Latest news with #MedicarePartB
Health Line
17 hours ago
- Health
- Health Line
Do Federal Retirees Need Medicare Part B?
If you get federal employee health benefits (FEHB) as a retiree, you can choose whether to also enroll in Medicare Part B. If you do, your FEHB premiums stay the same, and there may be some advantages. When you turn age 65, you will become eligible for Medicare. If you are a retiree with health insurance from a FEHB plan, you can use both together. Original Medicare comprises two parts, Part A, which covers inpatient care, and Part B, which covers outpatient medical services. Most people are eligible for premium-free Part A, but everyone pays a Part B premium. You will also continue to pay your FEHB premium. There are different considerations when deciding to enroll in Medicare, and FEHB provides robust coverage that is compatible with Medicare Part B. However, your healthcare needs may determine whether enrolling in Medicare Part B is your best choice. Do I need Medicare Part B if I am a federal retiree? Even when you become eligible for Medicare and have retired, you can choose not to enroll in Medicare and keep using only your FEHB plan. Medicare is optional, so you do not have to enroll in Part A or Part B. You can keep your existing health coverage if: you are enrolled in a federal health insurance plan when you retire you have been continuously covered by a FEHB plan, TRICARE, or civilian health and medical program for uniformed services (CHAMPUS) plan for 5 continuous years or the entire period since you first became eligible your annuity payments start within 30 days As Part A is typically premium-free, having the extra inpatient coverage in case you need it may be a good option. While you don't have to enroll in Part B during your initial enrollment period, if you decide you want to enroll later, you may have to pay a late enrollment penalty. TRICARE exception If you're enrolled in TRICARE, which is an FEHB plan for members of the military, you must enroll in Original Medicare parts A and B to be eligible for TRICARE for Life. Medicare will become your primary insurer, and TRICARE will pay remaining eligible expenses. FEHB and Medicare Part B Once you retire, you can keep your FEHB plan, but it will supplement Medicare, with Medicare becoming your primary insurer. Medicare Part B covers 80% of eligible outpatient medical expenses, and you would typically pay the remaining 20% as coinsurance, but when you use FEHB and Part B together, your FEHB plan may cover that coinsurance. In this respect, this can work similarly to a Medigap (Medicare supplement) plan, but for FEHB plans, you might notice it referred to as a 'wraparound benefit.' Your FEHB plan premiums will not change if you enroll in Medicare, but you will be responsible for paying the Part B premium, which in 2025 is $185. Due to the inflation reduction monthly adjustment amount (IRMAA), your Part B premium may be higher if you reported earnings of more than $106,000 in 2023, as the Internal Revenue Service (IRS) uses your tax records from 2 years prior to decide whether you owe a surcharge and how much. What should federal retirees consider about Part B enrollment? As a federal retiree, you have some choices when deciding on healthcare plans, and here are some key points to consider. Switch FEHB plans to better accommodate Plan B If you choose to enroll in Medicare Part B, you could consider changing your FEHB plan to manage the additional costs. Some FEHB plans have less expensive coverage, but they can 'wrap around' Medicare plans to cover the out-of-pocket expenses, including some plans that offer Part B premium reimbursements. Examine each plan's coverage options Some Part B services may not be covered or only partly covered by your FEHB plan, such as: orthopedic and prosthetic devices durable medical equipment (DME) home healthcare services medical supplies You can check your state's plan documentation for further coverage information. Consider your healthcare network Some FEHB plans have network restrictions on the healthcare professionals and facilities you can visit. Original Medicare does not have network restrictions, so this could be a more rounded healthcare option for some people. Medicare's late enrollment penalties As a retiree, if you choose not to enroll in Medicare Part B when you first become eligible, you can enroll during the next general enrollment period, but you will likely pay a monthly Part B late enrollment penalty. The late enrollment penalty is 10% of the Part B premium amount (in the year in which you enroll) for every year you could have enrolled but chose not to. Example of Part B late enrollment penalty You have waited 2 years to enroll in Medicare Part B. You do not qualify for a special enrollment period (SEP). You enroll in 2025, when the Part B premium is $185 Your late enrollment penalty is 20% (10% for each year's enrollment delay) 20% of $185 = $37 Your new monthly premium is $222 Late enrollment penalties for Part B will only apply if you have already retired when you reach age 65 and become eligible for Medicare. If you're still working when you become eligible, you can enroll in Part B once you retire with no late enrollment penalty for up to 8 months. FEHB prescription drug coverage is creditable FEHB provides coverage for prescription medications, and Medicare considers this to be creditable coverage. This means that even if you don't enroll in Medicare Part B, but choose to enroll in a Medicare Advantage plan that has drug coverage or a Part D prescription drug plan, you will not have to pay a Part D late enrollment penalty. Takeaway Choosing to enroll in Part B as a federal retiree is a very personal decision, and one that you must make based on your personal circumstances. If you retire before becoming eligible for Medicare, you may pay late enrollment penalties if you delay enrollment. However, there is no pressure to enroll in Medicare, and if it works best for your circumstances, you can continue to use your FEHB plan only. The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.
Miami Herald
16-07-2025
- Business
- Miami Herald
Millions of Medicare beneficiaries could see major price shock
If you think Medicare is a set-it-and-forget-it program, think again - especially if you've saved well for retirement. A growing number of retirees will soon face sharply higher Medicare Part B premiums, with some paying more than $1,100 per month, $13,200 per individual per year, or $26,400 per couple per year by 2034. The culprit? A combination of rising health care costs and the slow creep of income thresholds that trigger something called IRMAA - the Income-Related Monthly Adjustment Amount. Don't miss the move: SIGN UP for TheStreet's FREE daily newsletter Currently, 5.1 million Medicare beneficiaries pay more than the standard Part B premium today, but that number is expected to balloon to over 8.6 million people in the next decade. For those caught unaware, the financial hit can be surprising and steep. Medicare Part B covers outpatient medical services, including doctor visits, preventive care, durable medical equipment, and more. In 2025, the standard monthly premium is $184.90 - a modest $10.30 increase from 2024. But for higher-income retirees, that's just the starting point. Thanks to a law passed back in 2007 and expanded by the Bipartisan Budget Act of 2018, individuals with modified adjusted gross incomes (MAGI) above certain thresholds must pay an IRMAA surcharge. These thresholds begin at $106,000 for single filers and $212,000 for joint filers in 2025. Related: Retired workers to see frustrating change to Medicare in 2026 Depending on how high your income climbs, you'll pay a larger share of the program's cost - up to 85% of the total, compared to the 25% share paid by those at the standard level. Currently, about 8% of Medicare beneficiaries pay IRMAA, according to the Medicare Trustees Report. But due to unindexed income thresholds, a surge in Required Minimum Distributions (RMDs), and record-setting intergenerational wealth transfers, the number of IRMAA payers is expected to rise dramatically - to 8.6 million by 2034. Some of those retirees will pay as much as $1,181.50 per person per month - an 88% increase over today's top-tier rate. And don't count on inflation-adjusted relief anytime soon. While standard premiums rise with health care cost projections, the income brackets that determine IRMAA tiers are increasing at a snail's pace - essentially at the general rate of inflation, and in some cases, not at all until 2028. Why does this matter? Because many affluent retirees - especially those waiting until age 73 or older to take RMDs - will find themselves suddenly hit with four- or even five-figure annual Medicare surcharges. And for those who assumed that their careful savings strategy would provide peace of mind in retirement, IRMAA can come as a rude awakening. As Mantell Retirement Consulting President Marcia Mantell put it: "There's no way there is any balance between all the numbers. More and more retirees are going to fall into the IRMAA tiers. When they make the transition, it is a total shock. And they are unhappy - to say the least." Mantell points out the core imbalance: While Part B premiums are projected to jump by 11% or more per year, the IRMAA thresholds will only inch up modestly. This will drag more retirees into higher payment tiers, even if their real purchasing power hasn't changed. Related: Big Beautiful Bill Act makes Roth IRA conversions more complicated Katy Votava, founder of agrees - with a caveat. "This forecast may be reasonable based on demographic growth in the Medicare population," she said. "But a lot hinges on continued economic growth." She points to the 2008-2009 recession as a cautionary tale, when the number of high-income Medicare beneficiaries dropped by 14–17% and didn't recover for four years. In other words, IRMAA isn't just about income - it's about timing, tax strategy, and market cycles. If you're not planning for it now, you could be facing hundreds or even thousands of dollars in surprise Medicare premiums later - and smaller Social Security checks to boot. The Arena Media Brands, LLC THESTREET is a registered trademark of TheStreet, Inc.
Yahoo
15-07-2025
- Business
- Yahoo
Social Security 2026 COLA estimated at 2.7%, but much of it will go to Medicare Part B
Social Security recipients could get a 2.7% raise next year, up from last month's estimate of 2.5%, based on the latest inflation report, according to a new estimate. The Consumer Price Index for Urban Wage Earners and Clerical Workers (CPI-W), the index used to calculate the annual adjustment to Social Security benefits, gained 2.6% in June. Overall inflation rose 2.7% from May's 2.4% increase. The Federal Reserve's inflation goal is 2%. A cost-of-living adjustment, or COLA, is meant to help Americans keep up with inflation so they can maintain their standard of living year to year. But the hikes are falling short, especially when Medicare premiums, alone, are rising at a faster clip, seniors say. That happened in 2025 and is set to do so again next year. 'It's not uncommon for Part B premiums to consume much or even all of the annual COLA, leaving little extra to cover other big cost increases,' says Mary Johnson, an independent Social Security and Medicare policy analyst. Medicare Part B costs are rising several times faster than its average rate of increase in recent years. According to the 2025 Medicare Trustees annual report released in June, the Medicare Part B premium for 2026, is expected to increase to $206.50 from $185.00 in 2025 for a jump of $21.50 per month, or 11.6%. That's the largest Part B increase since 2022 when it rose 14.5%. The Social Security Administration automatically deducts the Part B premium cost from Social Security benefits for most Medicare recipients. A bigger Medicare bite means monthly checks will shrink. 'Medicare recipients are quick to point out that Part B premiums can frequently take much or even all of the annual COLA, leaving little extra to cover other big cost increases, such as housing or groceries,' Johnson said. If COLA rises by 2.7%, which is in line with the average 2.6% increase over the past 21 years, and Medicare Part B increases by 11.6%, those with the lowest Social Security benefits would hurt the most. "If the COLA in 2026 is 2.7%, a Part B premium jump of $21.50 would take the entire COLA of beneficiaries who receive around $800 or less," Johnson said. "This is especially the case for all individuals who receive a low Social Security retirement, spousal, or widow or widower's benefit." The Social Security Administration bases its COLA each year on average annual increases in the consumer price index for urban wage earners and clerical workers (CPI-W) from July through September. That means July inflation numbers will be especially important to pay attention to. The index for urban wage earners largely reflects the broad index the Labor Department releases each month, although it sometimes differs slightly. Last month, the overall consumer price index rose 2.7% and the index for urban wage earners increased 2.6%. In May, 74.269 million people received Social Security, according to the Social Security Administration. These beneficiaries include retired workers, disabled workers, survivors of deceased workers, and those receiving Supplemental Security Income (SSI). The average monthly benefit was $1,860.64 in May. Medora Lee is a money, markets, and personal finance reporter at USA TODAY. You can reach her at mjlee@ and subscribe to our free Daily Money newsletter for personal finance tips and business news every Monday through Friday. This article originally appeared on USA TODAY: Social Security 2026 COLA estimated up 2.7%. What about Medicare?
Business Insider
15-07-2025
- Health
- Business Insider
Organogenesis, MiMedx fall after CMS rule to cut skin substitutes spending
The Centers for Medicare and Medicaid Services announced a proposed rule 'that would increase quality care for Medicare recipients while significantly reducing unnecessary spending.' The 2026 Medicare physician fee Schedule proposed rule 'would advance primary care management through new quality measures, reduce waste and unnecessary use of skin substitutes, and introduce a new payment model focused on improving care for chronic disease management,' the agency said in a statement. 'CMS is proposing to improve the care of chronic diseases by reducing burdens associated with the integration of behavioral health treatment into advanced primary care management,' it added. CMS noted that Medicare spending on skin substitutes 'has had unprecedented growth,' rising from $256M in 2019 to over $10B in 2024, according to Medicare Part B claims data. 'CMS currently treats skin substitutes as biologicals for the purposes of Medicare payment, which can reach as high as $2,000 per square inch. CMS is proposing to pay for skin substitutes as incident-to supplies, a change expected to reduce spending on these products by nearly 90%.' Shares trading lower following the CMS proposed rule include Organogenesis (ORGO) and MiMedx (MDXG). Elevate Your Investing Strategy: Take advantage of TipRanks Premium at 50% off! Unlock powerful investing tools, advanced data, and expert analyst insights to help you invest with confidence. Make smarter investment decisions with , delivered to your inbox every week.
Miami Herald
07-07-2025
- Health
- Miami Herald
Retired workers to see shocking change to Medicare in 2026
It's only an estimate - but if history is any guide, it's one you'll want to watch. Tucked deep inside the 267-page 2025 Medicare Trustees report is a projection that the standard monthly Medicare Part B premium could rise to $206.50 in 2026. That's an 11.6% jump from the $185 premium set for 2025 - and it would be the largest single-year increase since 2016, when premiums climbed 16.1%, from $104.90 to $121.80. This estimate, however, is not the final number. In fact, it could be even higher. Don't miss the move: Subscribe to TheStreet's free daily newsletter "There is certainly a potential for the monthly premium to increase further," said Marcia Mantell, president of Mantell Retirement Consulting. "And each person's share - 25% of the total premium - could rise before the final numbers are published later this year in the third or fourth quarter." Photo by Nappy on Unsplash Medicare Part B is the portion of Original Medicare that covers outpatient and preventive care, including: Doctor visits and lab testsCancer screenings and flu shotsDurable medical equipment (e.g., walkers, wheelchairs)Some prescription drugs administered in outpatient settingsHome health care and skilled nursingMental health services and ambulance transportation In 2025, the standard monthly premium is $185. Beneficiaries also face a $257 annual deductible, and once that's met, typically pay 20% coinsurance on covered services. Related: Social Security payment dates for July 2025: what you need to know Around 7-8% of the 68 million Medicare beneficiaries pay higher premiums due to income-related monthly adjustment amounts (IRMAA). Most preventive services are covered at no cost if the provider accepts Medicare assignment. The projected jump to $206.50 in 2026 may be just the beginning. According to the Medicare Trustees, monthly Part B premiums are expected to continue rising, reaching $347.50 by 2034 - a $141 monthly increase per person over nine years. And that 2026 estimate doesn't yet reflect potential changes from federal budget decisions or shifting health care spending trends. "There is certainly a potential for the monthly premium to increase further," said Marcia Mantell, president of Mantell Retirement Consulting. "And each person's share - 25% of the total premium - could rise before the final numbers are published later this year in the third or fourth quarter." In recent years, the Trustees' estimates have been remarkably accurate, often landing just a few dollars off the final figure. But as Katy Votava, founder of points out, these aren't just projections - they reflect a deeper cost trend. "Medicare Part B premium estimates typically track within a reasonable margin of error year to year," Votava said. "That said, Medicare B is in a hyper-inflation mode for the foreseeable future." She identified two long-term forces driving these increases: A shift of cost-intensive care from inpatient (Part A) to outpatient (Part B) settings, such as major surgeries or cancer treatments. The growing popularity of Medicare Advantage (MA) plans, which now cover 54% of all Medicare beneficiaries. "The MA program costs 20% more than Original Medicare," Votava explained. "Given these cost shifts, I anticipate a +/- 10% increase in Medicare Part B premiums going forward." According to the 2025 Trustees Report: About 72-75% of Part B funding comes from general revenues from the U.S. 25% comes from premiums paid by beneficiaries - totaling $139.8 billion in revenue includes interest on trust fund investments ($3.5 billion) and brand-name drug fees ($2.8 billion). These Treasury contributions are legally required to automatically adjust to match program costs - helping keep Part B financially balanced. One question on many retirees' minds: Will the "hold harmless" rule kick in to protect benefits from the premium hike? According to The Senior Citizens League, the projected Social Security cost-of-living adjustment (COLA) for 2026 is 2.5% - the same as for 2025. That translates to a $50 per month increase for someone receiving the average $2,000 Social Security benefit. Since the projected Part B premium increase is $21.50, most beneficiaries will not be protected by the hold harmless provision - because the COLA is more than enough to absorb the increase. Related: Young workers face stark Social Security reality "The COLA would have to come in below 1.06% for hold harmless to apply broadly," Mantell explained. "That's highly unlikely. Only Social Security recipients receiving less than about $800 per month might be affected if the COLA is 2.5%." These might be, she said, dependent spouses whose spouse had low wages and lower-than-average benefits. Or an individual worker who spent many years outside the workforce and has many $0 years in their benefit calculation." According to the Social Security Administration, nearly 4 million Social Security beneficiaries receive less than $800 per month. She added that historically, those subject to the Windfall Elimination Provision (WEP) or Government Pension Offset (GPO) often had low benefits and would have been in the hold harmless group. But she noted, "With the Social Security Fairness Act eliminating those reductions, this should not be the case for most." There's no way to avoid the premium increase, Mantell said. "By law, each Medicare beneficiary pays 25% of the overall premium," she explained. "It is deducted from their Social Security payment automatically. If not yet claiming Social Security, premiums are generally paid quarterly from your checking account or using the online options at Medicare." But that doesn't mean you're powerless. Mantell offers these five planning steps: Forecast your 2026 healthcare budget "The most important step to take now is to forecast your own budget for 2026," Mantell said. "Consider all healthcare costs you can reasonably expect - there are often more costs than just Part B premiums." (Use Mantell's free worksheet: Boomer Retirement Briefs – Estimating Your Medicare Costs.)Learn to use the Medicare Plan Finder tool "Several major insurance companies are no longer paying brokers to sell their plans, so you will not necessarily see the lowest-cost providers this fall," she said. "You need to find the lowest premium plans on your own from now on." Use this tool, Medicare Plan Compare, during Open Enrollment (Oct. 15–Dec. 7).Call your members of Congress "Tell them you are not happy about such huge projected increases in your Part B premiums," Mantell advised. "This is a significant burden to your budget along with all the other increases in goods and services and local taxes, etc."Explore property tax relief locally "Talk to your town clerk or other local official who can help you find property tax savings opportunities in your town," she said. "In some towns, you can work a certain number of hours to reduce property taxes."File your taxes using IRS Form 1040-SR "It's generally the same as the regular 1040," Mantell noted, "but it includes the higher standard deduction for seniors." In addition to budgeting and plan shopping, it's wise to think about how rising premiums could impact your long-term investment plan. "I think people might need to stress-test their portfolios," said T. Rowe Price Senior Research Analyst Sudipto Banerjee. "Run your portfolio projections under current spending assumptions, and then test what happens if you increase your health care spending projections by X% (pick any number). If you don't like the results, you'll probably need to save more." If the Medicare Trustees are right - as they have been in recent years- beneficiaries will face the largest premium hike in a decade next year. And with health care costs continuing to outpace inflation, it puts pressure on retirement budgets. "There is certainly a potential for the monthly premium to increase further," Mantell warned. "And each person's share…could rise." Got questions about retirement, email What You Need to Know about Medicare Part D The Arena Media Brands, LLC THESTREET is a registered trademark of TheStreet, Inc.
