Medicare Part A covers short-term inpatient care in a hospital, skilled nursing facility or nursing home, as well as hospice care and certain home healthcare. Medicare Part B covers doctor visits, other outpatient services, mental health care, ambulance transport, durable medical equipment, laboratory tests, and preventive screenings. Part C Medicare Advantage Plans are private insurance alternatives to original Medicare that bundle hospital, medical, and often prescription drug coverage into one plan. Part D, under original Medicare, helps cover the cost of prescription drugs (including many recommended shots or vaccines).
Medicare open enrollment began October 15th and lasts until December 7th. During that time, you can join, drop, or switch Medicare Advantage or Part D drug plans. You can also return to Original Medicare from a Medicare Advantage plan.
You can navigate changes to Medicare and your health insurance by doing the following:
- do not automatically re-enroll in your current plan as it can change from year to year. You may feel loyal to your plan, but then suddenly find out that its provider network has changed and your doctors are no longer participating. Confirm that your plan still offers the best coverage for your area and budget compared to alternatives;
- read the list of covered medications in Part D plans carefully. These lists are called formularies. Medicare Part D plans and pharmacy benefit managers (PBMs) re-evaluate their formularies and pricing strategies due to negotiated drug prices. As a result, it is important to check if the medication you are taking is covered before joining a plan for 2026; and
- seek expert help and work with an independent Medicare insurance broker who does not just work for one insurance company. Your broker can help you understand your options, particularly if you are considering a switch from Medicare Advantage to Original Medicare plus a Medigap plan.
Hospital Care
Your benefit period ends once you have been out of the hospital for 60 days in a row. If you are admitted to the hospital again after those 60 days, a new benefit period will start. You must pay a Part A deductible each time you start a new benefit period. This could be multiple times in a calendar year. If you are readmitted to the hospital prior to 60 days after your initial discharge, you remain in the previous benefit period and will not have to meet a deductible.
Skilled Nursing Facility Care
Medicare covers short-term skilled nursing facility care after a 3-day minimum medically necessary inpatient hospital stay (not including the day you leave the hospital) for an illness or injury related to the hospital stay. Again, your care is measured in benefit periods, which are related to the number of days in a row you get care. Each time you start a new benefit period (after 60 days in a row) you must pay the deductible of $1,676 before Medicare starts to pay. However, you do not have to pay the Part A deductible for skilled nursing facility care if you already paid for care you received in a hospital during the same benefit period.
| Medicare Part A | 2026 Rates |
| Inpatient Hospital Care Days 1-60 Deductible for Each Benefit Period | $1,676/ $0 each day |
| In-patient Hospital Care Co-insurance Days 61-90 | $419/day |
| In-patient Hospital Care Co-insurance Days 91 –150 | $838/day while using your 60 lifetime reserve days. These are additional days that Medicare will pay for when you are in a hospital for more than 90 days. You have a total of 60 reserve days that can be used once during your lifetime. * |
| In-patient Hospital Care Days 151+ | Patient pays all costs |
| Skilled Nursing Facility Daily Co-insurance Days 21—100 | $209/day |
| Medicare Part B | 2026 Premium |
| Average Standard Monthly Premium (for those receiving Social Security benefits) | $206.50 (may be higher depending on income, see next table) |
*60 Lifetime Reserve days: An extra pool of 60 days of inpatient hospital coverage per lifetime, available after you have exhausted your 90 regular days of coverage in a benefit period. To use a lifetime reserve day, you must first be formally admitted to the hospital for a medically necessary reason, and your doctor must order two or more midnights of care. After your 90 regular days of coverage are used up, Medicare will pay for covered costs on your lifetime reserve days, but you will be responsible for the daily coinsurance cost. The daily coinsurance for a lifetime reserve day is a significant amount that increases each year. For example, if you have a 100-day hospital stay, you will use 10 lifetime reserve days. You would pay the daily coinsurance for those 10 days, and you would have 50 lifetime reserve days remaining for future use. Once used, lifetime reserve days cannot be replenished. You can elect not to use your lifetime reserve days if you want to save them for a future stay. This can be done at the time of admission or retroactively, as long as the election is made.
Income-Related Monthly Adjustment Amount (IRMAA) is an extra premium for Medicare Parts B and D that higher-income individuals must pay (see chart below for IRMAA rates). Medicare determines the 2026 IRMAA charge in the 4th quarter of 2025. Your IRMAA determination is based on 2024 filing status and income, as it is the latest data point Medicare can obtain from the IRS to determine the 2026 IRMAA charge. IRMMA charges for Part D are available at the Social Security website https://www.ssa.gov/medicare.
Projected 2026 IRMMA Brackets and Surcharges for Medicare Part B
| Beneficiaries who file an individual tax return with income: | Beneficiaries who file a joint tax return with income: | Total monthly Part B premium amount: |
| Less than or equal to $109,000 | Less than or equal to $218,000 | $206.50 |
| Greater than $109,000 and less than or equal to $137,000 | Greater than $218,000 and less than or equal to $274,000 | $289.10 |
| Greater than $137,000 and less than or equal to $171,000 | Greater than $274,000 and less than or equal to $342,000 | $413.00 |
| Greater than $171,000 and less than or equal to $205,000 | Greater than $342,000 and less than or equal to $410,000 | $536.90 |
| Greater than $205,000 and less than or equal to $500,000 | Greater than $410,000 and less than or equal to $750,000 | $660.80 |
| Greater than $500,000 | Greater than $750,000 | $702.10 |
There are numerous changes this year and you need to do due diligence and choose the best options for you and your spouse if you are married. As noted above, enlisting an independent Medicare insurance broker who does not just work for one insurance company is most important. Your broker can help you understand your options, particularly if you are considering a switch from Medicare Advantage to Original Medicare plus a Medigap plan.The official U.S. government Medicare handbook can be downloaded at Medicare and You Handbook 2026.
Medicare is just one important part of an overall elder law long-term care plan that will likely include advance directives, living trusts, and Medicaid planning. The attorneys in the Elder Law Practice Group of Meltzer Lippe can guide you through the planning process.
Ronald Fatoullah, Esq. Chairs the firm’s Elder Law Practice Group and is a Partner of the firm’s Trusts & Estates Practice Group. This blog posting is for informational and educational purposes only. It is general in nature and not person or circumstance specific. This blog posting is not intended, nor should it be construed as rendering independent investment, legal or tax advice. It may but does not necessarily constitute attorney advertising.