How Medicare Premium Increases Could Eat Into Your 2026 Social Security COLA
Written by
Jordan Rosenfeld
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Molly Sullivan
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Every year retirees await news of how much their Social Security checks will be adjusted for cost of living, known as the cost-of-living adjustment or COLA. While the Social Security Administration tries to tie these bumps to inflation, as healthcare expenses skyrocket, COLAs can feel like they aren’t keeping up.
In 2026, with temporary Affordable Care Act subsidy expansions expired and costs continuing to rise, Medicare premium increases could be taking a bigger bite out of that modest boost. Experts explained why and what retirees can do.
How Medicare Part B and Part D Premiums Affect COLAs
Medicare Part B premiums are typically deducted directly from Social Security checks, so even when benefits rise, the premium increase can quickly offset that gain. When the COLA isn’t much larger than inflation, it can feel like it eats up most of the increase, according to Calvin Bagley, healthcare expert and founder of PlanFit.
For example, in 2026, the Medicare Part B premium is going up $17.90 a month, while the Social Security cost-of-living increase is only 2.8%, Bagley explained. If you’re living on a low income and receiving around $1,000 a month, that COLA amounts to roughly $28, with $17.90 consuming more than half of it.
“For low-income beneficiaries, this is a real challenge. It’s kind of like Uncle Sam is moving money from one pocket to the other,” Bagley said.
Retirees Most Likely To See Little or No Net COLA in 2026
Retirees on fixed incomes are all affected by a modest COLA, but the most vulnerable “are those just above qualifying for Medicaid who are on that tight fixed income living on Social Security,” Bagley said.
Medicaid recipients are protected from Part B premiums because Medicaid pays them on the beneficiary’s behalf through Medicare Savings Programs. For retirees who qualify, that means the Part B increase never comes out of their Social Security check, shielding them from seeing their COLA reduced by higher premiums.
How IRMAA Changes the Equation for Higher-Income Retirees
For higher-income retirees, income-related monthly adjustment amounts, or IRMAA, can feel punitive, even though they function as a reduced government subsidy.
“If you have high income, you’re going to pay the full Medicare Part B premium without assistance from the government,” Bagley said.
While IRMAA charges do increase costs, their impact is typically smaller as a percentage of income compared with the hit lower-income retirees experience.
What Retirees Can Do Now To Reduce Medicare-Related Cost Pressure
Retirees looking to ease Medicare-related pressure on their Social Security income should have their coverage reviewed by a professional broker who works with multiple insurance companies, Bagley said. Savings may come from lower copays, better prescription coverage alignment or plan design, not just a lower monthly premium.
Whitney Stidom, vice president of consumer enablement at eHealth, also emphasized the importance of making strategic decisions around Medicare Advantage enrollment. Retirees should be especially mindful of the Medicare Advantage open enrollment period from Jan. 1 through March 31, when plan changes are still possible.
Planning Ahead Can Help Retirees Keep More of Their COLAs
Strategically planning for healthcare expenses while still working, along with making informed choices once eligible for Medicare, can help retirees stretch their savings while maintaining their level of insurance coverage, Stidom said.
She recommended building a health savings account (HSA) before enrolling in Medicare to create a tax-advantaged pool of money for out-of-pocket healthcare costs in retirement. Once on Medicare, regularly comparing plans remains important, especially during Medicare Advantage open enrollment, since coverage and costs vary widely. Reviewing prescription drug formularies and working with a licensed agent can also help retirees reduce medical and drug expenses without sacrificing care.
COLAs are only one side of the retirement equation. Medicare premiums, healthcare inflation and plan choices ultimately determine how much of that increase retirees actually keep, and small decisions can make a meaningful difference over time.
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