2026 Medicare Supplement Changes

What’s Happening in the 2026 Medicare Supplement Market?

New Medicare Pre-Authorization Requirements

Beginning January 1, 2026, per the Wasteful and Inappropriate Services Reduction (WISeR) Model, Medicare will require pre-authorizations for specific procedures in 6 test states, including Ohio, Arizona, Texas, New Jersey, Oklahoma, and Washington. These pre-authorizations are only for procedures identified as key contributors to wasteful spending, including fraudulent or abusive billing practices, services with little or no clinical benefit, or services in which the risk of harm outweighs the potential benefit.

Physicians will need to get a pre-authorization for the following procedures; Electrical Nerve Stimulators, Sacral Nerve Stimulation for Urinary Incontinence, Phrenic Nerve Stimulator, Deep Brain Stimulation for Essential Tremors and Parkinson’s, Vagus Nerve Stimulation, Induced Lesions of Nerve Tracts, Epidural Steroid Injections for Pain Management excluding facet joint injections, Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture, Cervical Fusion, Arthroscopic Lavage and Arthroscopic Debridement for the Osteoarthritic Knee, Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea, Incontinence Control Devices, Diagnosis and Treatment of Impotence, Percutaneous Image-Guided Lumbar Decompression for Spinal Stenosis, Skin and Tissue Substitutes in certain instances.  Your doctor will be well-versed in the process of obtaining pre-authorization, so there’s nothing you’ll need to do.  It’s not your Medicare Supplement that requires preauthorization; it’s Medicare itself.

Why Did Medicare Supplement Premiums Increase So Much?

Medicare Supplements have incurred larger increases across the board than in previous years, for two main reasons. It’s primarily due to the COVID-19 pandemic and the Birthday/Anniversary rules already in effect in 20 states. The Birthday or Anniversary rule allows a one-time-per-year Guarantee Issue opportunity to change Supplement plans (with some restrictions) without medical underwriting.   This is excellent news for anyone who hasn’t passed underwriting, as it allows them to purchase a new policy at potentially lower rates. Still, it’s also contributing to the increases in those states for everyone because the companies are forced to accept otherwise uninsurable applicants.  You can change your Medicare Supplement at any time of year if you answer a few health questions and pass the underwriting guidelines.

How To Lower Your Medicare Supplement Premiums

There are two ways to lower your Medicare Supplement premiums.  Either change the company or change the plan.

• If you have a Plan G with Company X, you may be able to keep Plan G and get a lower premium with Company Z
• If there aren’t any companies that offer a lower premium for Plan G, you could change to a Plan N or High Deductible G and still have great coverage

Unless you’re under age 68, your rates are probably going up anywhere from 8% to 25% this year for plans G or F.  Rate increase percentages on plans N and high deductible versions of G (HDG) and F (HDF) have been, and should continue to be, a lower percent increase than an the increase for a regular plan G or F.

What’s The Difference Between Plans N, G, and F?

• Plan N doesn’t cover Part B Excess, which can be up to 15% more than the Medicare-approved rate.  Only 1%-2%% of physicians charge excess fees, and unless you live in one of the very few exclusive areas of the country where physicians commonly charge excess, it’s unlikely you’ll ever be billed for excess charges. If you get medical care in Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, or Vermont, you won’t be subject to excess charges because those states don’t allow providers to charge excess fees.
• You might get billed up to $20 for an office visit if the provider doesn’t accept Medicare assignment. This doesn’t apply to physical therapy or blood work visits; it’s only when you see the doctor.
• If you go to an emergency room and you’re NOT admitted, you’ll be billed $50.

If you’re interested in exploring lower premiums with another company for the same plan or a more affordable option with an N or HDG/HDF, call (614) 402-5160 or click LOWER MY MEDICARE SUPPLEMENT PREMIUMS to request a call back to get a comparison of your options and prices.

Keep in mind that no matter what new bills are passed, your Medicare Supplement benefits under your current policy will not change. The only change you will ever have with your Medicare Supplement policy is an increase in your premiums.  We’re here to help. Please don’t hesitate to ask, and we can review your options.

2026 Medicare Deductibles, Premiums, Copays, Coinsurance And IRMAA

Part A Deductible and Coinsurance Amounts for Calendar Years 2025 and 2026
	2025	2026
Inpatient hospital deductible	$1,676	$1,736
Daily hospital coinsurance for 61st-90th day	$419	$434
Daily hospital coinsurance for lifetime reserve days	$838	$868
Skilled nursing facility daily coinsurance (days 21-100)	$209.50	$217

Medicare Part B Premium and Deductible

Medicare Part B covers physicians’ services, 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 $202.90 for 2026, an increase of $17.90 from $185.00 in 2025. The annual deductible for all Medicare Part B beneficiaries will be $283 in 2026, an increase of $26 from the annual deductible of $257 in 2025.

Medicare Part B Income-Related Monthly Adjustment Amounts (IRMAA)

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

Your yearly income in 2024 determines your total Medicare Part B 2026 Premiums			You pay each month (in 2026)
File individual tax return	File joint tax return	File married & separate tax return
$109,000 or less	$218,000 or less	$109,000 or less	$202.90
above $109,000 up to $137,000	above $218,000 up to $274,000	Not applicable	$284.10
above $137,000 up to $171,000	above $274,000 up to $342,000	Not applicable	$405.80
above $171,000 up to $205,000	above $342,000 up to $410,000	Not applicable	$527.50
above $205,000 and less than $500,000	above $410,000 and less than $750,000	above $109,000 and less than $391,000	$649.20
$500,000 or above	$750,000 or above	$391,000 or above	$689.90

 

Medicare Part D (Drug Coverage) Income-Related Monthly Adjustment Amounts (IRMAA)

Your yearly income in 2024 determines your Medicare Part D IRMAA (extra cost on top of Part D Premium)
File individual tax return	File joint tax return	File married & separate tax return	You pay each month (in 2026)
$109,000 or less	$218,000 or less	$109,000 or less	Your 2026 Part D plan premium
above $109,000 up to $137,000	above $218,000 up to $274,000	not applicable	$14.50 + your plan premium
above $137,000 up to $171,000	above $274,000 up to $342,000	not applicable	$37.50 + your plan premium
above $171,000 up to $205,000	above $342,000 up to $410,000	not applicable	$60.40 + your plan premium
above $205,000 and less than $500,000	above $410,000 and less than $750,000	above $109,000 and less than $391,000	$83.30 + your plan premium
$500,000 or above	$750,000 or above	$391,000 or above	$91.00 + your plan premium

*Amounts listed above do not include late enrollment penalties for Medicare Part B or D