Module 3
What Beneficiaries Pay
Deductibles, coinsurance with no ceiling, and the supplemental coverage market that exists because of it, plus the Part D benefit after the Inflation Reduction Act.
By the end of this module, you will be able to:
- State what a beneficiary owes under Part A and Part B in 2026
- Explain why Medigap enrollment rules make the Medicare Advantage decision hard to reverse
- Describe how the Inflation Reduction Act redesigned Part D and who now bears the cost
- What Beneficiaries Pay Traditional Medicare has deductibles, coinsurance without end, and no cap on out-of-pocket spending. The 2026 numbers make the exposure concrete. About 5 min
- Supplemental Coverage Most people in traditional Medicare hold a second policy to fill the gaps. Who has what, and why the enrollment rules make the choice hard to reverse. About 5 min
- Part D After the Inflation Reduction Act Part D gained a hard out-of-pocket cap and shifted catastrophic risk onto plans. It is the largest redesign of a Medicare benefit in two decades. About 5 min
Module quiz
Answer all questions to see your score.
1. How often does the Part A inpatient deductible apply?
The 2026 deductible of $1,736 covers the first 60 days of a benefit period, not a calendar year, which is a frequent source of confusion for beneficiaries.
2. Outside the six-month open enrollment window and specified trial periods, what happens to a Medigap applicant in most states?
Only four states require broader guaranteed issue. Elsewhere a beneficiary who became sick while in Medicare Advantage may be unable to buy the supplemental coverage that makes traditional Medicare financially safe.
3. Who absorbed most of the catastrophic-phase cost that Medicare reinsurance used to cover in Part D?
Capping beneficiary exposure at $2,100 did not remove the cost, it reassigned it. Plans now retain most catastrophic spending, which strengthens their interest in formulary and utilization management.