Medicare Part B Premium will be $202.90 in 2026

What Mainers Should Know

Every year Medicare updates its costs for the coming year. And every year, I get the same questions from clients across Maine:

• “Did Medicare go up again?”
• “Am I paying more?”
• “Do I need to do anything?”

The short answer is: costs did increase a bit in 2026, but for most people, there are no surprises as long as you understand where those increases show up.

Let’s walk through it in plain English.

---

Medicare Part A: Hospital Coverage

Monthly Premium

Good news first.
Most people pay $0 for Medicare Part A.

If you worked and paid Medicare taxes for at least 10 years, Part A doesn’t cost you anything each month.

If you didn’t, the maximum Part A premium in 2026 is $565 per month, and penalties can apply if enrollment is delayed.

---

Skilled Nursing Facility Coverage

If you qualify under Medicare’s rules, Part A helps with skilled nursing care:

• Days 1–20: $0
• Days 21–100: $217 per day
• After day 100: You pay the full cost

This is coverage for skilled care, not long-term custodial care, which Medicare does not cover.

---

Medicare Part B: Doctor Visits and Outpatient Care

Monthly Premium

The standard Part B premium in 2026 is $202.90 per month.

Most people in Maine pay this amount.

---

Income-Related Monthly Adjustment (IRMAA)

This is where things catch people off guard.

If your 2024 income was above certain levels, Medicare adds an extra charge to your Part B premium. This can happen because of:

• Retirement payouts
• Roth conversions
• Capital gains
• Selling property
• One-time income events

At the highest income levels, the Part B premium in 2026 goes up to $689.90 per month.

Two important things to know:

1. IRMAA is based on income from two years ago
2. It is often appealable after retirement or income changes

If you retired recently or had a one-time income spike, this is worth looking at.

---

Part B Deductible

In 2026:

• $283 per year
• Paid once annually

After that, Original Medicare generally pays 80%, and you’re responsible for the remaining 20% unless you have other coverage.

---

---

Medicare Part D: Prescription Drug Coverage

National Base Premium

For 2026, the national base premium is $38.99.

Your actual Part D premium depends on:

• The plan you choose (It could be $0/month)
• Where you live in Maine
• Your income

Even if your drug plan premium is low or $0, higher-income earners may still pay an income-related adjustment, ranging from $14.50 to $91.00 per month, added to the plan premium.

This is another area where people are surprised when Social Security sends the letter.

---

Medicare Advantage (Part C)

Medicare Advantage plans are still widely available across Maine, and many continue to offer $0-$44 monthly premiums.

Just remember:

• $0 premium does not mean $0 cost
• Networks matter
• Copays matter
• Prescription coverage is built in

For some people, these plans work very well. For others, Original Medicare plus a supplement makes more sense. It really depends on the doctors you see or may want to see, prescriptions, and how you use healthcare.

---

Who Should Pay Extra Attention in 2026

You’ll want to take a closer look if you:

• Are retiring in 2026
• Had higher income in 2024
• Sold property or investments
• Are considering delaying Part B
• Are helping a spouse transition onto Medicare

Most Medicare problems arise by choosing the “wrong” plan, timing and assumptions.

---

Final Thought

Medicare doesn’t usually change dramatically year to year, but it does get more complicated the closer you look.

If you ever find yourself thinking,
“I just want someone to tell me if this applies to me,”
that’s exactly what I help with.

No pressure, no rush. Just clear answers.

Seeking Expert Guidance

In 2026, there will be some additional changes to the Medicare program. By learning about these changes and talking to an expert, you can be prepared and understand what it means for you and/or your spouse. Remember, there are programs that can help with the costs, and experts who can explain things better. By being informed and planning ahead, you can make sure you have the healthcare you need when the changes come in 2027 and 2028.   

Could You Qualify for Help Paying for Medicare?

If you’re on Medicare in Maine, you may qualify for a program that helps pay your premiums and out-of-pocket costs. It’s called the Medicare Savings Program (MSP), and it can make a huge difference in your monthly budget.

There are two main levels of MSP coverage:

• Qualified Medicare Beneficiary (QMB)
• Qualified Individual (QI)

Both programs can lower what you pay for Medicare, but each works a little differently.

---

What QMB Covers

If you qualify as a QMB, you could have:

• Your Medicare Part B premium paid for you (that’s the monthly cost for doctor visits and outpatient care).
• Help with certain deductibles, copays, and coinsurance.
• Automatic enrollment into the Extra Help program for prescriptions, which reduces your Part D premium, lowers your copays at the pharmacy, and helps with the donut hole.

---

What QI Covers

If your income is a little higher, you may still qualify for the QI program. QI pays for your Part B premium and also enrolls you into Extra Help for prescription drug savings.

---

2025 Monthly Income Limits in Maine

• QMB: Up to $2,413 (single) / $3,261 (couple)
• QI: Up to $3,261 (single) / $4,407 (couple)

And here’s some good news: In 2025, Maine does not have an asset test for MSP. That means your savings, car, or home won’t prevent you from qualifying. Some income deductions may also apply, making it easier for people who are “just over” the limits to qualify.

---

Why This Matters for Your Medicare Plan

If you qualify for QMB or QI, it can change everything about how your Medicare works:

• Your prescription costs can drop dramatically.
• You may become eligible for different Medicare Advantage plans, including some with extra benefits like those grocery cards you’ve been hearing about.
• The plan you’re on now might not be the most economical choice once you qualify.

---

How to Apply

You can apply for MSP through My Maine Connection, or by submitting a MaineCare application by mail, email, or fax to the Maine Department of Health and Human Services.

But before you apply, it’s smart to talk with someone who understands how MSP interacts with your Medicare coverage.

---

Let’s See If You Qualify

That’s where I come in. As a local Medicare advisor, I can:

• Help you figure out if you qualify for QMB or QI.
• Review how Extra Help will affect your prescription costs.
• Compare your Medicare Advantage options so you’re not leaving benefits or savings on the table.

If you think you might qualify—or if you’re not sure—reach out to me today. Even if you’ve applied before and didn’t qualify, 2025 income limits are higher than previous years and will probably increase again in 2026, so it’s worth checking again.

You’ve worked hard for your benefits. Let’s make sure you’re getting all the help you deserve.

Still have questions?

If you would like to talk about this program or schedule a meeting, you can reach me at 207-370-0143 or use my simple form on the CONTACT ME page of this site to send an email message.

The best part about working with me is that it will not cost you anything to discuss your options or to review the plans that are available.  I am paid by the insurance companies in the form of a commission if you enroll in a plan, just like your car insurance agent.

You will not pay any more than anyone else and you are under no obligation whatsoever to enroll in any plans if you meet with me.  My goal is to help you and I have found great joy in being able to offer my services to people who need my help.

Schedule a phone call today.

I can answer all your questions over the phone and I can help you with everything you need to know. I have all the forms and applications you need and I can also help you complete the applications and submit them on your he.

Read more…

• Blog Article
• COBRA
• Dental
• Insurance
• Medicare
• Part A
• Part B
• Part C Medicare Advantage
• Part D Prescription Drug Coverage
• Top Posts
• Uncategorized

---

How Medicare Advantage Giveback Plans Can Help You Save in 2026

If you’re shopping for a Medicare Advantage (MA) plan, you may have noticed a benefit called the Part B giveback. At first glance, it looks simple: your plan pays part—or even all—of your monthly Medicare Part B premium (up to $185 per month in 2025). That money shows up as a credit in your Social Security check or as a reduced premium bill from Medicare.

But the smartest way to look at a giveback isn’t just as a discount. It’s an opportunity. With Medicare Advantage costs rising in 2026—higher out-of-pockets, bigger hospital copays, and premiums shifting—the giveback can give you breathing room in your budget and help you afford extra protection where it counts.

---

Why 2026 Changes Make Givebacks More Valuable

Medicare Advantage plans for 2026 are rolling out some important changes that every beneficiary should know:

• Maximum Out-of-Pocket (MOOP) costs are climbing. Many plans will cap your annual spending at $9,200—up from $8,300 in 2025.
• Hospital copays are increasing. Daily hospital copays are often $450–$500 per day for the first 5–7 days.
• Ambulance rides remain expensive. Many plans charge $400 per trip, which adds up quickly in an emergency.

These increases mean that, even if your monthly premium feels affordable, your potential exposure is bigger than ever before.

---

How a Part B Giveback Works

Here’s a quick refresher:

• Who qualifies? You must be enrolled in Medicare Parts A & B, live in the service area of a plan offering the giveback, and pay your own Part B premium. If Medicaid or another program pays your premium, you’re not eligible.
• How do you receive it? If your Part B premium is deducted from your Social Security check, you’ll see that check increase by the giveback amount. If you pay Medicare directly, your bill will shrink by the same amount.
• How much could you save? Giveback amounts vary by plan and location—from just a few dollars to the full Part B premium.

---

Who Are Giveback Plans Best For?

It’s important to know that giveback plans aren’t designed for everyone.

• They often work best for people who are relatively healthy and don’t use medical services on a regular basis.
• In exchange for the lower Part B cost, some giveback plans come with higher deductibles—sometimes up to $1,000—for certain higher-cost services like hospital stays.
• They may also carry a higher out-of-pocket maximum (MOOP) compared to non-giveback plans.

That means if you’re unlucky enough to face a serious illness or hospital stay, your overall costs could be higher than if you’d chosen a non-giveback plan.

---

Turning “Savings” Into Protection

Here’s where strategy comes in. Let’s say your giveback is $75/month. That’s $900 a year you’re no longer spending on Part B. Rather than simply pocketing the difference, many of my clients use that money to reinforce their coverage where it matters most.

1. Add a Hospital Indemnity Plan

Hospital indemnity plans pay you cash for each day you’re in the hospital. With 2026 copays nearing $500 per day, a short stay could easily cost $2,500–$3,000 out of pocket.

• Typical indemnity plans cost about $50/month.
• One hospital stay could trigger a benefit payout that more than covers the annual premium.
• By redirecting your giveback toward this coverage, you create a safety net without increasing your budget.

2. Strengthen Dental Coverage

Original Medicare and many Medicare Advantage plans still have limited dental benefits. Major dental work—like crowns, implants, or dentures—can run into the thousands.

• Standalone dental plans with vision benefits often run $40–$60/month.
• Using your giveback dollars to fund this coverage helps you stay ahead of costly dental bills that Medicare Advantage plans alone may not fully cover.

---

An Example in Action

Imagine you choose a giveback plan that returns $100/month to your Social Security check. Instead of just enjoying the extra cash:

• You apply $50 to a hospital indemnity plan.
• You apply $50 to a standalone dental plan.

Result: You’ve turned your giveback into $100 worth of added protection every month, all while keeping your total healthcare spending about the same as before.

---

The Bottom Line

Giveback plans can be a great fit for the right person—especially if you’re generally healthy and don’t need frequent medical care. But remember, the savings often come with trade-offs: higher deductibles and higher maximum out-of-pockets.

That’s why the smartest strategy is to use those giveback dollars to cover the gaps. In 2026, pairing a giveback plan with a hospital indemnity or standalone dental plan may give you all the benefits you want—at an economical price—while protecting you from the rising costs of hospital stays and major care.

It’s not just about keeping more of your Social Security check—it’s about putting those dollars to work to protect your health and your wallet.

---

Would you like my help? Call 207-370-0143.

Choosing either dental insurance or a dental discount plan can save you money, but there are important differences to consider before deciding which route to choose.

Dental insurance versus dental discount plans

Before jumping into details, here’s a quick overview of the two types of dental plans:

Dental insurance

Most dental insurance plans operate pretty much the same way. Although benefits vary, plans generally fully cover preventative care, like two cleanings and one set of X-rays per year. They also tend to cover about half the cost of major procedures such as root canals, bridges, and crowns.

Most plans have annual deductibles of $50 to $100 and usually limit annual coverage amounts, with a median cap of $1,000. Some plans may or may not cover orthodontics or have lifetime limits on the amount covered for implants, so that’s also something to consider when shopping around.

Insurance companies often have a “network” of dentists and some plans will only cover work done by this network while other plans may offer flexibility to see dentists outside this network but often at a lesser amount of coverage.

With the high cost of dentistry, it’s easy to see how paying for a plan with a low annual max plus a monthly premium may not make sense. According to their annual survey, the American Dental Association Health Policy Institute says the average cost of a cleaning for an adult in the US is $73 to $130; fillings, $108 to $246; crowns, $959 to $1,650; implants, $1,200 to $2,500; and root canals, from $613 to $1,200.

Dental discount plans

With a discount plan, you pay a monthly or annual membership fee and will receive a discounted price on services. Monthly membership fees for an individual range from about $10-$15.

Dental discount plan networks may be more limited than insurance networks, and compared with insurance, the out-of-pocket costs are often higher for patients. You can get full coverage of preventive care with some discount plans, but it is much less common than it is with insurance.

Discounts range from about 20-50 percent, with routine procedures getting the highest discounts. But unlike dental insurance, with discount plans there are no caps. You keep getting the discount on all services for the entire year and the discounts do not end.

Factors to consider when choosing one option over another

At first glance, you may think the only difference between dental insurance and a dental discount plan is the cost and amount of coverage, but there’s more to consider.

When do you need coverage to start?

Some insurance plans may allow you to get a cleaning or X-ray right away, but there are often waiting periods.

It’s common to see six-month waits for for major services like crowns and implants. These waiting periods prevent consumers from abusing the insurance plan — using the insurance for a procedure and then dropping it right away.

By contrast, dental discount plans don’t have any waiting periods. It may take a few business days for your membership to go through. If you have an immediate (non-emergency) need, you may be able to pay for a dental discount plan and get a discount on the procedure a few days later.

How many options do you want?

An important consideration is how many dentists you have to choose from, and if there’s a well-rated in-network dentist nearby. If you already have a dentist you like, check with the office to see if it will accept the insurance or discount plans you’re considering.

Which option is best for you?

Compared with having no coverage at all, you can save money with either a dental insurance plan or a dental discount plan.

If you already have a dentist whom you like to visit and are looking to save money, your best bet may be to ask which options your dentist accepts and compare the costs for your general needs. When you don’t have a dentist, it can be a bit easier because you can choose the plan that offers the best coverage and then look at the list of dentists that accept the plan you chose.

For those who regularly get cleanings and don’t have a history of dental problems, a dental discount plan could provide adequate coverage for a low monthly fee. Although you may only break even or save a little money on your twice-a-year cleanings and annual X-ray, you’ll have some added security in knowing you can save money on other procedures. However, since the discount plan isn’t likely to cover the entire cost for major work, you may want to have some savings set aside for an emergency.

More ways to Save On Dental Care

With or without dental insurance, there are many ways to make dental care more affordable. Check out these strategies.

Get covered if you can.

If you’re a veteran and have a service-connected disability, you may be eligible for free comprehensive dental care from the Department of Veterans Affairs. Other veterans can buy dental insurance at a reduced rate and some Medicare Advantage plans offer plans specifically tailored to compliment your VA benefits with enhanced dental benefits..

Click here to find out how Veterans are winning with Medicare Advantage!

Time your treatments.

If you need an expensive procedure, ask your dentist whether you can space out the treatments so that you can apply the cost against two annual limits instead of one by starting near the end of one year and finishing in January.

Create a dental emergency fund.

Put aside money you might have used for premiums. Instead of paying an insurance company $50 per month for a plan, transfer that money to a savings account each month and use that money when you need it.

Check out medical expense accounts.

Ask whether your employer offers tax-advantaged accounts to help save and pay for dental expenses not covered by its insurance, such as a health flexible-spending account (FSA) or a health reimbursement account (HRA).

And if you have a high deductible health plan (HDHP), you can fund a Health Savings Account (HSA) with pre-tax money and use it on a range of healthcare costs including dental.

For most dental expenses the IRS will allow HSA payments for “diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body.” As long as the expenses are not eligible for reimbursement through insurance or other sources.

Go to a dental school.

You could pay 30 percent to 40 percent less on dental services at university dental schools compared to a private practice. You’ll get care from students supervised by dentists but the downside is that it’s very time consuming.

It’s much slower because the student is doing work under the supervision of an instructor. Visits are longer and care that could be done in a few sessions in a dental office could take a few months to complete.

Check a community health center.

Some community health centers offer dental care and charge on a sliding scale based on your income. But they may have limited services and, possibly, waiting lists. Call your local health department or state dental association, or go to Tooth Wisdom to find clinics near you.

Do some haggling.

Whether or not you have insurance, you pay a lot for expensive procedures so you should compare prices for big ticket items. Use FAIR Health to research prices where you live.

Dentists are often open to negotiating prices and may offer a discount if you pay for a procedure when you get the service. Some dentists also offer in-office dental plans for people without benefits.

Spread out services.

Many employer plans provide 100 percent coverage for getting a checkup twice a year. But if you’re paying on your own and in good dental health, once a year may be enough according to American Dental Association guidelines.

The ADA also says that adults with generally healthy teeth only need bitewing x-rays every 18 to 36 months. There’s no one-size-fits-all dental treatment though. You can go to the ADA’s MouthHealthy.org site for more information on paying for dental care, preventive care and recommended frequency of visits.

Medicare Rate Increases in 2026: Here’s What to Expect

Rate changes for 2026 won’t be officially announced until November 2025, with final adjustments based on that announcement. But we can already guess expected changes using projections and guidance from the Center for Medicare and Medicaid Services (CMS).

---

✅ 2026 Medicare Part B Premium Projections

• 2025 standard Part B premium: $185/month (a $10.30 increase over 2024) (Kiplinger, PlanWell Financial Planning, Centers for Medicare & Medicaid Services).
• 2026 projected standard premium: ~$186.90/month, up ~1.04% (Kiplinger).
• Part D plan changes:
  • New out-of-pocket cap increases to $2,100 in 2026 (up $100 from 2025) (Kiplinger).

---

📊 2026 IRMAA Brackets Estimate

IRMAA surcharges for high-income beneficiaries (based on 2024 MAGI, filed in 2025):

MAGI (Single / Joint)	Projected Part B + IRMAA Total	IRMAA Surcharge
≤ $109,000 / ≤ $218,000	$186.90 (no surcharge)	—
$109,001–137,000 / 218,001–274,000	$261.70	$74.80
$137,001–171,000 / 274,001–342,000	$373.80	$186.90
$171,001–205,000 / 342,001–410,000	$485.90	$299.00
$205,001–500,000 / 410,001–750,000	$598.10	$411.20
	$635.50	$448.60

(Source: Kiplinger and planwellfp projections) (Kiplinger, The Finance Buff)

Note: Part D surcharges are expected to rise more sharply—over 6% on average—for similar income brackets. 

These brackets are anticipatory, not final—CMS will release the official tables in November 2025, after reviewing CPI-U inflation changes. (Kiplinger)

---

ℹ️ Timeline & What Influences These Numbers

• IRMAA based on 2024 income (filed April 2025)
• CMS updates brackets annually in November, based on CPI-U. Expected inflation bump ~1–3%.
• Final premiums and surcharges published late in the year, after which Social Security notifies you. (PlanWell Financial Planning)

---

📈 How 2026 Medigap (Supplement) Premiums Might Change

• Medigap prices in Maine will likely rise in 2026, reflecting broader trends like inflation, rising healthcare costs, and insurer adjustments.
• In 2025, lowest Medigap plan premiums in Maine were around $198.60/month. Expect similar or slightly higher base pricing into 2026.
• Premiums vary by plan type (A–N), your age, gender, and health status. Costs tend to increase yearly.
• Talking to a local agent in October or November of 2025 is smart to compare options when rate filings are public.

---

Why All This Matters

• Budgeting: Even modest increases, like Part B rising from $185 to ~$187, impact monthly costs.
• High‑income earners: IRMAA can add serious surcharges—sometimes hundreds per month—based on how your income compares to threshold cutoffs.
• Medigap choice: Premium spikes can occur—shopping around during Open Enrollment (Jan-Mar) can pay off.

---

🛡️ Planning Tips

1. Watch for 2026 announcements in October and November 2025—CMS’s final rates and IRMAA tables will determine your actual 2026 costs.
2. Assess your 2024 Income : avoiding even a $1 income increase into a higher bracket could save you thousands.
3. Plan Medicare reviews in late September 2025, so you can compare new rates effective Jan 2026.
4. Consult a local agent for personalized support—especially those endorsed by Plan Advisors in Maine.

---

✅ Want My Help?

My services are free to you—I’m paid by insurance carriers, so you pay nothing! Call me at 207‑370‑0143 or use the contact form to ask questions or arrange a consult. We’ll review your unique situation and shop Medigap plans together.

“My goal is to help people … I have found great joy in being able to offer my services to people who need my help.”

---

Sources:

• CMS, 2025 Part B premium and deductible facts (Centers for Medicare & Medicaid Services, Kiplinger, Kiplinger, PlanWell Financial Planning)
• CMS projections of Part B premium/surcharge increases (Kiplinger)
• Part D out‑of‑pocket cap increase (Kiplinger)

Will My Medicare Supplement Insurance Premiums Go Up?

Medicare Supplement Insurance, or Medigap, provides coverage for certain Medicare Part A and Part B out-of-pocket expenses like deductibles, coinsurance and copayments.

The lowest cost Medigap plan premium in Maine currently is $198.60 per month.²

This cost figure is weighted, which means that some 2020 Medigap plan premiums in some areas may be higher.

Each type of Medigap plan offers a different combination of standardized benefits. Plans with fewer benefits may offer lower premiums.

Other factors such as age, gender, smoking status, health and where you live can also affect Medigap plan rates.

Medigap premiums can increase over time due to inflation and other factors, so you can typically expect Medigap plan premiums to be higher in 2021 than they are currently in 2020.

Compare 2020 Medicare Supplement Insurance Plan Costs

A licensed insurance agent can help you find Medigap plans that are available where you live. You can find out the types of benefits each available plan may offer, the insurance companies that sell them and the premium costs you can expect to pay.

You can request an online plan comparison for free, with no obligation to enroll.

A local Medicare Advisor will not only dig into the details for a plan best suited for you, but assist with any service related needs you encounter after your plan becomes effective. If priorities or prescriptions change from year to year, we will conduct policy reviews to determine whether another plan is worth considering.  

There is no substitute for a qualified, local professional to navigate Medicare insurance with. Check out our map to find one of our 32 local agents endorsed by Plan Advisors.  

Would you like my help?

If you would like help understanding your costs or need help finding a plan or if just want to ask a few questions, you can  207-370-0143 or use my simple form on the CONTACT page of this site to send an email message.  

The best part about working with me is that it will not cost you anything to talk with me to discuss your options and review the plans that are available.  I am an independent insurance agent and I am paid by the insurance companies (not you) in the form of a commission when you enroll in a plan.  

You will not pay anything to meet with me and you will pay the same price for your insurance that everyone pays whether they had my help or not.

“My goal is to help people and I have found great joy in being able to offer my services to people who need my help.”

Why You Need an Advocate by Your Side

Imagine this: you’re frantically searching for a doctor to help with a health issue that’s keeping you up at night. You search through your Medicare Advantage plan’s provider list online, call number after number, only to hear, “Sorry, we don’t take that plan,” or worse, “That doctor hasn’t worked here in years.” Your plan’s network is supposed to have your back, but it feels like chasing a ghost.

This isn’t just a hypothetical—it’s a heartbreaking reality for too many. Take the story of Ravi Coutinho, a 36-year-old Arizona man who died after struggling to find a mental health provider through his Ambetter plan, run by Centene Corporation. His mother, Barbara Webber, filed a wrongful death lawsuit on May 23, 2025, in Maricopa County, claiming Centene’s inaccurate provider lists—sometimes referred to as “ghost networks”—left Ravi without the care he desperately needed. Despite making 21 calls to Ambetter in early 2023, Ravi couldn’t find an in-network therapist, and his death was ruled accidental, likely tied to complications from excessive alcohol use.

Here’s the thing: when you call your insurance company’s helpline, the person on the other end might explain how your plan works, but they won’t tell you about your rights. And you have some powerful ones.

If your Medicare Advantage plan’s network is letting you down—meaning you can’t find a doctor, surgeon, or therapist to meet your needs—you’re not stuck. Federal rules say your plan must cover medically necessary care from an out-of-network provider at the same cost (copays or coinsurance) you’d pay in-network. This isn’t just a nice gesture—it’s the law, backed by the Centers for Medicare & Medicaid Services (CMS). It’s there to make sure you’re not left high and dry when your plan’s network falls short.

But here’s the catch: most people don’t even know this right exists. They don’t know who to call, what to say, or how to push back when the insurance company drags its feet. That’s where the system can feel like a maze, and too many people get lost in it.

That’s why having an agent in your corner is a game-changer.

When one of my clients calls me saying, “The insurance company says I can’t get the service or see the doctor I need.” I don’t just sympathize—I roll up my sleeves. I help them request out-of-network care at in-network costs. I walk them through the steps, make calls, and follow up to ensure they get the care they need. I’m not just an agent—I’m their advocate.

Without an agent, you’re not just risking enrolling in a bad plan. You’re risking facing this confusing system alone.
If you’re my client, know this: you’ve got someone fighting for you. If you’re not, maybe it’s time we had a chat.

Certainly this short article does not cover everything related to your rights with Medicare Advantage plans so if you would like to talk about this more of have additional questions about your rights or another topic, you can reach me at 207-370-0143 or use my simple form on the CONTACT ME page of this site to send an email message.

The best part about working with me is that my help is free.  I do not charge anyone anything to discuss your options or to review the plans that are available.  I am paid by the insurance companies in the form of a commission if you enroll in a plan, just like your car insurance or home owners insurance agent – and I will work just as hard to help you find the best plans to compare!

You will not pay any more than anyone else and you are under no obligation whatsoever to enroll in any plans if you meet with me.  My goal is to help you and I have found great joy in being able to offer my services to people who need my help.

***

***

***

Sources
• CMS Network Rules: Medicare Advantage plans must have enough providers to cover your needs, per federal rules in 42 CFR § 422.116.
• Your Right to Out-of-Network Care: If your plan’s network doesn’t have the providers you need, federal law (42 CFR § 422.112(a)(1)(iii) and Medicare Managed Care Manual, Chapter 4, Section 110.1.1) says your plan must cover out-of-network care at in-network costs for medically necessary services.
• Appeals Process: If your plan denies out-of-network coverage, you can appeal through their grievance process, as outlined by CMS.

Updated 2025 Medicare & You Handbook
Available online at: https://www.medicare.gov/index.php/medicare-and-you

Summary: The Medicare & You 2025 handbook is available free of charge. It’s published by the Centers for Medicare & Medicaid Services (CMS). This is the official government guide explaining the Medicare program in detail. You can get Medicare & You in a variety of formats. You can get the handbook in an electronic, PDF form or paper form and in English, Spanish, large print, Braille, or audio.

Medicare & You 2025 Handbook

Medicare & You 2025 is an official government publication. Millions of people receive the Medicare & You handbook at their homes by mail each year. CMS usually mails the Medicare & You handbook in the fall of each year. This is to help prepare people for the Annual Election Period, which occurs October 15th to December 7th each year. During this time, Medicare beneficiaries can review their Medicare coverage and make changes, if they want.

Frequently Asked Questions (FAQ)

I’ve had Medicare for a number of years. Why is the Medicare & You 2025 Handbook important to me?
Each year, the Centers for Medicare & Medicaid Services (CMS) publishes a revised Medicare & You Handbook. The purpose of the Medicare & You Handbook is to provide Medicare beneficiaries with up-to-date information about the Medicare program. If you’ve been enrolled in Medicare for a few years, you may want to use the Medicare & You 2025 as a reference guide to the current features of the Medicare program and your rights as a Medicare beneficiary.

What topics are included in the Medicare & You 2025 Handbook?

The Medicare & You Handbook contains information on

• Medicare Part A (hospital insurance)
• Medicare Part B (outpatient/medical insurance)
• Medicare Supplement (Medigap) insurance
• Medicare Advantage plans
• Medicare Part D prescription drug coverage and information on out of pocket maximums
• Medicare & You 2025 lists many Medicare-covered services.
• Medicare Part A and Part B under the federal Medicare program with Medicare Advantage. Inside Medicare & You 2025 you’ll also find information on such topics as getting help with the cost of Part D prescription drug coverage, and much more.

What topics are not included in the Medicare & You 2025 Handbook?

Medicare & You 2025 doesn’t include plan-specific information – for example, when it comes to Medicare Advantage plans or Medicare prescription drug plans. If you have a Medicare Advantage or Medicare prescription drug plan, you’ll find plan-specific information in your plan’s 2022 Evidence of Coverage and Summary of Benefits. The Annual Notice of Change (ANOC) explains changes in the 2023 plan and benefits.

What if I didn’t get a Medicare & You 2025 handbook in the mail?

You can call Medicare at 1-800-MEDICARE (1-800-633-4227) 24 hours a day, 7 days a week. TTY/TTD users can call 1-877-486-2048. A Medicare representative can check your address on file and get a Medicare & You 2025 handbook mailed to your home.

Can I get the Medicare & You 2025 Handbook in other formats?

Yes. You can get an electronic version of Medicare & You 2025 from the Medicare website. In fact, if you want to “go green” as the kids say these days and inform Medicare you wish to receive communications electronically rather than by postal mail. You can download a PDF to your computer. Keep in mind Medicare & You is about 130 pages long. If you choose to keep it in an electronic format, you can find topics using key word searches and hyperlinks from the table of contents. You can get the Medicare & You 2024 handbook in English or Spanish. You can also download a copy of Medicare & You in large print or Braille. You can listen to audio podcasts of Medicare & You 2025 chapters. Finally, you can order paper or CD versions of Medicare & You by calling Medicare at 1-800-MEDICARE (1-800-633-4227) 24 hours a day, 7 days a week. TTY/TTD users can call 1-877-486-2048. You get Medicare & You free of charge.

Would you like to learn more about your Medicare coverage options?
I can help. Give me a call at 207-370-0143 or email by clicking here.

More information on Plans & Costs in 2025

Learn more about Medicare Supplement (Medigap) and costs

Learn more about the difference between Medicare Advantage and Medigap Plans

Lower income?  Find out how you can reduce your costs in 2024.

How do I get $100 added to my Social Security?

Medicare Part B Premium will be $174.70 in 2024

Medicare Part B covers doctors and specialist visits, outpatient hospital services, certain home health services, durable medical equipment, and certain other medical and health services not covered by Medicare Part A.

Each year, the Medicare Part B premium, deductible, and coinsurance rates are determined according to provisions of the Social Security Act. The standard monthly premium for Medicare Part B enrollees will be $174.70 for 2024, an increase of $9.80 from $164.90 in 2023. The annual deductible for all Medicare Part B beneficiaries will be $240 in 2024, an increase of $14 from the annual deductible of $226 in 2023.

Income-Related Adjustments

Since 2007, some people who make more money may have to pay more for their Medicare coverage. This is called an income-related adjustment amount (IRMAA). These income-related monthly adjustment amounts affect roughly 8 percent of people with Medicare Part B. The 2024 Part B total premiums for high-income beneficiaries with full Part B coverage are shown in the following table:

Full Part B Coverage
Beneficiaries who file individual tax returns with modified adjusted gross income:	Beneficiaries who file joint tax returns with modified adjusted gross income:	Income-Related Monthly Adjustment Amount	Total Monthly Premium Amount
Less than or equal to $103,000	Less than or equal to $206,000	$0.00	$174.70
Greater than $103,000 and less than or equal to $129,000	Greater than $206,000 and less than or equal to $258,000	$69.90	$244.60
Greater than $129,000 and less than or equal to $161,000	Greater than $258,000 and less than or equal to $322,000	$174.70	$349.40
Greater than $161,000 and less than or equal to $193,000	Greater than $322,000 and less than or equal to $386,000	$279.50	$454.20
Greater than $193,000 and less than $500,000	Greater than $386,000 and less than $750,000	$384.30	$559.00
Greater than or equal to $500,000	Greater than or equal to $750,000	$419.30	$594.00

Medicare Part D Income-Related Monthly Adjustment Amounts

Since 2011, a beneficiary’s Part D monthly premium has been based on his or her income. These income-related monthly adjustment amounts affect roughly 8 percent of people with Medicare Part D. These individuals will pay the income-related monthly adjustment amount in addition to their Part D premium. Part D premiums vary by plan and regardless of how a beneficiary pays their Part D premium, the Part D income-related monthly adjustment amounts are deducted from Social Security benefit checks or paid directly to Medicare. The 2024 Part D income-related monthly adjustment amounts for high-income beneficiaries are shown in the following table:

Beneficiaries who file individual tax returns with modified adjusted gross income:	Beneficiaries who file joint tax returns with modified adjusted gross income:	Income-related monthly adjustment amount
Less than or equal to $103,000	Less than or equal to $206,000	$0.00
Greater than $103,000 and less than or equal to $129,000	Greater than $206,000 and less than or equal to $258,000	$12.90
Greater than $129,000 and less than or equal to $161,000	Greater than $258,000 and less than or equal to $322,000	$33.30
Greater than $161,000 and less than or equal to $193,000	Greater than $322,000 and less than or equal to $386,000	$53.80
Greater than $193,000 and less than $500,000	Greater than $386,000 and less than $750,000	$74.20
Greater than or equal to $500,000	Greater than or equal to $750,000	$81.00

Premiums for high-income beneficiaries who are married and lived with their spouse at any time during the taxable year but file a separate return, are as follows:

Beneficiaries who are married and lived with their spouses at any time during the year, but file separate tax returns from their spouses with modified adjusted gross income:	Income-related monthly adjustment amount
Less than or equal to $103,000	$0.00
Greater than $103,000 and less than $397,000	$74.20
Greater than or equal to $397,000	$81.00

Medicare Part A Premium and Deductible

Medicare Part A covers inpatient hospitals, skilled nursing facilities, hospice, inpatient rehabilitation, and some home health care services. About 99 percent of Medicare beneficiaries do not have a Part A premium since they have at least 40 quarters of Medicare-covered employment, as determined by the Social Security Administration.

Most people have insurance plans to over the Part A deductibles and cost shares listed below. If you have questions about what you will have to pay in 2024 call the member services number on the back of your insurance card or schedule a call with a local agent using the blue button at the bottom of th page.

The Medicare Part A inpatient hospital deductible that beneficiaries pay if admitted to the hospital will be $1,632 in 2024, an increase of $32 from $1,600 in 2023. The Part A inpatient hospital deductible covers beneficiaries’ share of costs for the first 60 days of Medicare-covered inpatient hospital care in a benefit period. In 2024, beneficiaries must pay a coinsurance amount of $408 per day for the 61^st through 90^th day of a hospitalization ($400 in 2023) in a benefit period and $816 per day for lifetime reserve days ($800 in 2023). For beneficiaries in skilled nursing facilities, the daily coinsurance for days 21 through 100 of extended care services in a benefit period will be $204.00 in 2024 ($200.00 in 2023).

Part A Deductible and Coinsurance Amounts for Calendar Years 2023 and 2024 by Type of Cost Sharing
	2023	2024
Inpatient hospital deductible	$1,600	$1,632
Daily hospital coinsurance for 61st-90th day	$400	$408
Daily hospital coinsurance for lifetime reserve days	$800	$816
Skilled nursing facility daily coinsurance (days 21-100)	$200.00	$204.00

Enrollees age 65 and older who have fewer than 40 quarters of coverage and certain persons with disabilities pay a monthly premium in order to voluntarily enroll in Medicare Part A. Individuals who had at least 30 quarters of coverage or were married to someone with at least 30 quarters of coverage may buy into Part A at a reduced monthly premium rate, which will be $278 in 2024, the same amount as 2023. Certain uninsured aged individuals who have less than 30 quarters of coverage and certain individuals with disabilities who have exhausted other entitlement will pay the full premium, which will be $505 a month in 2024, a $1 decrease from 2023.

For more information on the 2024 Medicare Parts A and B premiums and deductibles (CMS-8083-N, CMS-8084-N, CMS-8085-N), please visit https://www.federalregister.gov/public-inspection.

Exploring Financial Assistance Options

If you’re worried about the costs of Medicare going up, there are programs that can help. These programs give financial assistance to families who need it. They can help you with the extra costs of Medicare. You can read more about these programs here: https://www.mainemedicareoptions.com/qmb/

Seeking Expert Guidance

This is where I come in!  Understanding changes in Medicare can be a little confusing, but there are people like me who can help you. As someone who knows a lot about Medicare, I can explain things in a way that makes sense and help you understand what you need to know so you can plan for the changes coming in 2024 and 2025.

In 2025, there will be some additional changes to the Medicare program. By learning about these changes and talking to an expert, you can be prepared and understand what it means for you and your family. Remember, there are programs that can help with the costs, and experts who can explain things better. By being informed and planning ahead, you can make sure you have the healthcare you need when the changes come in 2024 and 2025.   

Do you have a Health Savings Account (HSA) & Medicare Part A and/or B?

As you navigate the world of Medicare, it’s crucial to have a clear understanding of how various aspects of your healthcare coverage work together. One component that often raises questions is the interaction between Medicare and Health Savings Accounts (HSAs).  When I meet people who have had High Deductible Health Insurance Plans in the past and have contributed money to a tax-free Health Savings Account (HSA) over the years I often get asked how that works with Medicare.  Here are some of the most common questions I get asked.

Medicare Eligibility and HSAs

Once you enroll in Medicare Part A or Part B, typically at age 65, you are no longer allowed to contribute to your HSA. However, you can continue to withdraw funds from your existing HSA to pay for qualified medical expenses, including Medicare premiums, deductibles, copayments, and certain prescription drugs.

Medicare Part A and HSAs:

Medicare Part A is typically provided at no cost to most individuals. However, if you choose to delay enrolling in Part A while contributing to an HSA, it’s essential to cease contributions six months before your Medicare coverage begins to avoid potential tax penalties.

Approved HSA Expenses Specific To Medicare

You CAN use your HSA for any qualified medical expenses approved by the IRS, including:

• Premiums paid to Medicare (i.e. Part B, Part B IRMAA, Part D IRMAA)
• Premiums paid to an insurance carrier for Stand-Alone Part D Prescription Drug Plans
• Premiums paid to an insurance carrier for a Medicare Advantage Plan (Part C)
• Medical copays, coinsurance, deductibles
• Prescription drug copays
• Dental, vision, hearing costs

You CANNOT use your HSA to pay your:

• Premiums paid to an insurance carrier for a Medicare Supplement (Medigap) plan

Understanding the interaction between Medicare and Health Savings Accounts (HSAs) is crucial for making informed decisions about your healthcare and financial well-being. While Medicare eligibility restricts HSA contributions, HSAs can still be a valuable tool for covering medical expenses during your retirement. Remember to consult with your financial advisor or tax professional to explore the best strategies for optimizing your healthcare expenses and preserving your savings. With this knowledge, you can confidently navigate the complexities of Medicare and HSAs, ensuring your healthcare needs are met while maintaining financial stability.

Certainly this website does not cover everything related to HSAs and Medicare so if you would like to talk about this more of have additional questions about your HSA or another topic, you can reach me at 207-370-0143 or use my simple form on the CONTACT ME page of this site to send an email message.

The best part about working with me is that my help is free.  I do not charge anyone anything to discuss your options or to review the plans that are available.  I am paid by the insurance companies in the form of a commission if you enroll in a plan, just like your car insurance or home owners insurance agent – and I will work just as hard to help you find the best plans to compare!

You will not pay any more than anyone else and you are under no obligation whatsoever to enroll in any plans if you meet with me.  My goal is to help you and I have found great joy in being able to offer my services to people who need my help.

Your Medicare card is proof of your Medicare insurance. If your Medicare card was lost, stolen, or destroyed, you can request a replacement with your personal my Social Security account.

If you don’t already have an account, you can create one online. Go here: https://www.ssa.gov/myaccount

• Once you are logged in to your account, select the “Replacement Documents” tab.
• Then select “Mail my replacement Medicare card.”

Your Medicare card will arrive in the mail in about 30 days at the address on file with Social Security so be sure to make sure your mailing address is correct before completing the request.

If you need to know your new Medicare number now, you have some options. In your personal my Social Security account, you can get your Benefit Verification Letter, which includes your Medicare number. You can also visit Medicare.gov and sign in to see your Medicare number and print an official copy of your card. If you don’t have a Medicare.gov account, go to Medicare.gov and select “Log In/Create Account”. But, you will need your Medicare ID number to create an account.

If you cannot access your My Social Security Account or prefer not to use the online service, you can call 1-800-MEDICARE (1-800-633-4227) to request a replacement card be mailed to you.

Read more:

Need help paying for prescriptions and other Medicare expenses?

How to get Dental coverage if your have Medicare

Are you a Veteran. You can get so much more from Medicare!