Community Champion ⭐⭐⭐

What Ideas Do You Have To Hold Down Medicare Part B Premiums?

Forum|Forum|11 months ago
October 17, 2025
43 replies
8183 views

IF you are not one of the millions that currently has their Part B premiums paid by your state’s Medicaid program, then you will see an increase in these premiums for 2026. Estimates that I have seen, but yet have been announced, shows that we could top over $200 a month for this cost in 2026 for just regular Part B premiums. Then, of course, those with higher income will be paying a whole lot more for their Part B premiums in the form of IRMAA payments (Income Related Monthly Adjusted Amount).

So do you have any suggestions on how to hold down these Part B cost? In that regard, you have to know what Medicare Part B covers, how waste, fraud and abuse affects the program financially and the coverage determinations that affect it in usage.

Like this one:

It has long been the process of moving procedures that were at once considered major operation (Medicare Part A) to being done on an outpatient (ambulatory) status (Medicare Part B). To me, that isn’t saving money - that is just moving around the part of Medicare paying for this service. It takes the coverage strain off of Part A (paid for via your payroll taxes and matched by your employer) and puts it on Medicare Part B that is paid for by all Medicare beneficiaries whether directly or indirectly. It also ups the cost of Part B.

C

CBtoo

Community Champion ⭐

Besides cost shifting, people are living longer so that will drive the costs up too. Inflation drives up the cost and a chunk of that inflation right now is being caused by the increased tariffs. Reading all the deals that are being cut with pharmaceutical companies so they can escape tariffs, the drug price cuts appear to not include Medicare prices - the focus is on private insurance and Medicaid. That isn't going to help either since some of those drugs are paid for via B. People could advocate that Medicare is included in the price cuts of meds that are being negotiated via tariff reduction.

I read in several places they are estimating the 2026 price of B will be around $206. Of course we won't know for sure until it is announced.

GailL1Author

Community Champion ⭐⭐⭐

@CBtoo - Thanks for your suggestions - However . . . .

If people are healthier as they live longer, it should not have too much of an effect especially if we have younger and hopefully healthier beneficiaries always coming into the program.

Now we do have those who have Medicare because of a disability (younger than 65) also adding to this Part B cost. Perhaps we should have a separate Part B SMI just to see how this affects Medicare Part B - just for analytical purposes.

Part B is influenced by medical inflation - but with CMS controlling how much providers are paid for services, from physicians to DME, then that is already taken into consideration to a certain extent.

The only drug prices that are covered under Part B are those that are given in a provider setting and covered by the Part B program. The selected ones will begin negotiations in 2028.

KFF.org- 01/23/2025 - FAQs about the Inflation Reduction Act’s Medicare Drug Price Negotiation Program

from the link ~

For selected drugs covered under Part B that are administered to individuals in provider settings, Medicare beneficiaries enrolled in Part B, including those in both traditional Medicare and Medicare Advantage plans, are eligible to receive the maximum fair price. (Part B drugs will not be selected for negotiation until 2028.)

I do not know how many of these would be affected by the tariffs. I really doubt that the Part B premium that is being announced for 2026 would be that affected by any tariffs since they have not been in existence for very long.

Now we do have a huge problem with fraud in the DME area of remote monitoring and in supplies billed and never received. I personally think we need Medicare Contractor payers assigned to review all these claims BEFORE we pay them to verify their accuracy. This is just a problem in Traditional Medicare since of course, Medicare Advantage plans scrutinize these claims before they are paid.

Now what would other think about some rules along the line that are used by private insurers and even in other countries and that is for those on Traditional Medicare to have to have a referral to a specialist from their PCP (personal care physician) - this would serve (2) important cost saving tactics.

1. Encourage people to have a PCP - these type physicians can often treat many things without going to a higher priced specialist (2) Preserve the specialist care for those who medically need this sort of care. This also helps the beneficiary too - with many specialist now requiring such a referral to better utilize their own time and another physicians referral usually helps to get the beneficiary into the specialist office faster than a self-referral.

In other countries, this is called having a “gatekeeper” - and that is all that it is - a PCP that looks after you and oversees your care just so it is all moving in the best direction for the best care. This PCP also knows all the meds you take so that there is no bad cross reactions or that one med is not cancelling out the other. All kinds of benefits from having a PCP gatekeeper and it has been proven to save money just fro these actions.

I do not think that it is right that we can change procedures from hospital (Part A) to out patient (Part B) without some change in funds from one Medicare Part to the other - Government does want to control Part B cost because this is the area where they are paying the lion share of the cost. Part B premiums pay for 25% of the Part B cost; the general fund of our US Treasury pays the other 75% - Of course, with those beneficiaries having a higher income paying a higher % of the cost - sometimes the full cost of both the beneficiary (25%) and the government’s share (75%)

I am sure there are more practical changes - you may not think that some changes would save Part B a lot of cost - but multiply that by (now) 70 MILLION and it does add up.

Any other suggestions from anybody?

IT‘S ALWAYS SOMETHING . . . . .. . . . Roseanne Roseannadanna

C

CBtoo

Community Champion ⭐

They are not necessarily healthier to live longer. They do use far more medical care and have more chronic conditions than younger people that require more doctor visits to keep in check what is wrong with them. Medical care has improved over the years. The cost of our B increasing has more or less matched the percent that reimbursements have gone up.

One of the things that needs to be under better control so that will decrease the costs to B is the upcoding that goes on. That has also impacted the cost, thus what we pay for B.

D

dd98032427

Contributor ⭐⭐

Moving a procedure from an in-patient major operation to an outpatient status absolutely DOES save money. Shorter stay, maybe just a few hours instead of overnight. If in a clinic instead of a hospital, far less expensive. Less time spent by the staff. If it can be done safely, it's the way to go. Either way, Medicare pays. This way, it pays less.

GailL1Author

Community Champion ⭐⭐⭐

@dd98032427 - That is true - it does save money for the program in total but in this instance, we are talking about Part B premium - and in that regard, it increases Part B premiums.

When under the inpatient classification, it was paid for out of the Medicare Trust Fund (Part A or HI Trust Fund). A shift from Part A inpatient to Part B outpatient, decreases the cost to Part A but increases the cost to Part B and thus the Part B premium.

Came back to Edit and add: Because of this change, some people think they are getting shorted because making some procedures outpatient rather than inpatient, they also lose the rehab aspect of the inpatient coverage. Now that does save a lot of money - agreed - but some are definitely not happy about it.

IT‘S ALWAYS SOMETHING . . . . .. . . . Roseanne Roseannadanna

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CBtoo

Community Champion ⭐

Take it up with congress if you don't like what is happening in health care and get them to change how B is paid for - B is partly subsidized by the government for most of us, with that subsidy being reduced more and more as we hit certain income levels. And in advantage plans it may or may not be completely subsidized by the government.

Bringing down B by forcing people to be hospitalized when they don't need to just drives up issues for those people and drives up Medicare A's costs which will mean A will run out of money sooner than it already will.

So you'd rather be hospitalized when you don't need to be just to bring down the cost of Medicare B?

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Tonster521

Community Champion ⭐

@gail1, I believe most folks would opt for a larger Part B deductible if the Part B premium/contribution is decreased appropriately. Maybe add a $500, $1,000, or more deductible option that can be changed from year to year during October and/or November. In my opinion, the current 25% ($185) is an outstanding deal when compared to the estimated full cost ($740). I would also recommend that folks below a certain income level do not have any premium/contribution. To require those folks to pay/contribute the same as the wealthy is a shame. Congress just gave over $200 Billion of SS Benefits to folks with a "gold plated" government pension by eliminating the Government Pension Offset and Windfall Elimination Program. Many of those folks have government pensions that have present values in the hundreds of thousands if not millions. In Illinois, the median (not average) pension in the Teacher Retirement System is approximately $65,000/year. In cash payments, that will amount to $1,950,000 for an age 55 to 85 retirement. Moreover, many start full pensions in their 50's as opposed to the SS program which the earliest is age 62 and actuarially reduced. For comparison purposes, I believe the median SS Benefit is somewhere around $25,000 to $27,500/year. For these folks, Medicare should be provided with no additional premium/contribution. Same concept as the ACA (Obamacare). Additionally, there is no logical reason for providing a 75% Part B subsidy for higher income folks. The IRMAA income schedule should be adjusted to more reasonable income levels starting much lower than the current schedule. In simple terms, if one has more income, the subsidy is less. Medicare, just like all insurance benefits, are welfare benefits. Why does the Medicare program especially Part B subsidize highly compensated folks at the expense of the non-highly compensated folks?

GailL1Author

Community Champion ⭐⭐⭐

@Tonster521 wrote

I believe most folks would opt for a larger Part B deductible if the Part B premium/contribution is decreased appropriately. Maybe add a $500, $1,000, or more deductible option that can be changed from year to year during October and/or November

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That could work for many beneficiaries, suites me - except those with those very lucrative Medigap plans - cause then they would have to pay them since NO Medigap plans now can cover the Part B deductible.

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@Tonster521 wrote

I would also recommend that folks below a certain income level do not have any premium/contribution.

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That’s already done via the Medicare Savings Programs - state Medicaid pays their Premiums and even other stuff depending on the program they are in as they are described. Some will also get full Medicaid coverage while others will only get the described things covered. Part B deductible is constant in each of the programs.

Medicare.gov - Medicare Savings Programs (Federal Levels)

One thing that does bother me with the Medicare Savings programs - the eligibility income and asset levels are shown for the Federal level however states can make these more lenient and many do - in fact many states have NO asset level at all. And then some states have a much higher income eligibility -

I do not think that his is a MEDICAID program that is matched by the Feds as most are - BUT I DO NOT KNOW FOR SURE.

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@Tonster521 wrote

To require those folks to pay/contribute the same as the wealthy is a shame

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The wealthy pay a lots more - The IRMAA is a Part B adjusted premium that those with higher incomes pay into the Medicare Part B program to cover more than 25% of the beneficiary cost.

SSA.gov - Premiums: Rules for Higher-Income Beneficiaries

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Please do not get me started on the Social Security “Fairness” Act - we do agree that it was plain stupid the way it was done - especially when there was a new formula that could have been initiated instead of the way it was done.

A friend of mine got a $ 30,000 check and now in addition to her $ 75,000 civil pension she is getting a $ 3,000 Social Security retirement check every month. Course she is now having to pay the monthly IRMAA premiums every month and she is griping about that - LOL. Even she think she got a windfall since she never paid one cent into Social Security her whole working life.

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@Tonster521 wrote

Additionally, there is no logical reason for providing a 75% Part B subsidy for higher income folks. The IRMAA income schedule should be adjusted to more reasonable income levels starting much lower than the current schedule. In simple terms, if one has more income, the subsidy is less.

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That is specifically how the IRMAA works (see the SSA.gov link about for the explanation). But yes, I would agree that the income limits here should be removed from the inflationary requirement - leave them standing at the current level or lower them - I opt for leaving them at current level and then more and more people will get included in it as time goes by. Just like the Taxes on benefits was designed to work.

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I don’t think our Congress has too much on the ball when it comes to math, actuaries, etc, Our huge deficit should reaffirm this - they cannot add or subtract. Thank goodness we do have some that can do it but they don’t seem to be in Congress rather they are supportive staff. And the numbers don’t seem to matter when Congress decides to GIVE something.

IT‘S ALWAYS SOMETHING . . . . .. . . . Roseanne Roseannadanna

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Tonster521

Community Champion ⭐

@gail1, Generally, people want free or no cost items including insurance benefits. As many of us know, nothing is free. Someone or some institution may be paying for those items or costs on one's behalf including taxpayers. Many are not concerned with shifting costs as long as they did not have to pay. Some will pay a high premium for Medigap coverage with the expectation that both Medicare and Medigap coverage will pay all hospital/medical expenses. So, accepting a higher deductible in exchange for a lower premium may not be a priority. Even though accepting a lower premium may be a sound financial decision, I agree some will not elect a higher deductible because they will have to incur and pay some hospital/medical expenses.

With regard to the Medicare Savings Program, many eligible folks either do not apply for help or are frustrated with the application process. It is estimated that less than 60% of those eligible apply for help. I will try to copy and paste a link to an article from Medicare Rights Center https://www.medicarerights.org/policy-documents/medicare-savings-programs-a-lifeline-for-millions One would think that a Medicare Saving Programs should be administered without unnecessary "red tape", bureaucracy, and a reasonable income threshold. That is why I suggested a benchmark income level and eligibility is approved. Assets are another issue that needs to be determined. I am not sure if States contribute any money to the MSP. However, the Fed simply waives the Part B premium/contribution for folks that are approved.

IRMAA is a very good concept. However, it currently starts at $106,000 Single and $212,000 Married. It should start much lower, perhaps at 50% or 75% of the above amounts. Why should folks at income levels above 50% or 75% of current thresholds receive subsidized welfare benefits? They have the wherewithal to contribute a greater share by receiving a lessor subsidy. If you study the math regarding the premium/contribution as it relates to income, the lower paid folks are subsidizing the higher paid folks up to the point when IRMAA begins at $106 K Single and $212 K Married.

Lastly, I thought that some of the new folks in the current Administration may be problem solvers. However, it looks like the "same old same old". Maybe change for the better is in the future. Thanks for your positive support.

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