Medicare cost increases

Medicare is an essential lifeline for older (and disabled) people.

If Social Security is a person’s only income the Medicare deduction is a big deal. Poor people may be forced into Medicare Advantage because they can’t afford the standard Medicare premiums.

For high-income retirees, the IRMAA surcharge can be a big hit, especially if the income is a taxable RMD from an IRA and not actual income.

https://www.nytimes.com/2025/11/22/business/what-to-know-about-the-nearly-10-climb-in-a-key-medicare-expense-for-2026.html

What to Know About the Nearly 10% Climb in a Key Medicare Expense for 2026

The rapidly rising premium for Part B, which covers retirees’ outpatient services, reflects the fast pace of growth for health care costs nationally.

By Mark Miller, The New York Times, Nov. 22, 2025

The standard Part B premium, which covers services such as physician visits and hospital outpatient care, will be $202.90 a month — up 9.7 percent. Next year is the first time the monthly premium will exceed $200 — and it will be 66 percent higher than a decade ago.

The annual Part B deductible will also climb, to $283, up 70.5 percent over the past 10 years….

The new numbers reflect general increases in the cost of health care. National health expenditures rose about 8 percent in 2024, federal data shows, and are expected to outpace gross domestic product growth over the coming decade. Another cause for the rising Part B costs is a shift in health care delivery from hospitals to outpatient settings. More care and medications are being delivered in these settings…

Medicare spends about $80 billion more annually for Medicare Advantage enrollees than it would if they were enrolled in traditional Medicare, leading to higher spending for both Part A (which covers hospitalization) and Part B….

think about health care costs as part of an annual budgeting process that may change from year to year along with their health and medical needs. The projection should include insurance premiums, out-of-pocket expenses and any extras such as hearing, vision or dental services or an expected long-term-care need…. [end quote]

The government does provide financial assistance called Medicare Savings Programs for low-income seniors.

https://www.nytimes.com/2025/10/04/business/medicare-medicaid-low-income-seniors.html

The U.S. Census Bureau reported last month that the percentage of Americans aged 65 or older living in poverty rose in 2024 to 15 percent — up from 14.2 percent in 2023 and 10.7 percent in 2021 — the only age group that saw an increase in poverty.

Health care costs are a major culprit in that increase. Medicare Part B and D premiums and cost sharing account for nearly 25 percent of average monthly Social Security benefits, according to KFF — and that figure does not include other costs, such as dental care, long-term care or premiums for supplemental Medicare coverage, known as Medigap. Taking those costs into account, health care spending consumes 39 percent of Social Security benefits on average, KFF found.

The most affluent seniors can tap into savings to meet health expenses, but that’s not the case for most. Forty percent of older households have almost no savings or other financial assets — and all but the top 20 percent lack the cushion to withstand a significant economic shock. …

Enrolling in both the Medicare Savings Programs, known as M.S.P.s, and the Low Income Subsidy, or L.I.S., can save an individual as much as $8,400 annually in Medicare premiums, deductibles, co-pays and other out-of-pocket costs…[end quote]

There are very nice, knowledgeable volunteers at SHIPA (State Health Insurance Assistance Program) who can help people with the system. But the people who need the most help are probably the least capable of finding and working with them.

Wendy

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Usually about this time we get a statement from Social Security telling what our benefit will be next year and what Medicare deductions will be.

I haven’t seen mine yet but hope it has not been delayed by the shutdown.

The major change I have seen in Medicare Advantage from United Healthcare is addition of $400 deductible for brand name meds. Still no charge over basic Medicare deduction from Social Security. But yes IRMA is costly.

Millions of low-income seniors are missing out on crucial help paying for Medicare — and the recently enacted federal budget law blocks an effort to help them get it.

The Trump administration budget law does not reduce any of Medicare’s standard benefits. But the law does suspend until 2034 a requirement that states adopt a Biden-era plan to increase enrollment in state-run Medicaid programs that help seniors who qualify get a hand paying for out-of-pocket Medicare costs.

https://www.nytimes.com/2025/10/04/business/medicare-medicaid-low-income-seniors.html

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The problem is that the people who need help the most are least able to access it. They may not be literate, much less computer-savvy.

Wendy

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Are Medicare and Medicaid interchangeable in this context?

DB2

My wife received her’s today. I expect mine within a couple of weeks.

I don’t know much about this.

Wendy

It could be important because, as you wrote, “if Social Security is a person’s only income the Medicare deduction is a big deal.” People in that situation would almost certainly qualify for Medicaid.

DB2

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@DrBob2 why don’t you research this and let us know?

Wendy

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Since Medicaid is a joint Federal and state program (unlike Medicare) things vary from state to state. Some states, for example, charge premiums and copays.

If you’re working with low-income clients then it would be worth while to check out the State of Washington regulations.

DB2

I don’t quite get this part.

Firstly, I always considered the income from a taxable RMD as actual income, not theoretical or somehow nonexistent income. When did it not become actual income?

Secondly and more importantly, if you are a high-income retiree, the increase in Medicare monthly premium shouldn’t be that big a hit, right? Otherwise, it seems you’re not an especially high-income retiree.

Pete

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Yes, but that does limit the number of doctors they can see. Who knows it the “best” doctors do not accept Medicaid patients?

1.2 percent of non-pediatric physicians have formally opted out of the Medicare program. As of November 2024, 12,244 non-pediatric physicians have opted out of Medicare, representing a very small share (1.2%) of the total number active physicians, similar to the shares reported in 2013 and 2022

About 70% of all office-based physicians accept new Medicaid patients , including two-thirds of primary care physicians and close to three-quarters (72%) of specialists.

@MataroPete from the standpoint of the IRS, a RMD is taxable income. Period.

From my personal standpoint there is a difference between “real” income (such as earned income, interest, dividends, etc. which adds to the household net worth) and money which does NOT add to the household net worth but is simply shifted from one bucket (the tax-deferred IRA) to a different bucket (taxable). I track these separately.

Sorry to disappoint you. Maybe I’m not an especially high-income retiree. But I have been a dedicated LBYMer since forever. Adding a cost burden of thousands of dollars a year is something I don’t shrug off.

MAGI from 2023 Tax Return (Married Filing Jointly) Monthly Part B Premium (Per Person) Monthly Part D IRMAA (Per Person) Total Monthly Premium (Part B + Part D IRMAA for 2 People) Total Annual Cost (Part B + Part D IRMAA for 2 People)
$212,000$ or less $185.00$ $0.00$ ($185.00 + $0.00) times 2 = $370.00$ $4,440.00
$212,000$ to $266,000$ $259.00$ $13.70$ ($259.00 + $13.70) times 2 = $545.40 $6,544.80
>$266,000$ to $334,000$ $370.00$ $35.30$ ($370.00 + $35.30) times 2 = $810.60$ $9,727.20
>$334,000$ to $400,000$ $480.90$ $57.00$ ($480.90 + $57.00) times 2 = $1,075.80 $12,909.60
>$400,000 to <$750,000 $591.90 $78.60 ($591.90 + $78.60) times 2 = $1,341.00 $16,092.00
$750,000$ or above $628.90 $85.80 ($628.90 + $85.80) times 2 = $1,429.40 $17,152.80

I asked Google Gemini Add a column for Part B and Part D for a married couple (add the Part B and Part D, multiply by 2 and multiply by 12 to get the whole year).

@MataroPete YOU may not care about adding thousands of dollars of expenses to your budget…but I do.

Wendy

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I certainly DO care about adding thousands and thousands of dollars to my expenses, but I just don’t think at these income levels, they are a HUGE deal. Yes, they may keep me from investing a bit in another CD or T-bill, but they do not prevent me from any vacations or new roofs or restaurant-going, etc. If people’s expenses are that tight, they may not be particularly “high-income.” That’s all.

Pete

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You’ve got some inconsistent column titles in that table, @WendyBG . The Part B column is the total premium, including any IRMAA. But the part D column is only the IRMAA addition. So your total is not really a total annual cost, it’s a strange mish-mash of premiums. The best you can do with that total is consider the first line ($212K) to be a baseline figure, and look at the increases over that baseline. Those difference would be the total IRMAA addition.

So if we look at the second line in the table, IRMAA has added $2105 to the couple’s medicare premiums, or a little under 1% of their income.

Switching to the last line, the increase in premium is $12,713, or roughly 1.7% of income when just over the $750k threshold.

As a guy who has never made more than $100k a year in his life, I have little pity for those doing well enough to have to pay IRMAA premium additions. Yes, it’s between $2k and $13k of additional premium per year. But at those income levels, it’s not unaffordable. In contrast to my medical premiums, which at one point pre-Obamacare, were almost $1500 per month for my wife and I. They were north of 20% of my income at that point. If it weren’t for her medical condition, I was ready to drop health insurance and go without. Even at the maximum IRMAA addition and with the base Part B included, that’s roughly what I was paying pre-Obamacare. With 1/10 of that income.

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@ptheland I totally get what you are saying. You were stuck between a rock and a hard place.

Even so, it’s my job to optimize my household finances.

Wendy

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I agree. Only the wealthiest 7% of Medicare beneficiaries pay any IRMAA. And about 75% of your Medicare Part B premium is subsidized by the Gov’t (i.e., taxpayers) if you’re not paying any IRMAA.

If you’re paying any IRMAA, count yourself as fortunate. And it makes no sense for lower income taxpayers to be subsidizing your (Part B) health care premiums.

intercst

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Of course. I don’t begrudge anyone doing so within the bounds of the law. intercst did a remarkable job of that with managing his taxable income to qualify for significant Obamacare subsidies.

What we each do individually has to be divorced from what is good public policy.

–Peter

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The only thing I’m doing to “optimize” my IRMAA liability is to be attentive to the brackets (which are step functions, i.e., if you go $1 over the limit for the lower bracket, you owe the whole IRMAA liability for the next higher bracket.) Thus, it might make sense to do a Roth conversion or other tax maneuver to fill out the income for that next higher IRMAA bracket.)

intercst

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I sit with a retired VP of medical sales for coffee with the guys in the morning.

He would get peaved occasionally when I said something I’d hear from my dad a doctor. Most doctors would not let his salespeople into the offices.

He was bragging MA. Now he is not; his plan left the state of Connecticut, dumping him. He did not know it was possible. He is search for a new plan.

He is worth millions after a career in medical sales management. It is not just the poor. His expense accounts caused both himself and his wife open heart surgery after a very abusive life of feeding at the trough in hundreds of hotels across this country. He was 66 when he had his operation. He is now turning 76. He has lost over 100 pounds, but never got back into shape.

He has stayed in so many Marriotts he has a life time membership to their club.