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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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Medicare and Dental Coverage: What You Need to Know

When people think of Medicare, they often assume it covers all their healthcare need; including dental. Unfortunately, that’s not the case. Original Medicare (Parts A and B) does not cover most routine dental care. This can come as a surprise to new Medicare beneficiaries, and as an agent, it’s important to help clients understand Medicare and dental coverage.

What Original Medicare Covers

Original Medicare only covers dental care in very limited situations; usually when it is part of a hospital stay or a medically necessary procedure. For example:

• Jaw reconstruction after an accident.
• Tooth extractions needed before certain surgeries, such as heart valve replacement.
• Oral exams done in the hospital before a covered procedure.

Routine services like cleanings, fillings, dentures, or root canals are not covered.

Why Dental Coverage Matters

Oral health is closely tied to overall health. Poor dental health can contribute to heart disease, diabetes complications, and infections; all of which are major concerns for Medicare-aged clients. Helping your clients plan for dental costs can protect both their health and their wallets.

Options for Dental Coverage

Here are the most common ways beneficiaries can get dental coverage:

1. Medicare Advantage Plans (Part C)
   Many Medicare Advantage plans include dental benefits. Coverage can range from basic preventive care (cleanings, x-rays) to more comprehensive services like crowns, root canals, and dentures. Make sure to compare networks, coverage limits, and annual maximums.
2. Stand-Alone Dental Insurance Plans
   These plans are separate from Medicare and can offer flexible options. Beneficiaries can choose plans based on coverage needs and budget.
3. Discount Dental Plans
   Not insurance, but these plans provide negotiated discounts with participating dentists. They can be a low-cost option for those who only need occasional care.
4. Paying Out-of-Pocket
   Some clients may choose to budget for routine care rather than purchase coverage. This may work for those with minimal dental needs, but it carries financial risk if major dental work is required.

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Tips for Agents

• Ask about oral health needs during your fact-finding process. This helps you recommend plans that fit your clients’ situation.
• Compare annual maximums carefully — dental coverage is often capped between $1,000–$2,000 per year.
• Educate clients about timing — enrolling in dental coverage early can help them avoid waiting periods for major services.

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Medicare beneficiaries need to know that Original Medicare will not take care of their routine dental needs. By helping them understand their options Medicare Advantage plans, stand-alone dental insurance, or discount plans; you position yourself as a trusted advisor and help them maintain both their oral and overall health.

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Medicare Advantage Unused Benefit Rules – What Agents Need to Know

Medicare Advantage (MA) plans can be a great choice for clients; especially because of their extra perks like dental, vision, hearing, OTC allowances, and fitness memberships. But these benefits often go unused, which can lead to client dissatisfaction and plan switching. Recently, CMS has put some Medicare Advantage unused benefit rules in place.

Here’s what you need to know to guide your clients.

Key Points About Unused Benefits

• Most benefits expire monthly, quarterly, or annually; no rollovers.
• OTC allowances are among the most commonly missed benefits.
• Dental/vision/hearing dollars disappear at year-end if not used.
• Provider networks matter — clients must follow plan rules or they risk missing out on some benefits.

CMS’ Mid-Year Notification Rule

CMS recently finalized a rule requiring MA plans to send personalized mid-year notices (June 30–July 31) showing members which supplemental benefits they haven’t used and how to access them.

However, enforcement is paused for 2026, so most plans will not send these reminders. Some may do so voluntarily, but agents should not assume clients will get them.

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Why This Matters for Agents

• Client Retention: Clients often switch plans because they feel they aren’t getting value; even when benefits were available.
• Education Opportunity: Helping clients understand and use their benefits builds trust and keeps them engaged.
• Competitive Edge: Agents who proactively remind clients about OTC orders, dental visits, and other benefits stand out.

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Agents

• Review each client’s benefits during mid-year check-ins.
• Send reminders about quarterly OTC allowances and annual dental/vision appointments.
• Explain provider network requirements to avoid frustration.
• Track CMS updates; when they enforce the rule, you can align your outreach with plan notices.

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Even with CMS’ rule delayed, agents can fill the gap by educating clients and helping them use the benefits they signed up for. Proactive communication strengthens client relationships, improves satisfaction, and keeps your book of business stable.

Medicare Coverage of DME (Durable Medical Equipment)

When it comes to staying healthy and independent, many Medicare beneficiaries rely on durable medical equipment (DME). Whether it’s a walker, a hospital bed, or a CPAP machine, understanding Medicare coverage of DME is essential for many.

In this post, we’ll break down what DME is, how Medicare covers it, and what clients should know to avoid costly surprises.

What Is Durable Medical Equipment (DME)

Durable Medical Equipment is defined as reusable medical equipment that is:

• Medically necessary for the patient’s health condition
• Able to withstand repeated use
• Primarily used for a medical purpose
• Appropriate for use in the home

Examples of common DME include:

• Wheelchairs and scooters
• Walkers and canes
• Hospital beds
• Oxygen equipment
• Blood sugar monitors and test strips
• CPAP machines and supplies

How Medicare Covers DME

Medicare Part B

Most DME is covered under Medicare Part B (Medical Insurance). Here’s how it works:

• Doctor’s Order Required: A physician or other Medicare-approved provider must prescribe the equipment.
• Approved Supplier: The equipment must be purchased or rented from a Medicare-approved supplier that accepts assignment.
• Cost-Sharing: The beneficiary pays 20% of the Medicare-approved amount after meeting the Part B deductible.

Those who have a Medicare Supplement plan may pay as little as $0 depending on the plan they have.

Some equipment is available for purchase, while other items are only available for rental. For rentals, Medicare usually pays the supplier monthly for up to 13 months, after which the beneficiary typically owns the equipment.

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Prior Authorization and Competitive Bidding

In some cases, Medicare requires prior authorization for certain high-cost or frequently abused items (like power wheelchairs). Additionally, in certain areas, Medicare runs a competitive bidding program for DME, meaning beneficiaries must use specific contracted suppliers to get full coverage.

Medicare Advantage and DME

Medicare Advantage (Part C) plans also cover DME, but:

• Networks and suppliers may be different from Original Medicare.
• Some plans require prior authorization for more types of equipment.
• Cost-sharing may vary (some plans may have lower copays or coinsurance).

Agents should always remind clients to check their plan’s provider directory and approval process before ordering DME.

Tips for Agents and Beneficiaries

• Verify Coverage First: Always confirm that the prescribing provider and supplier are Medicare-approved.
• Check the Need: Make sure there’s documentation showing the equipment is medically necessary.
• Understand Costs: Explain that clients will still owe 20% coinsurance under Part B unless they have Medigap or other supplemental coverage.
• Watch for Scams: DME fraud is common – warn clients not to accept unsolicited equipment or offers.

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Durable Medical Equipment can be life-changing for Medicare beneficiaries, but coverage rules can be tricky. By helping your clients understand what Medicare covers, where to get equipment, and how to keep costs low, you can build trust and ensure they get the care they need without unexpected bills.

2026 Medicare Part D Costs & Drug Price Negotiations

Medicare Part D (the prescription drug benefit) has seen some major changes recently. For 2026, several provisions are coming into play that affect what enrollees pay, how much Medicare pays, and how drug prices are negotiated. Below are the key updates to the 2026 Medicare Part D costs.

Key Changes in Medicare Part D for 2026

Here are some of the most important cost‐related changes that beneficiaries should know:

What Is the Drug Price Negotiation Program

Under the Inflation Reduction Act of 2022, Medicare now has the power to directly negotiate prices for certain high-cost drugs covered under Part D (and later also Part B). Previously, Medicare was more restricted in its ability to force manufacturers to lower prices for prescription drugs.

Here’s how the negotiation program works in broad strokes:

• Each year, a certain number of “single-source” brand drugs (i.e. those without generics or biosimilars) that have been on the market for a set minimum time become eligible for negotiation.
• Medicare (through CMS) makes an initial offer (“maximum fair price” or MFP) based on drug spending, clinical benefit, manufacturer costs, price in comparable drugs, etc. Manufacturers can counter. There are meetings and data sharing to arrive at a negotiated price.
• If agreement is reached, the negotiated price becomes effective as of a certain date. For the first set of drugs, prices begin for 2026

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Which Drugs & Savings with Negotiation in 2026

• The first round of negotiation selects 10 Part D drugs.
• For 2026, these negotiated prices go into effect starting January 1, 2026.
• The discounts negotiated are substantial: for those 10 drugs, reductions range from 38% to 79% off list price.
• Estimated savings: If those new prices had been in effect earlier (e.g. in 2023), Medicare would have saved about $6 billion in overall drug spending on those drugs. For beneficiaries, out-of-pocket savings for those 10 drugs in 2026 are projected to be about $1.5 billion.

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How Negotiations & Costs Interact: What This Means for Beneficiaries

• Lower list/transaction prices for selected drugs should directly reduce what beneficiaries pay (especially in the initial and gap phases), because coinsurance or cost sharing is often a percentage of drug cost.
• The out-of-pocket cap ($2,100 in 2026) limits how high total costs for drugs can go in a year, making unexpected high drug bills somewhat more predictable.
• The negotiation program may also influence which drugs are placed on formularies or on preferred tiers, as plans respond to the new negotiated prices.
• However, the savings from negotiated drugs apply only to those drugs selected for negotiation; many other drugs will still be under traditional pricing structures.

Some Caveats & Things to Watch

• The negotiated max fair price is not always simply a percentage cut—there are statutory minimum discounts, comparisons with existing net prices, evaluation of alternatives, etc. Some drugs may see smaller reductions depending on existing rebates or other discounts.
• The program phases in over years: more drugs will be subject to negotiation in 2027, 2028, etc. So the full effects take time.
• Courts and industry challenges may affect implementation or enforcement.

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For 2026, people with Medicare should expect higher costs including; premiums, deductibles and out‐of‐pocket thresholds compared to previous years. Although there will be relief for certain high‐cost drugs thanks to the new Medicare drug price negotiation program. If you’re taking one of the drugs selected for negotiation, the discounts will reduce what you pay. Over time, broader negotiation and other reforms aim to make more drugs more affordable for all Part D enrollees.

Medicare Costs for 2026 – What Beneficiaries Need to Know

Each year, Medicare updates the premiums, deductibles, and coinsurance amounts for Parts A and B. These changes can have a significant effect on your budget; especially if you are living on a fixed income. Below we go over the projected Medicare costs for 2026. We have included a brief look at Part D and the high-deductible Medigap option.

Medicare Part A Costs for 2026

Medicare Part A covers inpatient hospital care, skilled nursing facility care, hospice, and some home health services. Most people do not pay a Part A premium, but you are still responsible for deductibles and coinsurance amounts.

• Part A deductible (per benefit period): Projected to rise from $1,676 in 2025 to about $1,716 in 2026.
• Hospital coinsurance (days 61–90): Expected to increase from $419/day to around $429/day.
• Lifetime reserve days (beyond day 90): Rising from $838/day to about $858/day.
• Skilled Nursing Facility coinsurance (days 21–100): Expected to increase to about $214.50/day.

Since the Part A deductible applies per benefit period, you could pay it more than once in a year if you have multiple hospital stays separated by 60+ days.

Medicare Part B Costs for 2026

Part B covers outpatient services, doctor visits, preventive care, and durable medical equipment.

• Standard Part B premium: Expected to increase from $185/month in 2025 to around $206.50/month in 2026.
• Part B annual deductible: Projected to rise from $257 to about $288 in 2026.

After you meet your Part B deductible, Medicare generally covers 80% of approved charges, leaving you responsible for the remaining 20% unless you have supplemental coverage.

Part D Prescription Drug Costs (Quick Note)

Even though Part D is separate from Parts A & B, it’s worth noting that the maximum Part D deductible is expected to increase from $590 in 2025 to $615 in 2026. There will also be a new out-of-pocket cap of $2,100 for covered drugs (it was $2,00 in 2025), which helps those with high prescription costs.

High-Deductible Medigap (HDG) Plans – A Quick Overview

For those who purchase a high-deductible Medigap plan (Plan G or F), the annual deductible must be met before the plan starts paying for costs that Original Medicare doesn’t cover.

• The 2025 high-deductible amount is $2,870.
• The 2026 amount has not yet been finalized but is expected to rise slightly in line with medical inflation.

These plans often have lower monthly premiums, making them attractive for healthier beneficiaries who expect lower healthcare usage, but you’ll need to budget for that large deductible in case of an unexpected illness or hospitalization.

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Why This Matters

The projected increases in Part B premiums and deductibles could take a big bite out of Social Security cost-of-living adjustments. Planning ahead helps you avoid surprises.

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Here’s what clients should do:

• Budget for higher premiums and deductibles.
• Review supplemental coverage to ensure it still meets your needs and budget.
• Compare Part D plans during the Annual Enrollment Period (AEP) to find one that best covers medications at the lowest cost.
• Stay informed—CMS will finalize these numbers in Fall 2025, so check back for updates.

Understanding Medicare Deductibles

Medicare deductibles are one of the most important; and sometimes confusing, parts of how Medicare works. Whether your clients are on Original Medicare or a Medicare Advantage plan, understanding Medicare deductibles is an important part of healthcare decisions. Knowing what they are, when they apply, and what services count toward them can help avoid costly surprises.

As an agent, being able to break this down simply is a great way to build trust and guide clients to the right coverage.

What Is a Medicare Deductible

A deductible is the amount a beneficiary must pay out of pocket for covered services before Medicare or their Medicare plan starts sharing the cost.

There are several types of Medicare deductibles:

• Medicare Part A Deductible – applies to each benefit period for inpatient hospital care.
• Medicare Part B Deductible – applies once per calendar year for medical services like doctor visits and outpatient care.
• Medicare Advantage (Part C) Deductible – set by the private plan and may apply to medical, drug coverage, or both.
• Medicare Part D Drug Deductible – applies to certain prescription drugs (usually higher-tier medications).

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Services That Use Deductibles

Here’s what typically applies to each deductible:

• Part A (Hospital) Deductible:
  • Inpatient hospital stays
  • Skilled nursing facility care (after meeting Part A requirements)
  • Some home health care and hospice services
• Part B (Medical) Deductible:
  • Physician visits
  • Outpatient surgery
  • Diagnostic tests (labs, X-rays, imaging)
  • Durable Medical Equipment (DME)
  • Preventive care is usually exempt — covered at 100%
• Medicare Advantage Deductible:
  • Inpatient hospital care (if plan requires it)
  • Outpatient hospital/surgical care
  • Advanced diagnostic imaging (MRI, CT scans)
  • Durable Medical Equipment (DME)
  • Emergency/urgent care (sometimes)
• Part D Deductible:
  • Applies to most Tier 3 and higher brand-name drugs
  • Generic drugs on lower tiers may bypass the deductible

Services That Skip the Deductible

To keep care accessible, Medicare and Medicare Advantage plans often waive the deductible for:

• Preventive screenings (wellness visit, mammogram, colonoscopy)
• Routine lab work
• Many primary care visits
• Many Tier 1 and Tier 2 generic prescriptions

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Deductibles Are Just One Piece of the Puzzle

When reviewing coverage options with clients, don’t just look at the deductible amount. Also compare:

• Coinsurance and copays – what clients pay after meeting the deductible
• Maximum Out-of-Pocket (MOOP) on Medicare Advantage plans
• Medigap coverage – many Medigap plans cover some or all deductibles, reducing out-of-pocket costs

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By helping clients understand when and how deductibles apply, you make it easier for them to budget for healthcare and choose the plan that fits their needs.

The Medigap Free Look Period and How to Use It

When clients are considering a Medicare Supplement (Medigap) plan, they want to be sure they’re making the right choice. Fortunately, Medicare gives beneficiaries a way to try out a new Medigap plan without fully giving up their old one; it’s called the Medigap Free Look Period.

As an agent, knowing how this works helps you guide clients through transitions confidently and avoid gaps in coverage.

What Is the Medigap Free Look Period

The Medigap Free Look Period is a 30-day window that allows Medicare beneficiaries to try out a new Medigap policy while keeping their current one.

This is helpful when a client isn’t sure if the new plan will meet their needs; for example, if they are switching from a Plan F to a Plan G or moving to a carrier with a lower premium.

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How the Free Look Period Works

Here’s how the process goes step by step:

1. Apply for the New Medigap Plan
   • Your client must be accepted by the new Medigap plan (and if underwriting is required, they must pass).
2. Keep Paying for the Old Policy
   • Even after the new plan starts, your client must keep paying premiums for their old Medigap policy during the 30-day free look period.
   • This ensures there’s no gap in coverage if they decide to go back.
3. Evaluate the New Coverage
   • Over the 30 days, your client can use the new Medigap plan and see how it works with their needs.
4. Decide Whether to Keep It
   • If they like the new plan, they can cancel the old one after the 30 days.
   • If they don’t, they can cancel the new plan and keep the old one; no harm done.

Important Things to Remember

• Two Premiums Are Due: Clients will pay two Medigap premiums during the free look period; one for the old plan and one for the new. This is often the biggest surprise for beneficiaries, so prepare them ahead of time.
• Coverage Overlap Is Intentional: The goal is to avoid any lapse in coverage while deciding which plan to keep.
• Act Within 30 Days: If the client decides to go back to their old policy, they must notify the new carrier before the free look period ends.

Why Agents Should Talk About It

Educating clients about the Medigap Free Look Period builds trust. Many people hesitate to switch plans out of fear of losing coverage or making the wrong choice. When you explain that they can try a new plan risk-free, you help them feel confident in making a change. That helps position you as a knowledgeable, client-first agent.

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The Medigap Free Look Period is a great tool to help beneficiaries compare coverage and costs without the stress of losing their existing plan. As an agent, you can guide them through the process, set clear expectations about paying two premiums, and help them decide which plan is the best long-term fit.

Empower your clients with this knowledge; it may be exactly what they need to take the next step toward better coverage and savings.

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What Is a Medicare Authorized Representative

Navigating Medicare can sometimes feel overwhelming; especially when it comes to forms, appeals, or plan decisions. That’s where a Medicare Authorized Representative comes in. If you need help dealing with Medicare, you can officially appoint someone to act on your behalf. But what is a Medicare authorized representative, and what are the limits to their authority? Let’s break it down.

What Is a Medicare Authorized Representative

A Medicare Authorized Representative is a person you choose to act for you in handling certain Medicare matters. You can name a trusted family member, friend, caregiver, or even a professional (like an attorney) to represent you.

To make this official, Medicare requires you to complete the “Appointment of Representative” form (CMS-1696) or provide a written statement that includes specific details. Once approved, Medicare recognizes this person as your representative for the issues you’ve specified.

What an Authorized Representative Can Do

When properly appointed, your authorized representative can:

• Communicate with Medicare on your behalf – including discussing claims, coverage, and appeals.
• File appeals or grievances – if you disagree with a coverage or payment decision.
• Submit plan enrollment or disenrollment requests – depending on your needs.
• Receive notices and correspondence from Medicare related to your case.
• Help you gather and send supporting documentation for appeals or claims.

Essentially, your representative steps into your shoes for specific Medicare-related matters, making the process less stressful for you.

What an Authorized Representative Cannot Do

It’s important to understand the limits of this role. A Medicare Authorized Representative cannot:

• Make medical decisions for you – They are not the same as a healthcare proxy or power of attorney for medical treatment.
• Automatically handle all financial or legal matters – Their authority is limited to Medicare issues.
• Act indefinitely without renewal – Representation typically applies to specific cases or timeframes and may need renewal if ongoing.
• Override your wishes – You remain in control, and you can revoke their authority at any time.

If you want someone to handle broader decisions about your finances or healthcare beyond Medicare, you would need a power of attorney or similar legal document.

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How to Appoint a Representative

1. Fill out Form CMS-1696 – This form is available on Medicare.gov or from your plan.
2. Submit the form – Send it to your Medicare Advantage, Part D, or other Medicare-related plan, or directly to Medicare if it’s about Original Medicare.
3. Wait for confirmation – Once accepted, your representative can begin acting on your behalf.

Why Appointing a Representative Can Help

Having a Medicare Authorized Representative can be especially useful if:

• You’re appealing a denial of coverage.
• You need help managing the paperwork.
• You have a trusted advocate who understands your situation.
• You want extra peace of mind that someone is handling your case correctly.

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Bottom line: A Medicare Authorized Representative is your advocate in dealing with Medicare, but their authority is limited to Medicare-related issues. They can help with forms, appeals, and communication, but they cannot make medical decisions or handle unrelated legal or financial matters.