Newsletter

SOCIAL SECURITY COLA FOR 2026 — WHAT IT MEANS FOR YOUR MONTHLY CHECK

The Social Security Administration announced a 2.8% cost-of-living adjustment (COLA) for 2026 on October 24, 2025. This increase, based on inflation data from the Consumer Price Index for Urban Wage Earners and Clerical Workers (CPI-W), will help offset rising costs in essentials like food, housing, and healthcare.

Key Numbers:

• The average monthly retirement benefit will rise from $2,015 to $2,071 — a $56 increase.

• SSI payments will increase to $994/month for individuals and $1,491/month for couples.

• The COLA takes effect with December 2025 benefits, which will be paid in January 2026.

While the increase is welcome, many seniors note that rising Medicare premiums and out-of-pocket costs may absorb much of the gain. Unless a beneficiary has been required to make IRMAA payments in the past, there is a safe harbor guarantee that any increase in the Medicare Part B premium cannot exceed the increase in Social Security benefits. Planning ahead is key to making the most of this adjustment.

PROJECTED MEDICARE CHANGES FOR 2026

As we approach the 2026 coverage year, Medicare beneficiaries face notable cost increases across Original Medicare. While final figures will be confirmed by CMS in November 2025, projections from the Medicare Trustees Report and industry experts offer a reliable preview. Here's what to expect for Part A and B premiums, deductibles, coinsurance, and IRMAA thresholds.

Part B Premiums: the standard monthly premium is projected to rise from $185 in 2025 to $206.50 in 2026. See below for information about how IRMAA (income related monthly adjustment amounts) are expected to change for 2025.

Part A Costs: Hospital Coverage

• Deductible (per benefit period): Rising from $1,676 to $1,716

• Hospital Coinsurance

• Days 61–90: Increasing from $419/day to $429/day.

• Lifetime reserve days (beyond day 90): From $838/day to $858/day

• Skilled Nursing Facility Coinsurance (days 21–100): Expected to reach $214.50/day.

Reminder: Part A deductibles apply per benefit period, not annually — multiple hospitalizations can trigger multiple deductibles.

 Part B Costs: Outpatient and Preventive Care

• Annual Deductible: Increasing from $257 to $288

• Coinsurance: After meeting the deductible, Medicare covers 80% of approved charges. Beneficiaries pay the remaining 20%, unless covered by Medigap or other supplemental insurance.

Note:  changes in Part A and B copays and deductibles will apply ONLY to those on Original Medicare, with or without Medicare Supplements. Medicare Advantage beneficiaries are not affected, as their hospital and provider charges are contractual commitments made between Medicare and their Medicare Advantage carrier and are not affected by changes in Parts A and B copays and deductibles.

2026 Medicare IRMAA Projections: Part B and Part D

Beneficiaries with higher incomes will pay more for Part B of Medicare and slightly less for Part D drug coverage. IRMAA is based on your 2024 tax return (or the latest return if a 2024 return has not been filed) and determined by the Social Security Administration. Affected individuals are notified via IRMAA letters that arrive in November or December.

The threshold for both Parts B and D IRMAA will change from $106,000 (single) to $109,000, and the threshold for married couples filing jointly will increase from $212,000 to $218,000. The top tier for IRMAA payments will remain at $500,000 (single) and $750,000 (filing jointly).

Part B IRMAA payments for the lowest tier are projected to increase from $259.00 to $289.10 ($30.10 increase) and payments for the top tier are projected to increase $73.20 (from $628.90 to $702.10).

The Part D IRMAA (this is a surcharge to the Part D premium) is projected to decrease from $13.70 to $12.90 for the lowest tier and from $85.80 to $81.00 for the highest tier.

We'll publish the new tables on our website as soon as they are finalized and will include the new tables in the December newsletter.

Note: Part B IRMAA is applicable to everyone with income that meets the IRMAA minimums, whether they are on Original Medicare, Original Medicare with a Medicare Supplement, or a Medicare Advantage plan. Part D IRMAA is applicable to anyone who has Part D coverage either through a Medicare Advantage Prescription Drug plan or stand-alone Part D coverage. Those who do not have Part D coverage will not be assessed a Part D IRMAA, but they will have a late enrollment penalty if they ever enroll in either a Medicare Advantage Prescription Drug plan or a stand-alone drug plan.



EARLY AEP: WHAT BENEFICIARIES ARE SEEING AND FEELING

In the first few weeks of Medicare’s Annual Enrollment Period (October 15–December 7), beneficiaries are diving into plan comparisons, reacting to copay and maximum out-of-pocket benefit increases; referral requirements imposed by some carriers that did not formerly require them; and navigating network changes. Many are surprised by reduced supplemental benefits or formulary shifts—and are reaching out early to avoid auto-renewals or coverage gaps.

Some plans are terminating as of December 31, and beneficiaries with terminating plans must enroll in a new plan by December 31 to avoid a gap in coverage. (They will not be able to enroll in a new plan at all if they don’t act by February 28.)

Those with PPO plans are especially affected. Some beneficiaries are retaining their present plan partly because their current plan covers their provider(s) and/or they have been happy with the service and benefits the carrier has provided in the past.

Others are changing to a PPO carrier offering higher benefits, even though in some cases one or more of their current providers are not in network. Some are switching to an HMO-POS version of their current plan with lower copays and lower maximum out-of-pocket costs, where the same doctors are in-network for both their present PPO and the HMO-POS.

We are fielding higher volumes of questions and requests to enroll in different plans than we have ever experienced.

Early action means better access to preferred providers and less stress as the deadline nears.



Please contact us, preferably on 561-734-3884 (land) or, if you can’t, reach us on that line on our cell at 786-970-0740.

We are servicing all our existing clients and prospects wanting to make changes in their Medicare Supplement or Medicare Advantage plan, but are unable to help non-existing clients seeking only to review their present Part D drug coverage to determine if they should change to different stand-alone Part D coverage. 

About Paul Cholak

Paul is a licensed, independent health and life insurance agent and has over forty years of benefits experience and specializes in helping Medicare beneficiaries obtain health insurance. However, he offers a complete array of life and health insurance products to individuals of all ages.

He guides Medicare beneficiaries through the steps of getting insurance and is available to help clients both BEFORE and AFTER they've made their purchase decision.

Disclaimer for Part C and D plans: "We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY: 1-877-2048) to get information on all your options."

Contact Us

Local: 561-734-3884 (TTY: 711)

Toll-free: 877-734-3884 (TTY:711)