasis on behavioral health.

“These proposed changes aim to refocus the program on clinical care, outcomes and patient experience where there is meaningful variation in performance across contracts,” CMS said in a news release.

What This Means for Insurers and Beneficiaries

Insurers could benefit from a simpler Star Ratings system, with less emphasis on administrative metrics. For beneficiaries, the changes signal a stronger focus on health outcomes and patient experience rather than operational benchmarks. The public now has a chance to weigh in on the proposals before CMS finalizes the rule.

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