✅ Medicare Part B Explained
Independent Insurance Support in Augusta, Evans, Martinez and Thomson GA. Also serving Aiken and North Augusta SC
📌 Tabs Overview:
- Who Qualifies
- What the Cost Is
- When Can One Sign Up
- Possible Changes in 2026
🧍♂️ Tab 1: Who Qualifies for Medicare Part B
You qualify for Medicare Part B if:
- You are 65 or older and:
- A U.S. citizen or lawfully present permanent resident for at least 5 years
- Eligible for Social Security or Railroad Retirement benefits
- You are under 65 and:
- Have received Social Security Disability Insurance (SSDI) for 24 months
- Have ALS (Amyotrophic Lateral Sclerosis) – automatic enrollment
- Have End-Stage Renal Disease (ESRD) and meet eligibility
Unlike Part A, Part B requires a monthly premium, even if you qualify based on work history.
💲 Tab 2: What the Cost Is for Part B
Medicare Part B has monthly premiums, deductibles, and cost-sharing:
🔹 2025 Monthly Premium:
- Standard Premium: $174.70/month (subject to change for 2026)
- Higher-income individuals pay more based on Modified Adjusted Gross Income (MAGI):
- IRMAA (Income-Related Monthly Adjustment Amount) tiers start at $103,000 (individual) or $206,000 (joint)
🔹 Other Costs:
- Annual Deductible: $240 (2025)
- After the deductible, you typically pay:
- 20% of Medicare-approved amount for covered services
- There is no out-of-pocket maximum under Original Medicare
💡 Medicare Supplement (Medigap) or a Medicare Advantage plan can help cover these out-of-pocket costs.
📅 Tab 3: When Can One Sign Up
There are several enrollment periods for Medicare Part B:
🟢 Initial Enrollment Period (IEP)
- 7-month window:
- Starts 3 months before your 65th birthday
- Ends 3 months after
🟡 General Enrollment Period (GEP)
- January 1 – March 31
- Coverage starts the following month
🔵 Special Enrollment Period (SEP)
- For individuals who:
- Are still covered by an employer group plan
- Recently lost job-based coverage
- You generally have 8 months after losing coverage to enroll without a penalty
⚠️ Late Enrollment Penalty
- If you delay signing up for Part B and don’t qualify for SEP, you may pay a 10% penalty for each full 12-month period you could’ve had Part B and didn’t.
🔮 Tab 4: Possible Changes in 2026
While no official numbers are released yet, here are expected or possible changes to Medicare Part B in 2026:
📈 1. Premium and Deductible Increases
- Premiums and deductibles typically rise slightly each year to keep pace with healthcare costs.
🧾 2. Income Threshold Adjustments
- The income brackets for IRMAA could be adjusted for inflation, affecting high-income earners’ premiums.
💊 3. Policy Reforms
- Potential improvements under federal law could:
- Expand preventive services
- Increase access to telehealth
- Simplify cost-sharing or drug pricing (affecting Part D more than Part B)
🧑⚕️ 4. Preventive & Primary Care Focus
- CMS may continue incentivizing more preventive care and chronic care management, possibly improving Part B services and care coordination.
🛑 Your local agent (that’s me!) will keep you informed as the 2026 changes are finalized.