Medicare Open Enrollment 2026: What Wealthy Retirees Should Know
If you’re in or approaching retirement with a healthy retirement nest egg, Medicare might not seem like a financial concern, but it can be. The choices you make during Medicare’s Annual Open Enrollment (October 15 to December 7, 2025) can impact your health care access, your tax strategy, and your bottom line. This year brings important updates, and high-net-worth individuals may benefit from reviewing their options carefully.
What’s Changing in 2026?
1. Premiums and Deductibles Are Going Up
The standard monthly premium for Medicare Part B is projected to rise from $185.00 for 2025 to $206.50 for 2026. Likewise, the Part B annual deductible is likely to see a modest increase of $31, as is the part D deductible ($25). The real impact for those with high incomes comes from the Income-Related Monthly Adjustment Amounts (IRMAA). If your income exceeds certain thresholds, you’ll pay significantly more. For example, couples earning over $218,000 could pay $300 or more per person, per month. At the highest income tier, premiums can approach an additional $800 monthly.
Mastering Health Care Expenses in Retirement
Planning for health care in retirement can be complicated, but it doesn’t have to be. Savant’s eBook, Mastering Health Care in Retirement, explains your options, from Health Savings Accounts to Medicare and Long-Term Care insurance.
2. Medicare Advantage Plans Are Evolving
Medicare Advantage plans continue to add perks like dental, vision, and wellness benefits. But networks and coverage can change year to year. If you are enrolled in an Advantage plan, it is important to confirm your doctors and medications are still covered. If you’re considering switching to or from Original Medicare with a Medigap supplement This period offers an opportunity to compare options.
3. Original Medicare May Soon Require Prior Authorization in Select States
A new pilot program in six states—Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington—is expected to introduce expanded prior authorization requirements for individuals enrolled in Original Medicare (Parts A and B). Under this model, certain services such as skin and tissue substitutes, electrical nerve stimulator implants, and knee arthroscopy for osteoarthritis would require Medicare approval before care can be provided. Traditionally, Original Medicare has only required prior authorization for durable medical equipment and select outpatient hospital services.
Smart Strategies for High-Net-Worth Individuals
Tax Planning to Manage Medicare Costs
IRMAA surcharges are based on your income from two years ago. That means your 2024 tax return affects your 2026 premiums. If you’re near an IRMAA threshold, consider strategies like contributing to a Donor Advised Fund (DAF), using qualified charitable distributions (QCDs) if you are 70.5+, or timing capital gains to manage your Modified Adjusted Gross Income (MAGI). A little planning could help reduce paying unnecessary premiums.
Coordinate Employer or Retiree Benefits
If you have retiree health coverage from a former employer, make sure you understand how it interacts with Medicare. Some plans act as a supplement, meaning you might not need to purchase Medigap. Others may require you to enroll in Part D. Avoid paying for duplicate coverage or missing out on benefits by reviewing your options carefully.
Choose the Right Coverage for Your Lifestyle
Medigap offers broad provider access nationwide, which can be ideal for retirees who travel or split time between homes. Medicare Advantage plans may be more cost-effective but come with network restrictions. If you value flexibility and predictability, Medigap may be worth the higher premium. If you’re healthy and stay local, a high-quality Advantage plan could be a smart choice.
Use Your HSA Wisely
If you have a Health Savings Account (HSA), you can use it to pay for Medicare premiums (excluding Medigap) and other qualified expenses tax-free. It is a potentially effective way to cover health care costs efficiently in retirement. While you can still use funds from your HSA after enrolling in Medicare, you can no longer make new contributions once you’re enrolled in any part of Medicare.
Take Control This Fall
Open Enrollment is your annual opportunity to review and adjust your Medicare coverage. Review your current plan, compare alternatives, and make changes by December 7. Even if you don’t switch, you can help protect your wealth by periodically reviewing your coverage to ensure it continues to align with your goals.
This is intended for informational purposes only. You should not assume that any discussion or information contained in this document serves as the receipt of, or as a substitute for, personalized investment advice from Savant. Please consult your investment professional regarding your unique situation.
Jonathan E. Millican
Interim Director of Financial Planning
CFP®