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Proposed CMS Regulation Changes 2027: What Medicare Agents Need to Know

The Proposed CMS regulation changes 2027 for Medicare Advantage and Part D include several major changes that will directly affect how Medicare agents, brokers, and TPMOs operate during the next Annual Enrollment Period (AEP). These proposals aim to strengthen beneficiary protections, reduce administrative burden, and improve marketing oversight.

TPMO Oversight: Targeting Bad Actors, Not Everyone

CMS is refining its approach to Third-Party Marketing Organization (TPMO) regulation. Instead of blanket oversight, CMS aims to better identify and hold “bad actors” accountable while reducing the burden on compliant agents and organizations.

Key proposed changes include:

• New methods to distinguish good-faith errors from misleading practices
• Better alignment of incentives between agents, brokers, and TPMOs
• Continued focus on consumer transparency

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Updated TPMO Disclaimer Requirements

CMS proposes that the TPMO disclaimer must be read before discussing any plan benefits. Additionally, State Health Insurance Programs (SHIPs) would be removed from the disclaimer wording.

Call Recording Relief for Agents

A major compliance update: CMS is proposing to reduce the call-record retention period from 10 years to 6 years, with alternatives like 3 years or transcript retention also under review. This would significantly reduce data storage requirements for Medicare agents.

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Marketing Events and Communications: More Flexibility for Agents

CMS wants to remove the 12-hour waiting period between educational and marketing events. Agents could immediately transition into a marketing presentation if they clearly announce the shift to attendees. This change helps agents plan events more efficiently and improves lead engagement.

Scope of Appointment (SOA) Changes That Benefit Agents

The proposal includes some of the most agent-friendly SOA updates in years:

• Elimination of the 48-hour SOA waiting period
• Written SOA required for in-person meetings, while electronic or audio formats remain approved for remote appointments
• BRCs, voicemails, and online lead forms recognized as SOAs, providing clearer compliance for digital marketing and lead generation

Click here for a generic SOA

These updates would help Medicare agents schedule appointments faster and reduce friction with prospects.

Advertising Rules: Superlatives Allowed Again

CMS proposes lifting the blanket ban on superlatives like “best” or “most”; as long as statements are accurate, substantiated, and not misleading. This gives agents more flexibility in plan comparisons and advertising campaigns while maintaining compliance standards.

Enrollment & SEP Updates for 2027

Key proposed changes include:

• Expanded provider termination SEP, allowing beneficiaries affected by any provider termination to switch plans
• Clearer rules requiring CMS approval for SEPs tied to sanctions or contract violations, processed through 1-800-MEDICARE

Additional CMS Updates Agents Should Watch

• Proposed elimination of the mid-year supplemental benefits notice
• Updates to Star Ratings and quality measures
• CMS requests feedback on C-SNP and I-SNP growth and support for dually eligible beneficiaries

CMS Medicare Regulatory Relief proposal – enter your comments/suggestions

Preparing for the 2027 AEP

The 2027 CMS Proposed Rule reflects a continued effort to balance consumer protection with administrative relief for agents. Medicare agents should begin reviewing these changes now to adjust their sales processes, marketing strategies, and compliance practices before final rules are released.

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Best Medicare Coverage for Travelers: What Agents Should Know

For clients who love to travel; whether across state lines or around the world, having the right Medicare coverage is essential. As an agent, helping beneficiaries understand what their plan does and doesn’t cover can prevent costly surprises and strengthen your value as a trusted advisor. Below is a breakdown of the best Medicare coverage for travelers and what makes them stand out.

One of the most common misconceptions is that Original Medicare offers extensive travel protection. While Part A and Part B provide nationwide coverage, they offer very limited benefits outside the United States. This is why many travelers lean on Medigap or specific Medicare Advantage plans for more robust protection.

Medigap Plans: The Gold Standard for International Travel

For clients who spend time abroad, certain Medigap plans; specifically Plans C, D, F, G, M, and N include limited foreign travel emergency benefits. These plans typically cover 80% of approved emergency medical costs after a small annual deductible, giving travelers peace of mind during unexpected situations. Medigap also shines for domestic travelers since it works with any provider who accepts Medicare, making it ideal for RVers, snowbirds, and retirees who move between states.

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Medicare Advantage Plans for Travel Flexibility

While Medicare Advantage plans can be restrictive due to network rules, some MA plans are designed with travelers in mind. PPO and Regional PPO plans often allow out-of-network coverage at higher cost-sharing, which can be helpful for clients who split time between locations. Some plans also include worldwide emergency or urgent care benefits, a valuable feature for international travel. Agents should review network strength, coverage areas, and emergency care provisions when guiding clients who are on the move.

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Part D and Prescription Access on the Road

Prescription drug access is another key consideration. Clients traveling domestically should choose a Part D plan with a broad pharmacy network or strong mail-order benefits. For travelers abroad, emphasize traveling with sufficient medication, since Part D does not cover drugs purchased outside the U.S.

Helping Clients Choose the Right Fit

Understanding a client’s travel habits helps you recommend the best Medicare option. Long-term international travelers may lean toward Medigap, while domestic travelers with predictable patterns may find strong value in certain Medicare Advantage PPOs.

By highlighting the coverage differences and asking the right questions upfront, agents can confidently guide their travel-savvy clients to Medicare solutions that protect their health no matter where the journey takes them.

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Avoiding Medicare Enrollment Mistakes: What Every Beneficiary Should Know

Enrolling in Medicare is one of the most important steps adults take as they approach age 65, yet it’s also one of the most common areas for costly mistakes. With multiple parts, deadlines, and coverage choices, it’s easy to feel overwhelmed. The good news is that with the right information, avoiding Medicare enrollment mistakes is easy. Here are the top mistakes to watch for and how to prevent them.

Missing Your Initial Enrollment Period

One of the biggest Medicare enrollment mistakes is missing the Initial Enrollment Period (IEP). Your IEP starts three months before your 65th birthday month and ends three months after. If you miss this window and don’t qualify for a Special Enrollment Period, you may face lifelong Part B late-enrollment penalties. To avoid this, mark your calendar early and begin evaluating your options at least three to six months before turning 65.

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Assuming Employer Coverage Automatically Delays Medicare

Many people continue working past age 65, but not all employer coverage allows you to delay Medicare. If your employer has fewer than 20 employees, Medicare becomes primary, meaning you must enroll in Part B to avoid coverage gaps. Always confirm whether your employer’s plan is considered creditable coverage before delaying enrollment.

Not Checking Creditable Drug Coverage

Medicare Part D also has its own late penalty if you go 63 days or more without creditable prescription drug coverage. Many people assume their employer or retiree plan counts, but not all do. Request a creditable coverage notice from your plan administrator each year and keep it for your records.

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Choosing a Plan Without Reviewing Networks and Formularies

Selecting a Medicare Advantage or Part D plan without checking provider networks and drug formularies can lead to higher costs and unexpected denials. Plans change annually, so a review during the Annual Enrollment Period (AEP) is essential; even if you’re happy with your current coverage.

Overlooking Out-of-Pocket Costs

Monthly premiums are only part of the equation. Deductibles, copays, and maximum out-of-pocket limits vary widely. Beneficiaries often choose the lowest-premium option only to discover higher costs later. Compare plans based on your actual health needs, not just the price tag.

Forgetting to Reevaluate Coverage Each Year

Your health needs and plan benefits change over time. Failing to review your coverage during AEP can lead to paying more than necessary or losing access to preferred providers or medications. A yearly comparison ensures your coverage stays aligned with your needs.

Not Working With a Licensed Medicare Agent

Medicare can be confusing, and many mistakes happen simply because beneficiaries don’t fully understand their options. A licensed Medicare agent can help you navigate enrollment periods, compare plans, and avoid penalties; all at no cost to you.

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Avoiding Medicare enrollment mistakes starts with awareness and preparation. By understanding your deadlines, verifying creditable coverage, reviewing networks and costs, and seeking expert guidance, you can make confident decisions that protect your health and your wallet.

Medicare Supplement Costs and Coverage: What Beneficiaries Need to Know

If you’re exploring ways to reduce out-of-pocket medical expenses, a Medicare Supplement Insurance plan (Medigap) can help fill the gaps left by Original Medicare. These standardized plans are designed to make healthcare costs more predictable, offering peace of mind and broader financial protection. We will go over the Medicare supplement costs and coverage and help you decide if this is right for you.

What Medicare Supplement Plans Cover

Medigap plans labeled A, B, D, G, K, L, M, and N offer the same benefits no matter which insurance company sells them. While the level of coverage varies by plan letter, most include:

• Part A coinsurance and hospital costs
• Part B coinsurance or copayments
• Blood (first 3 pints)
• Hospice care coinsurance
• Skilled nursing facility coinsurance (many plans)
• Part A deductible
• Foreign travel emergency benefits (select plans)

Today’s most popular option, Plan G, offers broad protection by covering nearly all Medicare-approved costs except the Part B deductible.

What Medigap Does Not Cover

It’s important to understand what Medicare Supplement plans exclude. Medigap policies do not cover:

• Prescription drugs (Part D is required separately)
• Routine dental, vision, and hearing care
• Long-term care or custodial care
• Services not approved by Medicare

Beneficiaries often pair Medigap with standalone dental, vision, and hearing plans for more complete coverage.

Watch a YouTube video on Medicare Advantage vs. Medicare Supplement

How Much Medicare Supplement Plans Cost

Medigap premiums vary widely. The main factors that influence cost include:

Plan Type

Plans with more benefits typically cost more. Plans with cost-sharing features often come with lower premiums.

Age and Rating Method

Carriers price Medigap plans using:

• Community-rated premiums
• Issue-age-rated premiums
• Attained-age-rated premiums

The rating method affects how your premium changes over time.

Location

Medigap costs vary by state and even by ZIP code due to regional healthcare expenses.

Tobacco Use and Enrollment Timing

Carriers may charge higher rates for tobacco users or applicants enrolling outside their guaranteed-issue period.

Available Discounts

Household or multi-enrollee discounts may lower monthly premiums.

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Why Many Beneficiaries Choose Medigap

Medicare Supplement plans are favored for their predictable costs, nationwide provider access, and minimal out-of-pocket expenses. With no networks or referrals required, Medigap offers flexibility that many retirees value.

A Medicare Supplement plan can significantly reduce healthcare costs and eliminate many gaps in Original Medicare. Reviewing coverage options, comparing premiums, and pairing your plan with Part D ensures you get comprehensive protection tailored to your needs.

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Medicare Commission Dispute Update: CMS’ Repsonse What Agents Need to Know

The growing conflict between insurers and state regulators has caused federal officials to step in to clarify who controls Medicare Advantage (MA) marketing practices. The latest Medicare commission dispute update dives in to CMS’ response to the current status of broker commissions. Several insurers have reduced or eliminated commissions and restricted access to enrollment tools. Therefore, state commissioners are pushing back, arguing these actions harm both agents and beneficiaries. CMS’ latest memo signals that the debate is far from over.

Medicare Advantage Enrollment Suppression

In recent months, multiple insurers have attempted to limit what they view as costly Medicare Advantage enrollment by adjusting broker compensation and curbing access to online enrollment portals. These moves have prompted roughly a dozen states to urge insurers to reverse course. Some state departments even issued cease-and-desist orders, sparking lawsuits from carriers.

On December 4, CMS issued a memo stating; regulation of Medicare Advantage and Part D ultimately rests at the federal level. The agency emphasized that federal law likely preempts state law on matters related to MA compensation and marketing. CMS also reminded stakeholders that commissions are negotiable annually, as long as they fall within federal limits.

Access to Enrollment Forms

Importantly, CMS did clarify one requirement: enrollment forms must remain accessible on insurers’ websites. This comes amid concerns that restricted access to online tools could limit beneficiaries’ ability to make informed choices.

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Agent Compensation

While CMS’ memo reaffirmed federal authority, states are unlikely to stay silent. Several state regulators have said they lack the authority to mandate compensation changes but continue urging insurers to restore commissions. Industry observers expect states to keep applying public pressure, even if their legal power is limited. Some also suggest states could focus attention on the Medicare Supplement market, which is regulated at the state level, especially as some carriers consider commission changes in that space as well.

Agents and brokers have voiced growing frustration as certain insurers have reduced or eliminated commissions; sometimes even retroactively. Many argue that these cuts ultimately hurt beneficiaries by reducing access to professional guidance during enrollment.

Watch a YouTube video – Multiple Medicare Advantage Plans going non-commissionable

The dispute has escalated significantly. Insurers have filed lawsuits in response to state actions, claiming that limiting commissions is part of their strategy to maintain plan stability amid rising costs. Meanwhile, regulators in several states have urged insurers to reinstate compensation, warning of the broader impact on consumers.

Let’s Sum it Up

With the 2025 Annual Enrollment Period now over and the 2026 window on the horizon, the tension between state regulators, insurers, and federal authorities is shaping what could become a pivotal policy fight. CMS’ memo clarifies federal preemption but leaves the door open for continued pressure from states. For agents, the message is clear: the debate over Medicare Advantage commissions is far from settled. The outcome will have meaningful implications for how the industry operates moving forward.

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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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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.

Watch a video on the discontinued Medicare advantage plan special enrollment period

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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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 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).

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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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