What Medicare Costs Changed This Year (And What to Know Going Forward)

Medicare Part B covers outpatient care such as doctor visits, preventive services, imaging, and many telehealth visits. This year, the standard Part B monthly premium increased.

That means most beneficiaries will see a higher amount deducted from their Social Security check or billed directly each month. For individuals with higher incomes, income-related premium adjustments (IRMAA) may further increase monthly costs.

Even small premium increases can add up over the course of a year, especially for people on fixed incomes.

The Part B Deductible Is Higher

In addition to higher premiums, the annual Part B deductible also increased. This is the amount you must pay out of pocket before Medicare begins covering most outpatient services.

Once the deductible is met, Medicare generally covers 80% of approved services, with the remaining 20% paid by the beneficiary or supplemental insurance.

Medicare Part A covers inpatient hospital stays, skilled nursing facility care, and some home health services. The Part A deductible — what you pay at the start of a hospital stay — also increased this year.

This change mainly affects people who are hospitalized, but when it applies, it can be a significant upfront cost.

Prescription coverage continues to be one of the most important — and most complex — parts of Medicare.

This year:

• The annual out-of-pocket cap for Part D medications increased

• Some plans raised deductibles

• Drug formularies and copays may have changed

Once you reach the annual out-of-pocket limit, you pay $0 for covered medications for the rest of the year, which is a major protection for people taking higher-cost prescriptions.

However, changes in drug tiers or coverage can still affect what you pay month to month.

Medicare Advantage plans bundle Parts A and B and often include prescription coverage. While many plans still advertise low or $0 premiums, cost-sharing rules vary.

This year, the maximum allowed out-of-pocket limit for in-network care changed, which affects how much beneficiaries could pay in a worst-case scenario.

Each plan sets its own deductibles, copays, and provider networks, so reviewing plan details annually remains essential.

Medicare plans are updated every year. Coverage that worked well last year may be more expensive or less comprehensive this year.

An annual review helps prevent:

• Surprise pharmacy bills

• Higher-than-expected copays

• Gaps in medication coverage

• Paying for benefits you no longer use

Staying informed allows you to adjust before costs become a problem.

While CallOnDoc doesn’t select Medicare plans, our providers help patients:

• Address rising medication costs clinically

• Explore covered alternatives when formularies change

• Manage chronic conditions efficiently through virtual care

• Avoid unnecessary visits that increase out-of-pocket spending

Cost concerns are part of healthcare — and it’s reasonable to ask questions.

Bottom Line

Medicare costs changed this year, and those changes can affect premiums, deductibles, and prescription drug expenses. Staying informed, reviewing coverage annually, and asking questions early can help you protect your access to care and avoid unexpected costs.