Medicare changes to expect in 2026

This month’s article provides an overview of Medicare coverage in 2026. The 2026 edition of the Medicare & You handbook provides much greater detail than is provided in this article; if you do not have a copy, then please contact the Medicare Information Office and we are happy to provide a copy. You may also find the handbook available on the Medicare.gov website (look for the link under the “Basics” topic header) as an eBook, as well as in large print, audio version, and in Braille. The Medicare & You handbook has also been translated into Arabic, Chinese, Korean, Russian, Spanish, Tagalog, and Vietnamese. Original Medicare includes both inpatient (Part A) and outpatient (Part B) care, with an additional coverage for prescriptions (Part D). This year, there are no Medicare Advantage (Part C) plans offered to Alaska residents.

Part A and Part B costs

Medicare Part A covers inpatient services when you are admitted to the hospital for treatment. Most people do not owe a monthly premium for Part A, but if neither you nor your spouse have 10 years of Social Security work credits, then you may owe a monthly premium. If you are admitted to the hospital as an inpatient, then you will owe a deductible of $1,736 at the beginning of your stay. After you meet your deductible, your first 60 days in the hospital and your first 20 days in a skilled nursing facility cost you $0 per day. After that, you owe an out-of-pocket cost each day for your continued stay. If you have multiple hospitalizations, you may owe the Part A deductible more than once in a calendar year, when more than 60 days have passed without inpatient or skilled nursing care.

Medicare Part B coverage is for outpatient care, which is the most common medical events for most of us, such as visits to a licensed health professional, home health services, lab tests, and durable medical equipment. In 2026, the Part B premium is $202.90 per month. If your reported income in 2024 was above $109,000 as a single person or $218,000 as a married couple, you may pay higher premiums, known as an Income-Related Monthly Adjusted Amount (IRMAA) assessment. Part B has a deductible of $283 for the calendar year, with a 20 percent coinsurance for most medical services. If you receive an IRMAA assessment, read over the letter for details including options to appeal. Contact our office if you do not fully understand this or any details sent to you.

Part D costs

Medicare Part D covers outpatient prescription drugs. You have the option to sign up for a payment plan for Part D out-of-pocket costs. The Medicare Prescription Payment Plan (MPPP) allows you to spread your drug costs throughout the year, with the goal of helping you manage your monthly expenses. In 2026, the national average premium for the Part D basic benefit is about $39 per month. In Alaska, five different insurance companies are offering nine individual Prescription Drug Plans (PDPs) with premiums ranging from $0 to $112.40 per month. While monthly premiums do matter, the goal is to have a Part D PDP which includes coverage for your prescriptions for the overall lowest cost (of premiums plus any co-pays or cost-shares).

This year, your annual out-of-pocket Part D costs for prescriptions which are included in your plan are capped at $2,100. After you reach this out-of-pocket limit, you owe nothing for covered drugs for the rest of the year; you can track this limit in your plan’s monthly statements. The annual Open Enrollment Period to review and update your prescription drug plan will be later this year, from October 15th through December 7th. You may be eligible for a Special Enrollment Period during which you may change your plan, for example if you also have Medicaid (DenaliCare), the Medicare Savings Program (MSP), or the Extra Help program. As mentioned above, for individuals who have higher annual incomes, there may also be an IRMAA assessment included with monthly Part D plan premiums.

To discuss any Medicare concerns, or to ask any questions regarding your specific situation, please contact the State of Alaska Medicare Information Office at (800) 478-6065 or (907) 269-3680; our office is also known as the State health Insurance Assistance Program (SHIP), the Senior Medicare Patrol (SMP), and the Medicare Improvements for Patients and Providers Act (MIPPA) program. If you are part of an agency or organization that assists Seniors with medical resources, consider networking with the Medicare Information Office. Call us to inquire about our Ambassador program.

Sean McPhilamy is a volunteer and Certified Medicare Counselor for the Alaska Medicare Information Office.

 
 
 
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