Compliance News | November 21, 2025
The Centers for Medicare & Medicaid Services (CMS) has released the Medicare Part B premiums and deductible and the Part A deductible and coinsurance that will take effect on January 1, 2026. The standard Part B premium will increase by nearly 10 percent and the Part B deductible for all Medicare beneficiaries will increase by just over 10 percent. The Medicare Part A inpatient deductible and coinsurance for hospital stays and care in a skilled nursing facility will increase by more than 3 percent.
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Sponsors of group health plans that cover retirees need to know this information when reviewing their coverage for Medicare-eligible retirees, including those enrolled in Medicare Advantage Plans.
Part B covers physician services, outpatient hospital services, certain home health services, durable medical equipment and other items. According to the November 14, 2025 announcement, the standard monthly Part B premium will be $202.90, an increase of $17.90. In 2026, the annual deductible for Medicare Part B beneficiaries will be $283.00, an increase of $26.00.
CMS stated that the increase in the 2026 Part B standard premium and deductible is mainly due to projected price changes and assumed utilization increases that are consistent with historical experience.
| 2025 | 2026 | |
| Standard monthly Part B premium | $185.00 | $202.90 |
| Medicare Part B deductible | $257.00 | $283.00 |
High-income Medicare-eligible individuals who enroll in the Part B and D programs are required to pay income-related monthly adjustment amount (IRMAA) premiums. The IRMAA is calculated based upon an enrollee’s modified adjusted gross income and income tax filing status. The income-adjusted premiums for 2026 are shown in the table below.
The Part D IRMAA is in addition to the individual’s Part D premium. CMS projects the average base monthly premium for standard Part D coverage will be $38.99 for 2026, up from $36.78 in 2025.
| Income Ranges for Individual Return Tax Filing Status* | Income Ranges for Joint Return Tax Filing Status | Monthly Adjustment Amounts for Part B Premium | Total Monthly Part B Premium |
Part D Premium Monthly Adjustment Amounts |
| $109,001 to $137,000 | $218,001 to $274,000 | $81.20 | $284.10 | $14.50 |
| $137,001 to $171,000 | $274,001 to $342,000 | $202.90 | $405.80 | $37.50 |
| $171,001 to $205,000 | $342,001 to $410,000 | $324.60 | $527.50 | $60.40 |
| $205,001 to $499,999 | $410,001 to $749,999 | $446.30 | $649.20 | $83.30 |
| $500,000+* | $750,000+* | $487.00 | $689.90 | $91.00 |
* Married beneficiaries with incomes of more than $109,000 and less than $391,000 who file a separate return from their spouse and lived with their spouse at some time during the taxable year must pay the following Part B monthly premium adjustment in 2026: $446.30 (resulting in a total monthly premium of $649.20). (The Part D monthly adjustment for these couples will be $83.30.) Married beneficiaries with income of more $391,000 who file a separate return from their spouse and lived with their spouse at some time during the taxable year must pay the following premium adjustment in 2026: $487.00 (resulting in a total monthly premium of $689.90). (The Part D monthly adjustment for these couples will be $91.00.)
Medicare enrollees who receive a kidney transplant lose eligibility for full Medicare coverage after 36 months. They can elect to pay a premium to continue Part B coverage of only immunosuppressive drugs. In 2026, the immunosuppressive drug premium will be at least $121.60 per month. High-income beneficiaries will pay a higher premium for this coverage, as shown in the following table.
| Income Ranges for Individual Return Tax Filing Status* | Income Ranges for Joint Return Tax Filing Status | Monthly Adjustment Amounts | Total Monthly Premium |
| $109,001 to $137,000 | $218,001 to $274,000 | $81.10 | $202.70 |
| $137,001 to $171,000 | $274,001 to $342,000 | $202.70 | $324.30 |
| $171,001 to $205,000 | $342,001 to $410,000 | $324.30 | $445.90 |
| $205,001 to $499,999 | $410,001 to $749,999 | $445.90 | $567.50 |
| $500,000+* | $750,000+* | $486.50 | $608.10 |
* Married beneficiaries with incomes of more than $109,000 and less than $391,000 who file a separate return from their spouse and lived with their spouse at some time during the taxable year must pay the following premium adjustment in 2026 for Part B immunosuppressive drug coverage: $445.90 (resulting in a total monthly premium for that coverage of $567.50). Married beneficiaries with income of more $391,000 who file a separate return from their spouse and lived with their spouse at some time during the taxable year must pay the following premium adjustment in 2026 for Part B immunosuppressive drug coverage: $486.50 (resulting in a total monthly premium for that coverage of $608.10).
Part A pays for inpatient hospital, skilled nursing facility, hospice and certain home healthcare services.
| 2025 | 2026 | |
| First-day Part A hospital deductible | $1,676.00 | $1,736.00 |
| Daily Part A coinsurance for the 61st through 90th day of a hospital stay* | $419.00 | $434.00 |
| Daily Part A coinsurance for hospital stays longer than 90 days | $838.00 | $868.00 |
| Daily Part A coinsurance for the 21st through 100th day in a skilled nursing facility | $209.50 | $217.00 |
* There is no cost-sharing requirement for the second through 60th day of a hospital stay.
Many public plans and employers have current and future retirees that do not have, or will not qualify for, zero-premium Part A coverage. Alternative market opportunities and strategies exist to provide benefits to these retirees in a more effective manner.
The premium increase is potentially significant, particularly for low-wage beneficiaries and for plan sponsors that reimburse all or part of an individual’s Part B premium. Plan sponsors that reimburse a portion of these premiums for Medicare-eligible retirees should ensure that plan documents clearly state the terms for premium reimbursement. Terms that are vague or unclear should be clarified. Plan sponsors should also determine whether they will pay any part of the IRMAA premiums.
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