N※N

2026 Medicare Part B Premiums Up 7.8% While Low-Income Subsidy Stays Flat

  //health-fitness.news-articles.net/content/2025/ .. -up-7-8-while-low-income-subsidy-stays-flat.html
  Published in Health and Fitness on Wednesday, December 17th 2025 at 5:40 GMT by Business Insider

• 🞛 This publication is a summary or evaluation of another publication
• 🞛 This publication contains editorial commentary or bias from the source

2025-12-17 245 x 206 / 11199 Bytes

2025-12-17 238 x 212 / 8822 Bytes

2025-12-17 224 x 224 / 11193 Bytes

2025-12-17 239 x 211 / 7707 Bytes

Health‑Insurance Overhaul on the Horizon: What the 2026 Changes Mean for You

The U.S. health‑insurance landscape is on the brink of a sweeping transformation. A Business Insider piece published on December 12, 2025 charts the major changes that will take effect in 2026, spanning the three pillars of the system—Medicare, Medicaid, and the Affordable Care Act (ACA) Marketplace. While each program will see its own set of adjustments, the common thread is that insurers, policymakers, and consumers alike will need to navigate a new set of rules that are designed to curb costs, boost coverage, and align premiums more closely with individual incomes.

Below is a comprehensive look at what’s coming, why it matters, and how you might anticipate its impact.

1. Medicare Part B: Higher Premiums, But No “Low‑Income Subsidy” (LIS) Hike

What’s Changing?
- Part B (medical) premiums will rise by 7.8 % in 2026, from $170.10 in 2025 to $183.30 next year.
- The “Low‑Income Subsidy” (LIS) for Part B, which covers the most economically vulnerable seniors and disabled persons, will remain at $9.60—the same as 2025.

Why?
The increase reflects a broader push to address the escalating costs of healthcare services, physician fees, and the national debt. While the LIS shields the poorest from premium inflation, the 7.8 % hike will affect all Part B enrollees who pay full premiums, nudging many to consider bundled or alternative coverage options.

How to Prepare
- Review your current Part B plan and see whether switching to a Medicare Advantage (MA) or a different provider will offset the higher cost.
- Check eligibility for the Part B “Low‑Income Subsidy”—you might qualify if your household income is below 150 % of the Federal Poverty Level (FPL).

The Business Insider article links to the official Medicare.gov page that lists the current eligibility criteria and steps to apply for the LIS.

2. Medicare Part D: Prescription Drug Coverage Increases

What’s Changing?
- Part D premiums—the prescription‑drug component of Medicare—will increase by 7.4 % in 2026.
- The average increase will be roughly $7 per month; the highest‑priced plans could see a jump of up to $10–$12.

Why?
The increase is part of a two‑year cap mandated by the Inflation Reduction Act (IRA) of 2022. While the IRA capped the rise at 7.4 % for both 2025 and 2026, the cap was set to expire in 2027. The 2026 hike reflects a shift from the IRA’s cap to the federal “Medicare Fee Schedule” adjustments that track drug cost inflation.

How to Prepare
- Shop for a new Part D plan during the open‑enrollment window (January‑February 2026).
- Compare the “Standard” vs. “Silver” plans and evaluate cost‑sharing structures.
- Check for “Premium Tax Credits” that may offset the increased premium if you qualify under the ACA’s “premium tax credit” rules (see the next section).

The Business Insider piece follows a link to the CMS (Centers for Medicare & Medicaid Services) “Part D Open Enrollment” page that lists plan changes and cost estimates.

3. ACA Marketplace: Premium Tax Credits, Cost‑Sharing Reductions, and the “Cap” Expiration

What’s Changing?
- The premium‑tax‑credit “cap”—the percentage of household income that can be deducted from the monthly premium—will expire at the end of 2025.
- For 2026, premium tax credits will revert to the “100 % income rule”, meaning that for households earning up to 400 % FPL, the credit will cover the entire cost of the second‑lowest‑priced Silver plan.

Why?
The American Rescue Plan (ARP) extended the 9.6 % cap until 2025. After the cap expires, the ACA’s original “100 % rule” comes back into force. This change is expected to reduce the premium tax credit for higher‑income households (those earning 200–400 % FPL) and increase it for lower‑income households (under 200 % FPL) who previously had been capped at 9.6 %. The net effect is an expected shift of subsidies toward the most needful families.

How to Prepare
- Re‑calculate your eligibility for premium tax credits using the 2026 “100 % rule.”
- File the IRS Form 1040 (or 1040‑EZ) in the same year as you would under the current rules.
- Review your marketplace plan—some insurers may lower premium costs to accommodate the new credit structure.

Business Insider’s article links to the IRS “Premium Tax Credit” page and the ACA “Marketplace” homepage for detailed calculators.

4. Medicaid Expansion: “Roll‑Out” Phase Continues

What’s Changing?
- In 2026, 27 states are slated to adopt Medicaid expansion under the ACA.
- The federal government will provide full cost‑sharing for these states for the first year, after which a 60‑% federal share will apply.

Why?
The ACA’s Medicaid expansion has been a cornerstone of reducing uninsured rates, especially among low‑income adults. The “roll‑out” plan is intended to phase in new beneficiaries gradually, ensuring states have the infrastructure to manage claims, while the federal government offsets initial costs.

How to Prepare
- Check your state’s expansion status on the Medicaid.gov “Eligibility” page.
- Verify your income—you must earn no more than 138 % of the FPL to qualify for expansion coverage.
- Apply online through your state’s Medicaid portal or through the ACA Marketplace if you are under 19, 19–26, or 26–50 with a household income up to 300 % FPL.

The article references the Medicaid.gov “State Plans” page, which lists expansion timelines for each state.

5. What These Changes Mean for Consumers

Financial Planning
- Budget for the higher premiums by adjusting your monthly expenses or exploring additional subsidies if you are in the lower income brackets.
- Utilize the “ACA Marketplace” savings calculator to estimate your net premium after tax credits.

Health‑Care Planning
- Coordinate with your primary care provider to anticipate any potential changes in drug coverage or copays that could affect your treatment plans.
- Verify your drug formulary in your new Part D plan to avoid higher out‑of‑pocket costs for brand‑name medications.

Stay Informed
- Sign up for the CMS newsletter to get updates on Medicare changes.
- Follow your state’s Medicaid website for real‑time updates on eligibility and application status.
- Use the IRS’s “Premium Tax Credit” calculator to stay ahead of changes.

Bottom Line

The 2026 health‑insurance changes are a mix of higher costs and increased subsidies, shaped by fiscal realities and the legacy of the ACA. Medicare enrollees will face a moderate premium hike, while those in the marketplace can expect a re‑establishment of the 100 % income rule for premium tax credits—potentially raising subsidies for low‑income households but lowering them for mid‑income families. Medicaid expansion will reach new states, offering coverage to millions of low‑income adults.

While the changes may initially seem daunting, the key to minimizing their impact lies in proactive planning: re‑examining your plan choices, leveraging available subsidies, and staying engaged with official resources. By doing so, you can maintain continuous coverage and protect your health and finances as the U.S. health‑insurance system evolves.