Most importantly: it is still open enrollment! If you think you missed open enrollment to get individual/family coverage, you actually have until January 15th to make changes.
Let’s talk about individual/family insurance first. In my September update, we talked about the imminent sunsetting of enhanced premium tax credits at the end of 2025. You’ve heard about this probably, it was a major point of contention during that government shutdown. Well it’s looking very probable that enhanced premium tax credits really are going away at the end of 2025, but Washington state has made some moves to help combat the negative effects. The strategy imposed by the office of the insurance commissioner is called ‘silver loading’, and if you’re an insurance nerd like me I’d love to tell you about it in more detail, but basically, tax credits are based on silver plan prices, so Washington state increased the cost of silver plans to inflate premium tax credits. And this approach is working, people are not facing 70%+ increases as predicted. But some of you are thinking, well what do you mean Emily, I used to get a premium tax credit but now my insurance is more expensive than ever! Unfortunately, the biggest hit is being delivered to those making income at or above 400% of the federal poverty level based on household size. You used to receive some premium tax credits even at this income level, now you won’t receive any…at all. For context, 400% of the FPL for a household of two is around $84,000. That’s a federal law that Washington state cannot influence with silver-loading.
Enough about all that, let’s talk about 2026 Medicare costs, which were just announced in November:
- Starting with Part A, hospital coverage: this is still free for most people! But cost-sharing has increased:
- Deductible is $1736 per in patient hospital benefit period up from $1676
- 0-60 days in the hospital are $0 per day – no change here!
- Days 1-90 in the hospital are $434 per day, – up from $419
- Skilled nursing facility stays remain $0 for the first 20 days
- Days 21-100 are $217 up from $209.50
- Part B, your medical insurance for doctor visits, durable medical equipment, and outpatient procedures cost $185 per month for most people in 2025. That base price is going up to 202.90 in 2026!
- And the Part B deductible is also up! It is now $283 from $257 in 2025.
- Coverage here hasn’t changed, you usually are charged 20% of the approved cost of an appointment or procedure (but doctors can charge excess charges remember, up to 15%, so additional coverage is available in the form of an Advantage plan or a Supplement of course!)
- IRMAA thresholds also changed! If you don’t know what that is, it’s okay, it doesn’t apply to everybody. If you are subject to an IRMAA we can talk about it!
That wraps up our winter 2025 update, reach out if you need to meet about open enrollment – it is not too late!! Happy holidays and happy new year!!
