In this Episode of the Secure Your Retirement Podcast, Radon and Murs discuss why Medicare 2026 is shaping up to be one of the most impactful years for retirees and those approaching retirement. With major Medicare updates, rising Medicare costs 2026, and several Medicare new rules taking effect, understanding how these changes affect your overall Retirement Planning is more important than ever. From prescription drug reforms to premium increases and income-based adjustments, Medicare is not something you can afford to “set and forget” when you’re planning retirement and working to secure your retirement.

Listen in to learn about how Medicare Part B premium 2026 increases, IRMAA surcharges, and Medicare income limits 2026 can directly impact your cash flow in retirement. Radon and Murs also explore how Medicare planning fits into a comprehensive strategy to help you retire comfortably, avoid costly surprises, and align your healthcare decisions with your long-term retirement checklist and broader financial plan.

In this episode, find out:

• How Medicare drug price negotiations and Medicare Part D changes 2026 are lowering costs for certain prescriptions
• What the new Medicare out of pocket cap means for retirees with high prescription drug expenses
• Why the increase in Medicare Part B premium 2026 matters for your monthly retirement income
• How IRMAA surcharges and income from strategies like Roth conversions can affect your Medicare premiums
• What Medicare does not cover, including the difference between a Medicare wellness visit and a traditional physical, plus updates on Telehealth Medicare

Tweetable Quotes:

• “Medicare isn’t separate from your financial plan—it’s interconnected with your taxes, income, and investment strategy.” — Radon Stancil
• “One decision, like a Roth conversion, can trigger higher Medicare premiums if you don’t account for IRMAA.” — Murs Tariq

Understanding Medicare 2026 is a critical part of Retirement Planning, whether you’re already enrolled or just beginning to plan for retirement. Staying informed about Medicare updates, knowing your coverage gaps, and proactively planning can make a meaningful difference in how confidently you approach Retirement.

Resources:

If you are in or nearing retirement and you want to gain clarity on what questions you should be asking, learn what the biggest retirement myths are, and identify what you can do to achieve peace of mind for your retirement, get started today by requesting our complimentary video course, Four Steps to Secure Your Retirement!

To access the course, simply visit POMWealth.net/podcast.

Here’s the full transcript:

Welcome, everyone, to the Secure Your Retirement Podcast, and thank you for joining 

in on this beautiful Monday. I have the pleasure today to hop on with Shawn Southard 

in our office. A lot of you have heard of Shawn. A lot of you have met with Shawn 

and given us incredible feedback on his ability to navigate Medicare and Medicare 

decisions and also pre -Medicare if you’re retiring before the age of Medicare. So, 

Shawn, let me just get started by saying thanks for carving out some time and 

hanging out with me today to give our viewers, our listeners, a little bit about 

Medicare. You’re welcome, Murs. Thanks again for having me. It’s always a pleasure to 

be here. All right. So, let’s jump in. Here’s what we’re talking about today is what 

do we need to be aware of regarding Medicare as we sit here in 2026. 

We’re at the beginning of the year and there’s been some changes to Medicare, some 

pretty important ones. It’s not a regular type of year where little things go 

change. We’ve got some pretty significant changes this year in 2026. And so, and why 

your financial plan should care. So, you know, I could try to do this myself and 

walk through this myself, but I just wouldn’t do a good job. And that’s why in our 

office, you know, a few years ago, we wanted to bring in a specialist in Medicare 

and in health care and insurance. And we were fortunate enough to find Shawn. And 

he’s been a tremendous value to the families that we serve navigating all these 

decisions and educating around them. And that’s what today is all about. So, Shawn, 

again, thanks for being here. We know Medicare in 2026. There are some changes that 

are coming our way. So why don’t you start off and just give us the big picture 

of 2026? Give us an overview. And why is it such a standout year in your eyes? 

Sure. Well, hopefully our little segment today will be a little more entertaining 

than going down to the DMV and get some good information to people. But 2026 is 

the year of first, I would say, in Medicare. There’s a lot of first going to be 

happening here in 2026 regarding Medicare. We’re going to have the first ever 

negotiated drug prices that came out of the Inflation Reduction Act a couple years 

ago. There’s a new Part D out of cap amount of $2,100. 

There’s the new monthly drug payment option that’s available to people is going to 

auto -renew. And then there’s some telehealth changes that could be occurring here in 

the middle of the year. And then, of course, you know, kind of going over what 

we’re still dealing with all the time is one of the biggest misunderstandings out 

there in Medicare, what it pays for and what it doesn’t pay for. Right. Okay. So 

that’s a good overview and a lot to kind of get through. So, let’s go ahead. You 

mentioned negotiated drug prices. So, let’s name some of those negotiated drugs because 

people want to know if theirs is on that list. And let’s walk through that one. 

Sure. So, the 10 drugs that went through the process of negotiation to get the costs 

down and now have been approved for 2026, and I’ll do my best in naming these out. 

You know, the people that name these drugs, it’s like, I don’t know how they come 

about some of these names, right? But I think people will get the gist here. So 

here’s the 10 drugs that have been negotiated successfully by Medicare for lower 

prices for people in 2026.  

So, there’s Eliquis, Jardiance, Xarelto (with an X), Xarelto, Januvia, Farxiga, Entresto, Enbrel, Brufaca, Stelara, and the NovoLog insulin. 

So, formulation. So those were the 10 successful drugs that were negotiated on 

Medicare negotiated those down for lower pricing. So, if anybody in the listening 

audience takes any of these or on any of these drugs, your pharmacy bill is 

probably going to have some, you’re going to have some relief there in 2026. Yeah, 

hopefully a sign of relief on some of those prescription drugs. I know that’s always 

been an issue, which kind of leads us into the next topic of part D and the out 

-of -pocket cap. So, I don’t know, Sean, was this kind of referred to as the donut 

hole at one point? Is this what we’re talking about here? Is this something 

different? I know there’s a cap on how much you can pay on prescription drugs, and 

there’s been a change to it. Is this what we’re talking about? Yeah, no, it’s, 

it’s, it’s somewhat related. There were prior to, prior to 2025, 

there were four phases of the drug plan in Medicare. One of those phases was called 

the coverage gap or the donut hole phase. But in January of 2025, that phase was 

ruled out completely by the changes in the inflation reduction act. So now there’s 

really just three phases that remain on the drug plans. There’s the deductible phase, 

which is the first stage. There’s the initial coverage stage, which is the second 

phase. and then there’s the catastrophic phase, which is the third and final stage. 

And then in order to hit the catastrophic, you have to come out of pocket a 

certain amount for your co -pays with your drugs prior to 2025, that was $8 ,000. 

And then last, in 2025, it was brought down to $2 ,000. But they decided here in 

2026, starting in January 2026, that cap is going to be moved up just $100 to $2 

,100. So basically, if a person comes out of pocket $2 ,100 for their drug co -pays 

under a Medicare prescription drug plan, whether it’s in a Medicare Advantage plan or 

standalone drug plan, they will have no co -pays for the remainder of the year 

because these drug plans run on a calendar year, Jan 1 to December 31. So, they 

were used to a 2 ,000 maximum out of pocket in 2025. It’s just going to be raised 

up $100 to $2 ,100 in 2026. Right. And go back a little bit before, 

you know, a pretty significant jump from 8 ,000 down to 2000 and now a small 

increase here in 2026 to 2100. But at the end of the day, for those that are 

pretty heavy on prescription drugs and the cost there, I think there’s tremendous 

savings for those that it does apply to. Would you agree? No, exactly. I would 

agree. And I guess a good way to sum that up is, you know, being in catastrophic 

coverage no longer means that you had catastrophic bills or co -pays to get yourself 

there. Right. Okay. So, let’s move on to the next big change here in 2026. 

Let’s talk about monthly drug costs, the cost smoothing and the prescription payment 

plan. What’s going on there? Yeah. So also, out of that the Inflation Reduction Act 

legislation in 2025, they basically said that the carriers or the plan providers that 

offer these drug prescription drug plans needed to make it easier for people to 

smooth out or plan out their finance, basically, their co -pays over the year. 

Because some people are on some of those high brand name drugs. And to go get 

those filled initially, it could be $600 or more just to get that drug filled for 

a month or a three -month supply. And for people that are retired and on a fixed 

incomes, you know, coming out of pocket that much at one time is a lot. So, they 

said moving and starting in 2025 and continuing on here in 2026, these prescription 

payment plans, Medicare is telling the drug providers of the plans that you have to 

offer if the beneficiary enrollee wants it, a payment plan where they can finance 

over 12 months. So, let’s them spread it out over the year. There’s no interest 

charged or accrued. There are no late fees. It’s just a way to help people be able 

to pay their, you know, that pay their co -pays in a much easier, smoother fashion. 

And then what’s really nice in 2026 is they’re going to allow these plans to just 

auto renew. So, if you had it set up in 2025, you don’t have to do anything to 

make sure it’s going to stay in place for 2026. It’ll automatically renew. There’s 

one exception, though, if you did change your drug plan carrier over annual 

enrollment period back in 2025, October 15, December 7th, you changed to a new plan 

and a new carrier you’re going to have to reset, you’re going to have to set it 

up again with the carrier. But if you stay with the same plan and just renewed it, 

this, and then you’re on the prescription payment plan, everything’s going to 

automatic renew for you. Okay. Well, yeah, I mean, that’s good news in the sense 

of, I mean, we all know that there are issues with the medical system in the 

United States, and it’s very expensive. But for those that have been impacted by, 

you know, inflationary things and, and like you said, being on a fixed income, I 

can imagine that the decision of when not, while not having the payment plan is, 

well, do I get it this month, or do I wait till next month and do I miss some of 

my prescriptions that I’m supposed to be taking, right? There’s a constant stressor 

there. So hopefully this will smooth things out a little bit. It’s to where, 

you know, they can get the care that they need in that moment and then, you know, 

pay for it over time. Right, right. Okay. Well, so let’s talk about Medicare in 

general, I know that there are some misunderstandings in your world. And I am guilty 

of that too with those misunderstandings on all the different sections of Medicare 

and everything like that. And you do a really good job of clarifying that for our 

families and the people that listen on the podcast. So, what are some of the big 

misunderstandings that you hear? And what are the major ones that you want to cover 

here today? Yeah, Sure. So, one of the things that I’ve heard for many, 

many years, you know, people, a lot of people believe that once they get into 

Medicare, Medicare is going to cover everything for them, right? Everything’s going to 

be all set. They don’t have to worry about anything anymore. And Medicare is a 

great health program for people, age 65 and older. And of course, those that are 

disabled that can get into Medicare at a younger age. It’s a really great health 

program for so many people, millions of people, by the way. But it doesn’t cover 

everything. And some of the major things that it doesn’t cover that people are 

convinced that it covers is long -term care. Okay. 

That is something that so many people believe it does cover and are told by others 

that it does, and Medicare does not cover. care covers skilled nursing, 

short -term skilled nursing benefit. They have a skilled nursing benefit period of 100 

days. A person is able to qualify for one of those. If they are an inpatient in 

the hospital for three consecutive days, excluding their discharge day, they can get 

a skilled nursing benefit period of 100 days. But it’s a very short -term thing. 

So, if you are admitted one day into a nursing home or assisted living facility and 

you need long -term, long -term care skilled nursing, Medicare does not cover it. 

Another thing is hearing aids. Medicare does not cover the cost of hearing aids. 

So, if you run original Medicare, Part A and Part B, and you need hearing aids, 

Medicare does not pay for those. Preventive dental care, 

your teeth cleanings and your bite wing x -rays that you get every year, not covered 

by Medicare. Routine vision exams and glasses and contact lenses and that type of 

thing, not covered. And of course, another one is the annual physical examination, 

something that we’re used to our whole lives going a year after year, hopefully, you 

know, getting our blood work checked and other things checked with the doctor. 

Original Medicare does not cover that, but people are convinced, 

you know that it does. Right, yeah. So, like a physical, I just think of my annual 

checkup, but in Medicare it’s defined a little bit differently as what it looks 

like. There’s you’ve got the annual physical and then the annual wellness visit. 

Right. So, help us or help the listeners kind of understand what’s, what’s that 

difference and which one is Medicare going to cover? Yeah. So, Medicare does cover 

what’s called a wellness check or a wellness visit that is covered by Medicare. 

It’s really an interview, if you will, with the doctor. I’ve never personally, 

I’m not in Medicare yet, so I’ve never personally had one done. But, you know, I 

have so many clients that have been through it and they basically say, you know, 

the doctor comes in with the iPad and kind of just reviews their medical history, 

updates their medications, 

you know, has a conversation with them, asks a bunch of questions. They try to 

assess fall risk, any cognitive or potential depression of the person, 

just update their height and their weight and that type of thing. There’s no pre 

-blood work, you know, for your annual physical exam that you go to get your blood 

drawn before. They don’t listen to your heart of your lungs with the stethoscope. 

You know, they don’t check, you know, different parts of your body manually, you 

know, as they do in an annual physical exam. There’s no other type of diagnostic 

testing that’s going on with the wellness visits. So, so people just need to be 

aware that when they get into Medicare, that if they, if they’re going to be an 

original Medicare and not on a Medicare Advantage plan, they just need to be 

prepared that if they do want the traditional annual physical exam, they will have 

to pay for it because Medicare does not pay for it. Medicare Advantage plans, 

many of them do, but original Medicare does not. So that’s, that’s one of the big 

clarification there on that one. Right. So, what would you say as advice to someone 

that is scheduling their what they have in their minds as their annual visit? How 

do you make sure that, you know, it’s communicated properly so that they don’t get 

a bill after the fact for something that they didn’t think they were asking for, 

you know? Yeah. So, so, so basically, you know, when people call, now if providers 

are going to be taking Medicare patients, you know, obviously these provider 

offices know, you know, what Medicare covers and what Medicare doesn’t. They’ve been 

doing it for a while. So, but I do also understand, you know, that with everything 

also, that a lot of these offices, you know, that are primary care physicians and 

so forth that do take Medicare patients and have for a long time, you know, if you 

work with that office, because obviously it’s going to boil down many times to what 

the billing codes are, like what the office sends out, you know, after they meet 

with people and what kind of codes, diagnostic codes or whatever they’re going to 

send in. There’s, you because sometimes they’ll work with the person and say, hey, 

you know, you call in and say, hey, I really want to have an annual physical exam. 

I know original Medicare doesn’t cover it. What can I do to kind of do that? And 

I do understand from many clients that many providers will help guide you through 

that and kind of help you or coach you on how to set up the appointment and what 

to say to make sure that it potentially could be covered, 

you know, so you won’t get billed for it, right? And then, of course, if you come 

see me and you can work with me, 

I know of some carriers and some plans and some things that we can do here that 

can help people in this area as well. 

that we pay on part B, and then this thing that kind of gets in the way sometimes 

or can be especially, let’s just say, annoying if you weren’t prepared to see it or 

feel it, which is Irma, Medicare Irma surcharges. 

Let’s talk about that for a little bit in the updates on those numbers. Sure. So 

Irma, so it’s an acronym. I -R -MAA, Medicare loves acronyms, right? So, IRMAA stands 

for income -related monthly adjustment amount. And basically, that is just a fancy way 

of saying the extra money someone is going to pay for Part B of Medicare or Part 

D of Medicare, which is the prescription drug plans premiums. The extra they’re going 

to pay based off of income, right? So, Medicare, how its equation is always the 

same. They take the current year, so we’re 2026. All right. And so, what a person 

is going to pay that’s enrolled in Medicare, Part B and Part D in 2026 is what 

they filed for taxes in 2024. They always go back two years from the current year. 

So, people will need to reference their 1040 from 2024. And then they always look at 

the line 11 in the 1040, which is the modified adjusted gross income amount, 

found on line 11 of the 1040. And based on that, these IRMAA levels change every 

year. So don’t try to memorize at all because every year they change. And so, in 

2026, they’re different than 2025. So, the new income thresholds for single filers are 

$109 dollars modified adjusted gross and for married or joint filers it’s the 

modified adjusted gross income level is 218 ,000 so if you earned less than those 

two income thresholds the new base premium for part B in 2026 is 202 and 90 cents 

a month That’s a per person rate, okay? It is up quite a lot from, 

from 2025. The premium base premium last year was $185 a month. 

So, we’re looking at, what is that, about, about 9 %, 9 .5 % increase, 

give or take. So, it was a shocker for it to increase that much, 

especially since the cost-of-living adjustment on social security for 2026 was 2 

.8. So, it’s basically, you know, more than three times the COLA adjustment. 

But that’s what it is for 2026. So, and of course, D is also impacted as well for 

the surcharges there. But the part B was, was the biggest, was the biggest increase 

there. Right. Yeah, from 185 to 202 and 90 cents. Not to get over philosophical 

here, but do you have any thoughts as to why it was such a big increase on Part 

B and Part D this year? I mean, there’s been some changes that are covering some 

drug costs and things like that. So, any thoughts there? Yeah, so all the feedback, 

all the different, you know, I call them white papers and, you know, executive level 

type of communications from the carriers and different things that I receive as an 

independent broker from all these different sources, they’re basically saying and 

arguing that medical loss ratios are at an all -time high. So, you know, the amount 

of premium that’s being brought in versus how much is being paid out in claims 

creates that ratio, the medical loss ratio, and the higher the ratio, you know, 

the more is going out in claims. And I think That’s one of the key drivers in all 

this is, unfortunately, there’s so many people that are, you know, 

needing the health care system for one reason or another. And it’s really creating 

this increase. Everything is just so expensive now. Right. So, IRMAA, 

and paying attention to IRMAA, we believe, is incredibly important just because you 

don’t want to run into a scenario where you did something that you thought was for 

one purpose. So, let’s say we talk about Roth conversions a lot on our podcast and 

our tax strategy meetings with clients. And the idea of a Roth conversion is very 

nice because you move some money from a pre -tax bucket into a tax -free bucket. 

But it does add to your income for that year. You have to pay some taxes on those 

that are moved. So, if you just look at it independently and say, how do I optimize 

my tax brackets and you make the decision solely on the tax brackets and you forget 

to think about Irma, well, you could get a surprise, and you could have for the 

entire year, your Part B and your Part D premiums are elevated, which can negate 

the entire benefit of doing the Roth conversion. So, we truly do believe that, 

you know, when it comes to your financial plan, Medicare is one piece of that pie, 

but they all kind of interlinked together and you’ve got to be paying attention to 

everything. So, I’m glad we touched on IRMAA. It’s a big topic. And it can be one 

that, you know, makes people pretty bitter even more than losing money in the stock 

market sometimes. So that’s a good one to pay attention to. John, let’s talk about 

telehealth, telehealth in 2026. This is a growing area where people are feeling more 

and more comfortable, getting answers without having to go into an office. So, let’s 

talk about that as it applies to Medicare. Sure. So, in 2026, I know we’re kind of 

highlighting the changes and the things to be aware of in 2026. So, the word is, 

you know that we understand, brokers at this point are through January 30th 

of 2026. Medicare is still going to allow the telehealth from home. 

Okay. 

Audio, they’re going to still allow audio only for certain visits. 

There are no restrictions on rule, people living in rural areas. 

So, all that’s still a go. But starting on January 31 of 2026, unless Congress acts 

and changes the legislation on this, the rules are going to tighten up on 

telehealth. So, people who use telehealth in 2026 are going to have to pay close 

attention to this because we’re only, you know, basically have a short lease here to 

the end of January unless Congress acts. So, for example, in the rules getting 

tightened up, if Congress doesn’t do something that’s going to contradict any of 

this, if you live in a suburban area and you’ve been using and seeing your 

cardiologists through telehealth at your home, through January 30th, you’re going to 

be fine. But after January 31st, Medicare may require that you actually live in a 

rural area, not a suburban area. And they’re going to, 

you’re going to, they’re going to make you physically visit a medical facility as 

opposed to connecting via video. Okay. So behavioral health, 

we believe, will still remain flexible on this, but, you know, like, you know, going 

to see specialists and so forth, they’re most likely going to make you have to come 

into the office. So, but also to also keep in mind that some Medicare Advantage 

plans, if you’re enrolled in a Medicare Advantage plan, which many people may be on 

listening to this, those plans may still be able to have the broader telehealth 

offerings. It’s original Medicare where it’s going to really be impactful. Yeah, if 

you are one that’s gotten to become accustomed to telehealth, especially since the 

pandemic, and it looks like you may want to pay attention here as we start the 

year 2026 and kind of understand what your requirements are if you’re one of those 

that fall into that bucket of telehealth preference. So, well, Shawn, this has been 

great. You know, the takeaway here today for 2026 in Medicare is we’ve got some 

changes on drug prices in a lot of people’s favor. If they are taking those drug 

prices, the out -of -pocket cap has gone from 2000 to 2100. 

But let me remind you it was 8 ,000 a couple years ago, so still in a good place 

as far as benefit for those that it applies to. Monthly drug payment, smoothing. 

So, for the ones that can’t afford or are overwhelmed by the one hit of paying for 

a prescription, that could be a little bit expensive, the ability to smooth that 

through payment plans. And then some telehealth changes that this one may be the one 

negative that or a little bit, uh, that there’s going to be a little bit more work 

that needs to be done on telehealth as far as qualifying for it and, uh, 

understanding what your options are there. But in general, man, uh, I, I stand by. 

Medicare is confusing. And so, for that reason, you know, it’s not something that you 

want to set and forget. It’s part of your living, breathing financial plan, just 

like all the other elements that we talk about here on the podcast from income 

planning, the tax strategies to tax planning, the investment strategy, you know, 

everything, your health, all of this is intertwined, and we need to be paying 

attention to it every single year. And that’s a big part of what we do here, peace 

of mind wealth management, along with Sean, Sean being that key figure on the health 

insurance side and Medicare planning side for our clients. We wrap it all together 

to make sure that nothing is being overlooked and that all of the facets of our 

financial plan is kind of well monitored and they’re operating together as 

efficiently as possible. So, with that, Shawnn, let’s do this really quick. If you don’t 

mind, you know, as we sit here in the new year and there’s different types of open 

enrollment, there’s new people that are turning 65 and becoming eligible for Medicare. 

Briefly here, just kind of walk through your process and tell them what it looks 

like to work with you. Sure. Well, I appreciate that. So, I’m an independent Medicare 

broker here at Peace of Mind, wealth management, and the way that the leadership 

here has allowed me to come into this wonderful firm. And the way I’m compensated, 

I’m not influenced by commissions in any way. So, and I’m able to be completely 

educational and consultative with people, you know, in their journey, 

their health care journey. So, when you come to work with me, we can actually have 

a really wonderful, in -depth conversation about your situation. And I can give you, 

you know, a very non -biased recommendations on what you should do and what would be 

the best way to approach all of this for you and for your family. And there’s no 

fees that are involved whatsoever. And so, it really can really help a lot of people 

out because I’ve seen over my many, many, many years of doing this, people when 

they try to wing it. And granted, you can do this on your own. I mean, you can 

do all this on your own if you want. And there’s some people out there who do 

it insists on doing it that way and i must say that uh percentage wise you know 

the people who have success kind of doing that um it’s a small number uh many 

many people make mistakes and a lot of these mistakes that are made with 

Medicare uh they can’t be undone so uh so i definitely uh encourage people that are 

listening on the call either yourself or someone that you may know or a loved one 

that’s out there that needs help with all this, please give me a call here at the 

firm. You know, 919 -787-8866 is the number to the firm or send me an email, 

Shawn at S -H -A -W -N @ P -O -M -Wealth.net, and get in touch and let me know 

how we can connect. And it would be my pleasure to work with you. Yeah, and I’ll 

come back and reiterate what Shawn said. When we wanted to bring Medicare in-house a 

couple years ago, we, as a firm, we operate under a fiduciary standard, 

which means we want to take care of the client, put the client’s interests first. 

And so, when we’re out there searching, we wanted to make sure that we found someone 

that has the same mentality of, I’m not worried about commissions. We created a 

system where Shawn isn’t truly not worried about commissions, his sole purpose is to 

add value to the current clients that we have and then help educate for people that 

are entering into the Medicare space. On that note, Shawn actually does a monthly 

Medicare webinar that has been picking up a lot of traction and it’s purely 

educational to help you understand, especially if you’re approaching 65, what Medicare 

could like for you and the different avenues and routes that you could be taking 

there. So, if you’d like access to that or you’d like to be invited to that, please 

just reach out to our office. Or you could email us at info at POMwealth.net. 

And we’ll make sure you get those invites to the future Medicare webinars that Sean 

does very, very smoothly. But Shawn, it’s always nice to have you here on the 

episode, on the podcast. It’s always nice to kind of bring Medicare into 

understandable terms and you do such a good job of that. So, thanks again for your 

time today. Yeah. Thank you, Murs. I appreciate it.