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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.

Watch a quick YouTube video on the prescription payment plan

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 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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Medicare Supplement Plan Sales Growth

As Medicare Advantage plans undergo major changes for 2026, more seniors are taking a closer look at Medicare Supplement (Medigap) coverage. With tighter MA budgets, reduced benefits, and growing network concerns, Medigap is becoming the go-to choice for beneficiaries who want simplicity, stability, and predictable healthcare costs. This has helped with Medicare Supplement plan sales growth.

Why Medicare Advantage Changes Are Driving the Shift

For 2026, many Medicare Advantage carriers are reducing cost-sharing perks, scaling back extras, and becoming more selective with enrollment growth. Factor in increased marketing scrutiny and commission pressure, and the MA landscape feels less predictable than it has in years.

Seniors are noticing; many are now reevaluating whether MA plans still fit their needs.

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Why Medicare Supplement Plans Stand Out in 2026

1. Predictable Costs and Simple Coverage

Medigap helps shield members from unexpected bills by covering the gaps in Original Medicare. Plan G and other popular options remain consistent year after year.

2. Freedom From Networks

Members can see any doctor or hospital nationwide that accepts Medicare; no referrals, no authorizations, and no surprises.

3. Long-Term Stability

While MA benefits change annually, Medigap benefits do not. This makes Medigap especially appealing amid shifting MA offerings.

How to Position Medigap in Your Sales Strategy

• Lead with predictability: Emphasize long-term cost stability compared to fluctuating MA benefits.
• Highlight provider freedom: Seniors frustrated with shrinking MA networks respond well to Medigap’s nationwide access.
• Target MA switchers: Many beneficiaries use the Medicare Advantage Open Enrollment Period to move into more stable coverage.
• Educate early: Start conversations before annual plan changes create confusion or frustration.

Watch a quick YouTube video on MA OEP best practices

Key Takeaways

• Medicare Advantage plans are cutting back on supplemental benefits and tightening networks for 2026.
• Medicare Supplement plans offer predictability, nationwide access, and long-term stability.
• Demand is increasing as seniors seek more control and fewer surprises.
• Agents can leverage this shift to build trust, long-term relationships, and stronger retention.

As Medicare Advantage plans tighten benefits in 2026, Medicare Supplement insurance stands out as a stable, reliable alternative. For agents, this shift presents a strong opportunity to guide clients toward coverage that offers flexibility, control, and predictable healthcare spending.

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Medicare Part B Enrollment Periods

Medicare Part B is a vital part of your healthcare coverage, helping to pay for doctor visits, outpatient care, preventive services, and medical supplies. However, knowing when to sign up is just as important as understanding what Part B covers. Enrolling at the right time ensures you avoid costly late penalties and gaps in coverage. Here’s a breakdown of the key Medicare Part B enrollment periods and what each means for you.

Initial Enrollment Period (IEP)

Your Initial Enrollment Period is your first chance to enroll in Medicare Part B. It lasts seven months — beginning three months before, including your birth month, and continuing three months after you turn 65.

• If you enroll before your birthday month, your Part B coverage starts the month you turn 65.
• If you enroll during or after your birthday month, coverage begins the month after you enroll.

Tip: Even if you’re still working, check with your employer’s HR department to see whether you should enroll right away or delay Part B to avoid duplicate coverage.

Special Enrollment Period (SEP)

If you or your spouse are still working past 65 and have employer-sponsored health coverage, you can delay enrolling in Part B without penalty. Once that coverage ends, you qualify for a Special Enrollment Period.

The SEP lasts eight months from the date your employment or group coverage ends — whichever comes first. Enrolling during this window ensures you don’t face the Part B late enrollment penalty, which can increase your premium by 10% for every 12 months you were eligible but didn’t sign up.

Important: COBRA or retiree coverage doesn’t count as active employer coverage, so your SEP clock may start ticking sooner than you think.

Watch a YouTube video on Medicare OEP, SEPs and Late Part B Enrolllments

General Enrollment Period (GEP)

If you missed both your Initial and Special Enrollment Periods, the General Enrollment Period gives you another chance. The GEP runs every year from January 1 to March 31.

• Coverage begins the first day of the month after you enroll.
• You may owe a late enrollment penalty added to your monthly premium for as long as you have Part B.

While this period can be a helpful safety net, it’s best to avoid relying on it if possible due to potential penalties and delayed coverage.

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Medicare Advantage (Part C) and Other Related Enrollment Periods

Once you have Part B, you can explore Medicare Advantage (Part C) or Medigap plans to supplement your coverage. Enrollment in these plans often depends on your Part B effective date, so timing your Part B enrollment correctly is crucial for coordinating your full Medicare coverage.

Understanding Medicare Part B enrollment periods can save you money and prevent headaches down the road. Whether you’re turning 65 soon, working past retirement age, or helping a loved one with their coverage decisions, planning ahead is key.

If you’re unsure when to enroll, a licensed Medicare agent can review your situation, explain your options, and help you avoid penalties or coverage gaps.

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Medicare Costs 2026: What Beneficiaries and Agents Need to Know

As Medicare undergoes significant shifts in 2026, beneficiaries will face new premiums, deductibles, and cost-sharing structures. These costs impact how they access and budget for care. For agents, understanding these changes is essential for guiding clients through enrollment decisions and helping them prepare for the year ahead. Here’s a breakdown of important Medicare cost updates for 2026 and what they mean for the people you serve.

Higher Costs Driven by Utilization and Program Changes

Several factors are driving cost increases across Medicare Part A and Part B in 2026:

• Greater healthcare utilization: Hospital and outpatient visits continue to rise.
• Higher reimbursement requirements: Centers for Medicare & Medicaid Services (CMS) is adjusting payments to hospitals, physicians, and Medicare Advantage plans due to inflation and increased care complexity.
• Changes in Medicare Advantage rules: Policy shifts for 2026; including tighter oversight and reduced supplemental benefit flexibility, are indirectly affecting Original Medicare spending trends.

While Medicare costs rise most years, 2026 brings a more noticeable increase driven by combined economic and regulatory pressures.

Medicare Part A Costs for 2026

Most beneficiaries still receive Part A with no monthly premium (if they qualify via work-history) but other Part A cost-sharing amounts are increasing:

• Inpatient hospital deductible (Part A): For 2026 the deductible for a benefit period is $1,736, up from $1,676 in 2025.
• Daily coinsurance for days 61–90 in hospital: $434 per day in 2026, up from $419.
• Lifetime reserve-day coinsurance: $868 per day in 2026.
• Skilled Nursing Facility (SNF) coinsurance (days 21-100): $217 per day in 2026, up from $209.50.

Agents should remind clients that even if Part A premium is “free,” they can still face significant out-of-pocket exposure via hospital stays and extended care—making Medigap or a well-selected Medicare Advantage plan even more important.

Medicare Part B Costs for 2026

Part B sees some of the most direct increases:

• Standard monthly premium (Part B): $202.90 per month in 2026 (up from $185.00 in 2025).
• Annual deductible (Part B): $283 in 2026 (up from $257 in 2025).
• Income-related monthly adjustment amounts (IRMAA): Beneficiaries with higher incomes will pay more than the standard premium; for 2026 the standard premium applies to individuals with a modified adjusted gross income (MAGI) up to $109,000 (or $218,000 for joint filers)

For agents, breaking down these numbers early in AEP and during SEP conversations helps clients avoid sticker-shock and budget accurately.

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Prescription Drug Costs

• The annual deductible for the standard Part D benefit in 2026 is $615.
• Beneficiaries will pay cost-sharing (typically coinsurance) during the initial coverage phase until their true out-of-pocket (TrOOP) drug spending hits $2,100 for 2026. At that point, the plan pays 100% of covered drugs for the rest of the year.
• All 2026 Part D plans are required to include this $2,100 cap.
• For beneficiaries with very high drug costs, this cap provides meaningful protection, limiting their maximum annual out-of-pocket prescription drug expense (excluding premiums).

Learn more about the drug cap – watch a YouTube video

Medicare costs are rising in 2026; with thoughtful planning, beneficiaries and their agents can manage these changes with confidence. By staying informed and proactively communicating updates, agents stand out as trusted, knowledgeable guides.

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Medicare A and B Basics

Understanding Medicare can feel overwhelming at first, but it becomes much simpler once you break it down into the two core parts of Original Medicare: Part A and Part B. These two components form the foundation of Medicare coverage and help beneficiaries access essential hospital and medical care. Whether you’re approaching age 65 or helping a loved one navigate enrollment, here’s the Medicare A and B Basics.

What Medicare Part A Covers (Hospital Insurance)

Medicare Part A is often called hospital insurance because it helps cover care you receive in a hospital or similar inpatient setting. Most people receive Part A premium-free as long as they or their spouse worked and paid Medicare taxes for at least 10 years.

Part A covers:

Inpatient Hospital Care

This includes semi-private rooms, meals, nursing care, medications given in the hospital, and other hospital services. Part A does not cover private rooms unless medically necessary.

Skilled Nursing Facility (SNF) Care

Part A may cover care in a skilled nursing facility after a qualifying three-day inpatient hospital stay. This is not long-term custodial care, but medically necessary rehabilitation services such as physical or occupational therapy.

Home Health Care

If ordered by a doctor and medically necessary, Part A can help cover intermittent skilled nursing care, physical therapy, or speech therapy delivered in the home.

Hospice Care

For patients with a terminal illness and a prognosis of six months or less, Part A provides comprehensive hospice benefits, including pain relief, symptom management, and family support.

Part A Costs

Most beneficiaries pay no monthly premium, but deductibles and coinsurance still apply. For example, there is a per-benefit-period deductible for hospital stays and daily coinsurance after certain lengths of inpatient care.

Watch a YouTube video on Medicare Enrollment Periods

What Medicare Part B Covers (Medical Insurance)

Medicare Part B is medical insurance that covers outpatient and physician services. Unlike Part A, everyone pays a monthly premium for Part B, and higher-income beneficiaries may pay more.

Part B covers:

Doctor Visits

This includes primary care, specialists, and certain preventive screenings and exams.

Outpatient Services

Such as X-rays, lab work, outpatient surgeries, and emergency room or urgent care services (when not admitted as an inpatient).

Durable Medical Equipment (DME)

Items like walkers, wheelchairs, CPAP machines, and home oxygen equipment.

Preventive Care

Medicare Part B provides a wide range of preventive services at no extra cost when using participating providers; annual wellness visits, vaccines, mammograms, colonoscopies, and more.

Mental Health Services

Includes outpatient therapy, psychiatric evaluations, and some partial hospitalization programs.

Part B Costs

Beneficiaries pay a standard monthly premium, an annual deductible, and typically 20% coinsurance for most covered services. Part B has no out-of-pocket maximum unless you pair it with a Medigap plan or choose a Medicare Advantage plan.

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How Medicare A & B Work Together

Part A and Part B complement each other to provide broad medical coverage. Part A focuses on inpatient care, while Part B handles outpatient and ongoing medical needs. Many people choose to add:

• A Medicare Supplement (Medigap) to reduce out-of-pocket costs
• A Part D prescription drug plan
• Or a Medicare Advantage plan that bundles A, B, and often D into one

Your choice depends on your budget, health needs, and preferred style of coverage.

Understanding the basics of Medicare Parts A and B is the first step in building reliable coverage for your healthcare needs. By knowing what each part covers and what it doesn’t; you can make confident decisions as you prepare for enrollment or compare additional coverage options

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Medicaid and Long-Term Care

When it comes to paying for long-term care, many families are surprised to learn that Medicare doesn’t cover most long-term care costs. That’s where Medicaid can step in as a vital resource. For seniors and individuals with limited income and assets, Medicaid can help cover the high cost of nursing home care and, in some cases, in-home or assisted living services. However, the rules can be complex and understanding how Medicaid and long-term care work together can be important to planning ahead.

Medicaid coverage of Long-Term Care

Medicaid is a joint federal and state program that helps people with low income and limited resources pay for healthcare. One of its most important benefits is coverage for long-term care services, such as:

• Nursing home care (room, meals, skilled nursing, and personal care)
• Home and community-based services (HCBS) like in-home aides, adult day care, or home modifications
• Assisted living services in some states

Because Medicaid is managed by each state within federal guidelines, coverage details and eligibility requirements vary depending on where you live.

Financial Eligibility: Income and Asset Limits

To qualify for Medicaid long-term care, applicants must meet strict financial and functional requirements.

Most states have both:

• Income limits — based on a percentage of the federal poverty level or a fixed monthly cap.
• Asset limits — typically allowing applicants to keep only a small amount in countable resources (often around $2,000 for an individual).

However, not all assets are counted. For example, your primary residence (up to a certain equity limit), one vehicle, personal belongings, and certain burial funds may be excluded.

Couples have special rules called “spousal impoverishment protections”, which allow the healthy spouse to retain a portion of income and assets so they are not left destitute.

Functional Eligibility: Level of Care Requirements

In addition to financial need, applicants must demonstrate a medical need for long-term care. Each state has criteria to determine whether a person requires nursing home level of care; such as needing assistance with multiple daily activities (bathing, dressing, eating, toileting, or mobility).

Medicaid Estate Recovery

It’s important to note that Medicaid can seek repayment for long-term care costs from the estate of the deceased beneficiary. This process, called estate recovery, generally occurs after the recipient’s death, often through the sale of property or assets left behind. However, exceptions and delays may apply if there’s a surviving spouse or dependent child.

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Home and Community-Based Waivers (HCBS)

Many states now offer Medicaid waivers that allow people to receive care at home or in community settings rather than in nursing homes. These programs help individuals remain as independent as possible while still receiving support services. Waiver programs often have limited slots and waiting lists, so early planning is essential.

The Importance of Planning Ahead

Medicaid long-term care planning can be complex; involving income limits, asset transfers, and look-back periods (typically five years). Attempting to give away assets or transfer property before applying can trigger penalty periods of ineligibility.

Working with a qualified elder law attorney or Medicaid planning specialist can help families understand their options, protect assets legally, and prepare for future care needs.

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Medicaid is a lifeline for many Americans who need long-term care but cannot afford it privately. By understanding the program’s eligibility rules, coverage options, and planning strategies, families can make informed decisions that protect both their health and their financial well-being.

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Understanding Medicare Part D Coverage

Medicare Part D is the portion of Medicare that helps pay for prescription drugs, providing essential coverage for those who rely on medication. While Part D plans differ, they all follow general Medicare guidelines. This makes understanding Medicare Part D coverage a little easier. Here’s a breakdown of what Part D covers, and what it does not cover, to help avoid surprises at the pharmacy.

What Medicare Part D Covers

Medicare Part D plans are offered by private insurance companies, and each plan has its own formulary, or list of covered medications. Still, all plans must include a wide range of commonly used prescription drugs.

Retail and Mail-Order Prescriptions

Part D primarily covers medications you pick up at a pharmacy or receive through mail-order. Drugs are grouped into tiers, which determine your copay or coinsurance.

Essential Drug Classes

Plans must include at least 1 medication in each key category such as:

• Antidepressants
• Antipsychotics
• Immunosuppressants
• HIV/AIDS medications
• Anticonvulsants
• Some oral cancer drugs not covered by Part B

Certain Vaccines

Part D pays for vaccines not covered by Part B, including the shingles vaccine.

Insulin and Related Supplies

Many plans have capped insulin costs and cover supplies like needles and syringes.

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What Medicare Part D Does Not Cover

While Part D covers many prescriptions, several important exclusions apply.

Drugs Given in a Hospital

If you’re admitted as an inpatient, medications provided during your stay are covered under Medicare Part A, not Part D.

Medications Administered in a Doctor’s Office

Any drug that must be given by a healthcare professional; such as injections, infusions, or biologics, is usually covered under Medicare Part B.

Examples include:

• IV antibiotics
• Chemotherapy infusions
• Injectable osteoporosis treatments

Over-the-Counter Products

Part D does not cover vitamins, supplements, or OTC medications unless a plan offers them as an added benefit.

Watch a YouTube video on the $2K drug cap

Cosmetic and Weight-Loss Medications

Most drugs used for cosmetic purposes or weight reduction are excluded.

Non-Formulary Drugs

If a drug isn’t listed on a plan’s formulary, it generally won’t be covered unless your doctor requests and the plan approves a formulary exception.

Experimental Drugs

Any medication that is not FDA-approved is excluded.

Medicare Part D is a valuable benefit, but understanding what it covers and doesn’t, helps you choose the right plan and avoid unexpected costs. Reviewing formularies and pharmacy networks each year ensures you get the most from your prescription drug coverage.

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Weight Loss Drugs and Medicare

If you are a Medicare agent, there is no doubt you have been asked about weight loss drugs and Medicare coverage. There is some big news for Medicare beneficiaries: starting in 2026, weight loss medications will be covered through a Medicare Part D pilot program. Thanks to recent deals between the Trump administration and drug makers Eli Lilly and Novo Nordisk, eligible clients can access these medications for just $50 per month, down from $1,000 or more.

Who Qualifies

Not everyone will be eligible. The program targets about 10% of Medicare enrollees with severe obesity or high-risk conditions:

• Severely obese (BMI > 35)
• Overweight (BMI > 27) with prediabetes or cardiovascular disease
• Obese with advanced kidney disease, heart failure, or uncontrolled hypertension

Medicare will cover about $245 per month, making the program affordable and accessible.

Watch a quick YouTube video to learn more about the Canadian Medstore

How We Got Here

Initially, in April 2025, CMS decided not to cover anti-obesity medications due to high costs. Estimates suggested a potential $25–35 billion increase in spending over the next decade.

Everything changed in November 2025 when the Trump administration negotiated directly with manufacturers as part of the “Most Favored Nation” initiative. The result: a dramatic price drop that made coverage feasible without straining the Medicare budget.

TrumpRx: Option for Everyone

Even those who don’t qualify for Medicare coverage will have access to lower-cost medications starting January 2026 through TrumpRx.gov.

• Starting price: between $350 and $245/month
• Oral GLP-1 options expected pending FDA approval
• Available to anyone, regardless of insurance

What Medicare Covers Now

Before 2026, Medicare Part B covers obesity screenings and behavioral therapy, while Part D may cover GLP-1 drugs only if prescribed for diabetes or other approved conditions. Weight loss drugs are not otherwise covered.

Why This Matters for Agents

This is a game-changing opportunity for clients managing obesity or related health conditions. Agents can:

• Check Part D formularies for covered weight loss medications
• Compare plans for eligible clients
• Track policy updates in real time

The new coverage replaces compounded semaglutide options, giving clients access to brand-name medications at lower costs.

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Two Pricing Tracks

• Trump Deal (2026): $245/month to Medicare, $50 copay for eligible beneficiaries
• IRA Negotiations, put in place by the Biden administration, (2027): Could bring additional savings for Ozempic and Wegovy

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What seemed improbable months ago is now reality. By staying informed and guiding clients through their coverage options, agents provide real value during the 2026 enrollment season and beyond.

Why Medicare Supplement Rates Are Increasing

Many Medicare beneficiaries have recently noticed that their Medicare Supplement (Medigap) premiums are climbing; sometimes more than expected. The Medicare supplement rate increases can be frustrating, especially for retirees on fixed incomes. However, there are several factors driving these adjustments that help explain why costs are rising across the board.

Rising Healthcare Costs Nationwide

Healthcare costs in the United States continue to rise each year, driven by inflation in hospital charges, doctor fees, prescription drug prices, and medical technology. Medicare Supplement insurance companies base their premiums on the cost of paying future claims. As healthcare services become more expensive, insurers must collect more in premiums to keep up with the cost of covering beneficiaries’ care.

An Aging Policyholder Population

As people age, they typically require more frequent and costly medical care. Medicare Supplement plans, particularly those with long-standing enrollees, experience higher claim volumes as the average age of their members increases. When claims outpace the amount collected in premiums, insurers must adjust rates to remain financially stable.

Inflation and Administrative Expenses

General economic inflation affects almost every industry; including insurance. Administrative expenses such as employee wages, technology costs, and compliance requirements have all increased in recent years. Insurers incorporate these higher operating costs into their premium calculations, which contributes to annual rate increases.

Medical Advancements and Utilization

Medical advancements help seniors live longer and healthier lives, but they also come with higher price tags. New treatments, diagnostic tools, and specialized therapies often cost more than older alternatives. At the same time, people are using more healthcare services overall, from preventive screenings to outpatient procedures, raising total claim costs and, ultimately, premiums.

Plan Type and Rating Method

The way a Medicare Supplement plan is priced also affects future rate increases. There are three main rating methods:

• Community-rated: Everyone pays the same rate regardless of age. Increases are usually due to inflation or claim experience.
• Issue-age-rated: Rates are based on the age when you enroll; increases come from inflation and claims, not your age.
• Attained-age-rated: Rates start lower but increase as you age, plus inflation and claim adjustments.

Those enrolled in attained-age plans often experience the steepest long-term increases.

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Smaller Risk Pools and Market Shifts

As Medicare Advantage enrollment continues to grow, fewer people are buying new Medicare Supplement plans. A smaller pool of members means less spread of risk, which can cause rates to rise faster for remaining policyholders. Additionally, some carriers exit certain states or discontinue specific plans, leaving fewer options and less competition.

Watch a video on the special enrollment periods for discontinued Medicare advantage plans

Managing Future Increases

While rising premiums are often unavoidable, beneficiaries can take steps to manage their costs. Reviewing your plan annually, comparing rates from other carriers, or switching to a different Medigap plan type may help reduce expenses. Working with a licensed Medicare agent ensures you understand your options and can make informed decisions based on your health needs and budget.

Medicare Supplement rate increases reflect broader trends in healthcare spending, demographics, and the insurance market. While the numbers may fluctuate, understanding the reasons behind them helps seniors plan ahead and make the most of their Medicare coverage.

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