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A clear, easy-to-understand guide to Medicare, Social Security, Medicaid, benefits, enrollment and financial assistance.
By Sam Silva
Principal, EZ Access Insurance
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Everything you need to know about Medicare, in one complete guide.
Retirement planning, work credits and how to apply.
When and how to enroll in Parts A and B.
Hospital and medical coverage, costs and what is covered.
Compare your options and key differences.
Help with out-of-pocket costs and enrollment guidance.
Programs that help pay Medicare costs, and state guidelines.
Eligibility categories, income and asset limits.
Help with Part D drug plan costs.
Drug plans, costs and how to enroll.
Part B and Part D lifetime penalties, with examples.
Understanding what you pay and where help is available.
Key dates, side-by-side comparisons and important resources.
Understanding care options, what Medicare does and does not cover, and how to plan ahead.
How asset transfers are reviewed when applying for long-term care Medicaid, and why timing matters.
Putting your wishes in writing and protecting your family.
The basics of trusts and how they can fit into a plan.
Choosing who speaks for you if you cannot.
A simple checklist to get your coverage, care and legal papers in order.
Estate, trust and long-term care topics are general education only, not legal advice. Rules vary by state, so talk with a licensed elder-law or estate attorney about your situation.
This book is an evergreen reference guide. Medicare figures change every year, so you will find a QR code in the book that leads to our Medicare Updates Center. There you can see the latest premiums, deductibles, income limits and rule changes, with official sources, without buying a new edition.
The First Edition will be available in several formats. Links and prices to be added when each retailer listing is live
Call EZ Access Insurance
EZ Access Insurance provides educational information. This guide is not a substitute for advice about your individual situation.
Latest Medicare Updates for Your Book
Get the latest Medicare figures, income limits and important changes in one convenient place. This page is a permanent resource for readers of The Complete Medicare Guide — First Edition.
Every figure shown here will include its effective year, the date it was last verified and a link to the official source.
Tap a section to jump straight to it. Every section shows its official source link, a short summary and the date we last checked it.
| Book page | Table in the book | Go to |
|---|---|---|
| p. 9 | Table 3.1 Work credits | Social Security → |
| pp. 13-14 | Table 3.3 Social Security amounts | Social Security → |
| p. 14 | Table 3.4 Taxable benefits (no QR; same page) | Social Security → |
| p. 15 | Senior deduction callout (Ch. 3) | Social Security → |
| pp. 17-18 | Table 4.1 Part A | Part A → |
| p. 20 | Table 5.1 Part B | Part B and IRMAA → |
| p. 27 | Table 7.1 Medigap plans | Medigap → |
| p. 29 | Table 7.4 Medicare Advantage limits | Medicare Advantage → |
| pp. 32-33 | Table 8.1 Part D amounts | Part D and Extra Help → |
| pp. 34-35 | Table 9.1 IRMAA | Part B and IRMAA → |
| p. 40 | Table 10.1 Medicare Savings Programs | Savings Programs → |
| pp. 40-41 | Table 10.2 Medicaid NY and FL | Medicaid NY and FL → |
| p. 45 | Table 11.1 Long-term care figures | Long-Term Care → |
| p. 51 | Table A.1 Poverty guidelines | Poverty Guidelines → |
| p. 52 | Table A.2 SSI and benefit formula | Social Security → |
| pp. 52-53 | Table A.3 Trustees projections | What Changes Next → |
| p. 53 | Table A.4 New York regions | Long-Term Care → |
| p. 54 | Table A.5 NY and FL figures (no QR; same page) | Long-Term Care → |
| pp. 54-55 | Table A.6 What changes next | What Changes Next → |
Part A helps pay for hospital stays, skilled nursing care after a hospital stay, hospice and some home health care. Most people pay no premium because they have 40 or more work credits. You pay a deductible for each benefit period, then a daily amount for long stays. CMS has not yet published the 2027 amounts, so the official 2026 amounts are shown. We do not guess.
| Part A item | 2027 | 2026 (official) |
|---|---|---|
| Premium (40+ work credits) | $0 | $0 |
| Premium (30–39 credits), per month | Pending — CMS has not yet published 2027 amounts | $311 |
| Premium (under 30 credits), per month | Pending — CMS has not yet published 2027 amounts | $565 |
| Inpatient deductible, per benefit period | Pending — CMS has not yet published 2027 amounts | $1,736 |
| Hospital days 61–90, per day | Pending — CMS has not yet published 2027 amounts | $434 |
| Lifetime reserve days, per day | Pending — CMS has not yet published 2027 amounts | $868 |
| Skilled nursing, days 21–100, per day | Pending — CMS has not yet published 2027 amounts | $217 |
Part B covers doctor visits, outpatient care and preventive services. After the yearly deductible you usually pay 20% of the Medicare-approved amount. If your income is higher, you pay an extra amount called IRMAA, based on your tax return from two years earlier. One dollar over a line moves you to the next tier. 2027 amounts are pending, so official 2026 amounts are shown.
| Part B item | 2027 | 2026 (official) |
|---|---|---|
| Standard monthly premium | Pending — CMS has not yet published 2027 amounts | $202.90 |
| Annual deductible | Pending — CMS has not yet published 2027 amounts | $283 |
| Coinsurance after the deductible | 20% | 20% |
| Premium if you have higher income | See the IRMAA table below | See the IRMAA table below |
| Tier | Single (2024 return) | Married, joint (2024 return) | Part B total / month | Part D extra / month |
|---|---|---|---|---|
| Tier 1 | ≤ $109,000 | ≤ $218,000 | $202.90 | $0.00 |
| Tier 2 | > $109,000 to $137,000 | > $218,000 to $274,000 | $284.10 | $14.50 |
| Tier 3 | > $137,000 to $171,000 | > $274,000 to $342,000 | $405.80 | $37.50 |
| Tier 4 | > $171,000 to $205,000 | > $342,000 to $410,000 | $527.50 | $60.40 |
| Tier 5 | > $205,000 and < $500,000 | > $410,000 and < $750,000 | $649.20 | $83.30 |
| Tier 6 | ≥ $500,000 | ≥ $750,000 | $689.90 | $91.00 |
For 2027 the most a Part D plan may charge as a deductible is $700, and once your covered drug costs reach $2,400 you pay nothing more for covered drugs that year. There is no “donut hole.” Extra Help (the Low-Income Subsidy) lowers drug costs for people with limited income. The 2027 Extra Help income and resource limits are not out yet, so 2026 limits are shown.
| Part D item | 2027 | 2026 |
|---|---|---|
| Maximum deductible | $700 | $615 |
| Yearly out-of-pocket cap (then $0) | $2,400 | $2,100 |
| National base beneficiary premium | $41.33 / month | $38.99 / month |
| Extra Help copay, generic / preferred | $5.80 | $5.10 |
| Extra Help copay, all other drugs | $14.40 | $12.65 |
| Extra Help income limit, single (per year) | Pending — CMS has not yet published 2027 amounts | $23,940 |
| Extra Help resource limit, single | Pending — CMS has not yet published 2027 amounts | $18,090 |
| Extra Help limit | 2027 | 2026 single | 2026 couple |
|---|---|---|---|
| Yearly income limit (150% of poverty) | Pending — CMS has not yet published 2027 amounts | $23,940 | $32,460 |
| Resource limit | Pending — CMS has not yet published 2027 amounts | $18,090 | $36,100 |
Resource limits include a burial allowance of $1,500 per person. 2027 limits come from a CMS memo that has not been released yet. Extra Help recipients do not pay the Part D late-enrollment penalty.
Every Medicare Advantage plan has a yearly cap on what you pay for Medicare-covered services. These are the highest limits the federal rules allow for 2027. Many plans set lower limits. The cap does not include premiums, services Medicare does not cover, or Part D drugs.
| Federal limit on plan MOOP | 2027 (official) | 2026 (official) |
|---|---|---|
| In-network only | $9,850 | $9,250 |
| In-network and out-of-network combined | $14,800 | $13,900 |
Many programs, including Extra Help, Medicare Savings Programs and Medicaid, set their income limits as a percentage of the federal poverty guidelines. HHS publishes new guidelines each January, so the 2027 numbers are not out yet. The official 2026 guidelines are shown for the 48 contiguous states and D.C. Alaska and Hawaii are higher.
| Household size | 2027 guideline | 2026 guideline (official) |
|---|---|---|
| 1 person | Pending — CMS has not yet published 2027 amounts | $15,960 |
| 2 persons | Pending — CMS has not yet published 2027 amounts | $21,640 |
| 3 persons | Pending — CMS has not yet published 2027 amounts | $27,320 |
| 4 persons | Pending — CMS has not yet published 2027 amounts | $33,000 |
| Each additional person | Pending — CMS has not yet published 2027 amounts | $5,680 |
Alaska and Hawaii have separate, higher guidelines. Many programs (Extra Help, Medicare Savings Programs, Medicaid) are set as a percentage of these guidelines, so their limits change when new guidelines are published each January or when a state adopts them. New York applies the 2026 levels under state guidance GIS 26 MA/05.
These state programs help people with limited income pay Medicare costs. QMB is the most help; SLMB and QI help with the Part B premium. The income limits below are the 2026 federal amounts and include the standard $20 disregard. 2027 limits follow the new poverty guideline. States can use higher limits. QDWI has no dollar figure here because published sources disagree, so check with your state.
| Program | Monthly income, single | Monthly income, couple | Resources, single / couple |
|---|---|---|---|
| QMB | $1,350 | $1,824 | $9,950 / $14,910 |
| SLMB | $1,616 | $2,184 | Same |
| QI | $1,816 | $2,455 | Same |
| QDWI | See note | See note | Limited (see note) |
Amounts include the standard $20 income disregard. QDWI has its own income and resource tests set by the state; because published sources currently disagree on the dollar figure, none is printed here. Check with your state. 2027 limits: Pending — CMS has not yet published 2027 amounts. States may use higher limits or no resource test.
New York has expanded Medicare Savings Programs well past the federal minimum and does not apply an asset test to QMB and QI. Florida uses the federal limits, including an asset test. For nursing-home Medicaid, Florida uses a hard income cap and a Miller (Qualified Income) Trust, while New York uses a different income method. Amounts shown are official 2026; 2027 amounts are pending.
| Topic (official 2026) | New York | Florida |
|---|---|---|
| QMB: income limit / month (single / couple) | $1,836 / $2,489 (up to 138% of poverty) | $1,330 / $1,804 (100% of poverty) |
| SLMB: income limit / month | Not a separate tier in the NY chart | $1,596 / $2,164 (120%) |
| QI: income limit / month | $2,474 / $3,355 (up to 186%) | $1,796 / $2,435 (135%); funded first-come, first-served |
| Resource test for MSPs | None for QMB and QI | $9,950 single / $14,910 couple |
| Full Medicaid, age 65+: income / month | $1,836 / $2,489 (138% of poverty) | Income cap $2,982 / $5,964 (300% of SSI). Over the cap needs a Qualified Income Trust |
| Full Medicaid: countable resources | $33,038 single / $44,796 couple | $2,000 single / $3,000 couple |
| Nursing-home personal needs allowance | Set by state; see the New York regional table below | $160 / month |
| Free Medicare counseling | HIICAP 1-800-701-0501 | SHINE 1-800-963-5337 |
Income limits are shown before the standard $20 general income disregard, which agencies apply when they count your income.
When one spouse needs nursing-home care, Medicaid lets the spouse at home keep some income and savings. Medicaid also looks back 60 months at gifts, in both states. A New York 30-month look-back for home care has been enacted but is not in effect, so confirm before relying on it. Spousal-protection amounts for 2027 are pending; official 2026 amounts are shown.
| Item (official 2026) | Amount or rule |
|---|---|
| Community spouse resource allowance, federal range | $32,532 to $162,660 |
| Community spouse resource allowance, New York | Greater of $74,820 or one-half of the couple’s countable resources, up to $162,660 |
| Minimum monthly income for the community spouse (MMMNA), federal range | $2,705 to $4,066.50 |
| Home equity limit | Florida $752,000; New York $1,130,000 |
| Look-back period for nursing-home care | 60 months in both states |
| Transfer-penalty divisor, Florida (per month) | $10,645 |
| Transfer-penalty divisor, New York (per month) | NYC $15,282; Long Island $15,193; Rochester $15,675; Western $13,765 |
| New York look-back on home care | A 30-month look-back has been enacted but is not in effect. Confirm before relying on this |
The divisor converts a gift into months of ineligibility. Full New York regional divisors are in the New York regional table below. Spousal-impoverishment amounts for 2027: Pending — CMS has not yet published 2027 amounts.
| New York region | Transfer-penalty divisor (per month) | Housing allowance, managed long-term care (per month) |
|---|---|---|
| New York City | $15,282 | $2,104 |
| Long Island | $15,193 | $1,828 |
| Northern Metropolitan | $15,024 | $1,380 |
| Rochester | $15,675 | $505 |
| Northeastern | $14,783 | $567 |
| Central | $14,146 | $439 |
| Western | $13,765 | $402 |
Divisors are used to turn a gift into months of Medicaid ineligibility (penalty months = gifts ÷ regional divisor). Housing allowances apply to the home-care income allowance for managed long-term care members.
| Item | New York | Florida |
|---|---|---|
| Community spouse resource allowance | Greater of $74,820 or half of countable resources, up to $162,660 | Up to $162,660 (federal minimum $32,532) |
| Community spouse income standard (MMMNA) | $4,066.50 | $2,705; up to $4,067 with shelter allowance |
| Nursing-home personal needs allowance / month | Set by state | $160 |
| Home care (waiver) personal needs allowance / month | $653 | — |
| Transfer-penalty divisor / month | By region (above) | $10,645 |
| Home equity limit | $1,130,000 | $752,000 |
Waiting too long to sign up can cost you for life. The Part B penalty is 10% of the standard premium for each full 12 months you waited. The Part D penalty is 1% of the national base premium for each full month without drug coverage. The Part A penalty applies only if you owe a Part A premium. The formulas are set by rules, so they stay the same; only the dollar premiums change each year.
| Penalty | Formula | Good to know |
|---|---|---|
| Part A late-enrollment penalty (only if you owe a Part A premium) | Monthly premium increased by 10%, paid for twice the number of years you could have had Part A but did not sign up | Does not apply to premium-free Part A. |
| Part B late-enrollment penalty | 10% of the standard Part B premium for each full 12-month period you could have had Part B but did not enroll; paid for as long as you have Part B | Avoided by a qualifying Special Enrollment Period, such as employer coverage. |
| Part D late-enrollment penalty | 1% x national base beneficiary premium x number of full, uncovered months without creditable coverage (after IEP ends); rounded to nearest $0.10; added to the monthly premium for as long as you have Part D | Starts after a gap of 63 or more days without creditable coverage. Not charged to Extra Help recipients. |
| Example | Calculation | Result |
|---|---|---|
| Part B: enrolled 24 months late (2026 premium) | $202.90 × 20% = $40.58, rounded to the nearest $0.10 | $243.50 per month total |
| Part D: 14 uncovered months (2026 base premium) | 14% × $38.99 = $5.46, rounded | $5.50 per month, added to the plan premium |
| Part D: 14 uncovered months (2027 base premium) | 14% × $41.33 = $5.79, rounded | $5.80 per month, added to the plan premium |
The Part B penalty lasts as long as you have Part B. Part D’s uses the current year’s national base beneficiary premium (2026: $38.99; 2027: $41.33).
Medigap policies help pay costs Original Medicare leaves behind, such as deductibles and coinsurance. They are sold by private companies, and plans with the same letter cover the same benefits in most states. The best time to buy is your six-month Medigap open enrollment, when you cannot be turned down for health reasons. Use the official chart to compare plans.
| Item | Rule |
|---|---|
| Medigap open enrollment | Six months starting the first month you have Part B and are 65 or older. One time only. You get a guaranteed right to buy regardless of health. |
| Plan benefit chart (Plans A to N) | Open the official chart from the link below. The chart is not copied here so that it is never out of date. |
Plans C and F are sold only to people who were first eligible for Medicare before January 1, 2020. Massachusetts, Minnesota and Wisconsin use different plan standards.
Some 2027 amounts are still waiting on the government. Part A, Part B and IRMAA come from CMS, usually in the fall. Poverty guidelines come from HHS in January, and Extra Help and Medicare Savings Program limits follow them. Spousal-protection amounts come near year-end. The Trustees Report projections below are estimates, not official amounts.
| What may change | Latest official amount (2026) | Expected update | Section |
|---|---|---|---|
| Part A premium (30–39 and under 30 credits) | $311 / $565 | CMS announcement, usually fall | Go → |
| Part A deductible and daily coinsurance | $1,736 deductible | CMS announcement | Go → |
| Part B premium and deductible | $202.90 / $283 | CMS announcement | Go → |
| IRMAA income thresholds and premiums | See Table 9.1 | CMS announcement | Go → |
| Extra Help income and resource limits | $23,940 income, single | After the 2027 poverty guideline | Go → |
| Federal poverty guidelines | $15,960, 1 person | HHS, January | Go → |
| Medicare Savings Program limits | See Table 10.1 | After the 2027 poverty guideline; New York and Florida follow their own schedules | Go → |
| Spousal-impoverishment amounts (CSRA, MMMNA, home equity) | $162,660 CSRA maximum | CMS, usually near year-end | Go → |
| Qualified Disabled and Working Individuals (QDWI) limits | No dollar figure printed | Sources disagree; confirm with your state | Go → |
| Senior deduction (age 65+), 2025 law | $6,000 per person, tax years 2025 to 2028 | Expires after tax year 2028 | Go → |
| New York home-care look-back (30 months) | Not in effect | Awaits federal approval; confirm before relying | Go → |
Items that are already official for 2027 on this page: Part D deductible, out-of-pocket threshold and base premium; the Medicare Advantage out-of-pocket maximums; and all Social Security amounts including the 3.6% cost-of-living adjustment.
| Item | Projected 2027 (not official) | Official 2026 |
|---|---|---|
| Part B standard premium / month | $209.50 | $202.90 |
| Part B deductible | $292 | $283 |
| Part A inpatient deductible | $1,788 | $1,736 |
| Part A hospital coinsurance, days 61–90 | $447 | $434 |
| Part A lifetime reserve days | $894 | $868 |
| Part A skilled nursing, days 21–100 | $223.50 | $217 |
| Part A premium, 30–39 credits / month | $330 | $311 |
| Part A premium, under 30 credits / month | $600 | $565 |
Projected, not official: the Trustees publish forecasts each spring. They are estimates for planning only. CMS announces the real amounts in the fall.
Educational information only, not individual advice. Rules and amounts change; always confirm with the official source or call EZ Access Insurance at (800) 901-8849.
Past years’ figures will be kept here, each labeled with its year, so readers of any edition can compare. Archive to be added after the first verified update
Learn more about The Complete Medicare Guide — First Edition.
Questions? Call EZ Access Insurance at (800) 901-8849. Educational information only; not individual advice.
🏛️ Social Security: COLA, Credits, Earnings Limits and Taxes
Social Security benefits rise 3.6% beginning in January 2027 (the COLA). One work credit takes $1,970 of earnings in 2027, and you can earn up to four credits a year. The earnings limits matter only if you claim before full retirement age and keep working. Social Security is still taxable for many people (up to 85% of benefits). The 2025 tax law added a temporary senior deduction, but it did not end the tax.
Social Security amounts Book: Table 3.3, pages 13-14
Earnings needed for Social Security work credits Book: Table 3.1, page 9
The amount rises each year with the national average wage index. Source: SSA, Quarter of Coverage.
SSI amounts and the benefit formula Book: Table A.2, page 52
When benefits become taxable (combined income) Book: Table 3.4, page 14
2025 tax law: temporary senior deduction Book: Chapter 3, p. 15
“No tax on tips” and “no tax on overtime” are separate deductions for workers, not Social Security rules.