2026 Social Security and Medicare Facts

Michael D. Thomas, Marc Kiner, Jim Blair

• Publisher: The National Underwriter Company
• Year: 2025
• eBook ISBN: 9781588528896
• Topic: Business
• Subtopic: Insurance
• Index: Business

2026 Social Security & Medicare Facts is the premier one-stop guide for attorneys, CPAs, and retirement and financial planning professionals to advise on tax and policy changes affecting Social Security and Medicare. Structured in a unique and user-friendly Q&A format with over 1,100 entries, this book enables professionals to swiftly locate precise solutions to address clients' important planning issues efficiently.

This book features:

• Enhanced discussion of strategies with updated insights on planning techniques to optimize your clients' Social Security benefits
• Changes related to Social Security, Medicare, and Medicaid coverages
• Updated questions addressing coverage, benefits, costs, taxation, computation, and maximization of benefits
• Adjustments resulting from the One Big Beautiful Bill Act
• Significant modifications to Medicare, especially Part D, with the elimination of the "donut hole" changes in cost sharing and out-of-pocket, elimination of the Coverage Gap Discount Program, as well as the negotiated lower prices for certain Part D drugs

New in the 2026 Edition:

• Changes effected by the Trump Administration and the 119th Congress, including the changes to Social Security, Medicare, and Medicaid by the "One Big Beautiful Bill"
• Continuing effects of the Inflation Reduction Act on Medicare Part D and Part D Drug Costs
• Higher Part B and Part D programs
• Increase in out-of-pocket Part D prescription drug costs
• Addition of coverage of Part A as the second payer and explanations of situations of dual coverage
• Expanded coverage of Home Health Care
• Additional Community Health Integration Services, coverage of RSV/Shingles, Caregiver training, and Principal Case Management and Principal Illness Navigator coverage in Part B
• Expanded coverage of Part B services and non-coverages
• Ending sales incentives for Medicare Advantage and Part D plans
• Requirement that Medicare Advantage providers provide mid-year notification to policyholders of unused benefits
• Additional Community Health Integration Services, coverage of RSV/Shingles, Caregiver training, and Principal Case Management and Principal Illness Navigator coverage in Part B
• Expanded coverage of Part B services and non-coverages
• Ending sales incentives for Medicare Advantage and Part D plans
• Requirement that Medicare Advantage providers provide mid-year notification to policyholders of unused benefits
• Part B only coverages
• Inflation Reduction Act Part D changes to out-of-pocket expenses, changes to Part D base premium, Part D cost-sharing, and spending caps
• Part D drug price negotiations to lower prescription costs
• Changes in MOOP
• Changes to Medicaid Expansion, PACE, and Long-Term Care programs in Medicaid
• Expanded coverage of Durable Medical Equipment coverage
• Expanded coverage of compassionate allowances in Social Security
• Continued expansion of Social Security hearing and appeals processes
• Updated coverage of the Program for All-Inclusive Care for the Elderly (PACE)
• New checklist of what events can lead to loss of benefits by each type of beneficiary
• New coverage of the effect of loss of citizenship/permanent resident alien status on Social Security and the ability of non-resident aliens to collect
• Enhanced coverage of the impact of divorce and remarriage on Social Security eligibility and benefits
• Effect of MACRA on Medigap
• Expanded distinct coverage of Medigap plans for Massachusetts, Minnesota, and Wisconsin
• Expanded coverage of the Government Pension Offset (GPO) and the Windfall Elimination Provision (WEP)
• Continued changes in state taxation of Social Security benefits
• "De minimus" coverage expansion
• Coverage of potential changes in Social Security because of R-CPE-E
• Potential changes in the calculation of Primary Insurance Amount (PIA)
• Plans to increase special minimum benefits for lower-wage beneficiaries
• Expanded coverage of methods for curing overpayments from Social Security and SSDI
• Expanded coverage of non-covered items and services by Medicare
• Changes in coverage and costs under Medicare Advantage, Medicare gap policies, and Medicare appeals
• Updated coverage of disability, retirement, and survivor benefits for Social Security, military, government, and railroad workers
• Update in how military service, reserve duty, and merchant marine duty can affect railroad creditable service
• Expanded coverage of Railroad Retirement Unemployment and Illness benefits
• Changes in railroad worker coverage and the differences from Social Security
• Expanded coverage of the Medicare appeals process
• Updated Medigap policy coverages and costs
• Additional coverage of military retirement, including expansion of coverage of the new blended retirement program, military disability pay, and coverage for National Guard and Reservists, including the effect of the CARES Act on the TSP program
• Effect of the elimination of the Special Survivor Indemnity Allowance for Service Members and Veterans
• Changes to SGLI and disability benefits
• Effect of the PACT Act on Veterans' coverage
• Changes in Survivor Benefit Plan – Dependency Indemnity Compensation Increase in Full Retirement Age
• Amount subject to maximum taxable earnings
• Elimination of paper checks
• Cost-of-Living Adjustments (COLA)
• 2026 inflation-adjusted numbers for Social Security and COLA increases

Table of contents

• Title
• Copyright
• About ThinkAdvisor & National Underwriter
• DEDICATION
• PREFACE TO 2026 SOCIAL SECURITY AND MEDICARE FACTS
• ABOUT THE AUTHOR
• ABOUT THE CONTRIBUTING AUTHORS
• LIST OF QUESTIONS
• INTRODUCTION TO THE 2026 EDITION
• PART I: SOCIAL SECURITY
• UNDERSTANDING AND PLANNING FOR SOCIAL SECURITY
• RETIREMENT AND DISABILITY BENEFITS
• COVERAGE
• FILING FOR BENEFITS
• BENEFIT COMPUTATION
• MAXIMIZATION OF BENEFITS
• LOSS OF BENEFITS BECAUSE OF “EXCESS” EARNINGS
• TAXATION OF SOCIAL SECURITY BENEFITS
• SOCIAL SECURITY TAXES
• WAGES AND SELF-EMPLOYMENT INCOME
• RAILROAD RETIREMENT BENEFITS
• BENEFITS FOR SERVICE MEMBERS AND VETERANS
• BENEFITS FOR FEDERAL GOVERNMENT EMPLOYEES
• CASE STUDIES USED IN PLANNING FOR SOCIAL SECURITY MAXIMIZATION
• PART II: MEDICARE
• INTRODUCTION
• PART A: HOSPITAL INSURANCE
• PART B: MEDICAL INSURANCE
• PART C: MEDICARE ADVANTAGE
• PART D: PRESCRIPTION DRUG INSURANCE
• MEDIGAP INSURANCE
• HOW TO SUBMIT CLAIMS AND APPEALS
• MEDICAID
• APPENDIX A: SOCIAL SECURITY TABLES
• APPENDIX B: FEDERAL EMPLOYEE TABLES (2026)
• APPENDIX C: SERVICE MEMBERS AND VETERANS’ TABLES
• APPENDIX D: MEDICARE TABLES
• APPENDIX E: WHAT MEDICARE DOES NOT COVER
• APPENDIX F: EXAMPLE OF MEDICARE BENEFITS
• APPENDIX G: MEDICARE PART A AND B ADMINISTRATIVE CONTRACTORS AS OF OCTOBER 2025
• APPENDIX H: MEDICARE QUALITY INNOVATION NETWORK (QIN) QUALITY IMPROVEMENT ORGANIZATIONS (QIOs)
• APPENDIX I: DURABLE MEDICAL EQUIPMENT (DME) MEDICARE ADMINISTRATIVE CONTRACTOR (MAC) JURISDICTIONS
• APPENDIX J: INSURANCE COUNSELING — GENERAL INFORMATION (2026)
• APPENDIX K: STATE AGENCIES ON AGING (2026)
• APPENDIX L: MEDICARE ADVANTAGE BY STATE
• INDEX
• Back Page