The Medicare Dude

01/05/2026

Why a hospital stay can cost more on Medicare Advantage than Original Medicare (A & B)

— explained by The Medicare Dude

One thing that surprises a lot of people on Medicare is that hospital costs are handled very differently depending on the type of coverage you have.

Original Medicare (Part A & B)

With Original Medicare, inpatient hospital stays fall under Part A.

You pay one deductible per benefit period 2026 $1,736 (One day or 60 same price) Once that deductible is met, Medicare covers the hospital stay (up to 60 days)

No daily hospital copay during that period ( You pay nothing else..just $1,736)

So whether you’re hospitalized for 3 days or 10 days, your out-of-pocket cost is generally the same single deductible (assuming you’re in the same benefit period).

Medicare Advantage (Part C) Medicare Advantage plans work differently.

Instead of a single deductible, many Advantage plans charge a per-day (per diem) hospital copay, such as:

$250–$400 per day

Often for the first 4–7 days (sometimes longer)

That means your cost is tied to how long you’re hospitalized, not just whether you were admitted.

Why this matters? This is where people get caught off guard:
A short hospital stay may cost less on Advantage.A longer or unexpected stay can cost significantly more. Multiple hospitalizations in a year can stack costs quickly

A 5-day stay with a daily copay can easily exceed what someone would have paid under Part A’s single deductible.

This doesn’t mean Medicare Advantage is “bad.”
It means the financial risk is structured differently.

The takeaway

Original Medicare: predictable hospital cost per benefit period

Medicare Advantage: variable cost based on length of stay

Understanding how you pay is just as important as how much you pay monthly.

If Medicare is confusing or you just want a second set of eyes on what you have, I’m happy to help explain it — no cost, no pressure.

— William Gray
The Medicare Dude
📱 Call or text: 386-871-3858

12/20/2025

From January 1st to March 31st, 2026,

Medicare Advantage Open Enrollment Period (MAOEP) to make one switch between Medicare Advantage plans or return to Original Medicare.

Key Actions You Can Take (Jan 1 – Mar 31, 2026):

Switch Advantage Plans
Return to Original Medicare
Join a Medicare Part D prescription drug plan.

12/18/2025

12/17/2025

Thank you! My clients made this happen.

12/15/2025

11/29/2025

🏡📣 Turning 65 in The Villages? Here’s What You Need to Know About Medicare & Social Security

Living in The Villages means enjoying an amazing lifestyle—golf, friends, recreation, and freedom. But when you’re approaching age 65, Medicare and Social Security can feel like a maze. Here’s what every Villager should know to avoid costly mistakes.

✅ Automatic vs. Manual Enrollment

If you’re already receiving Social Security benefits when you turn 65, your Medicare Part A and Part B will start automatically on the first day of your birthday month.

If you’re not receiving Social Security yet, Medicare does not enroll you automatically. You’ll need to apply for Part A and Part B during your Initial Enrollment Period to avoid penalties.

⚠️ Medicare Penalties to Watch Out For

Part B Penalty:
Delay Part B without credible employer coverage and Medicare can impose a 10% lifetime penalty for every 12 months you delay.

Part D Penalty:
If you go 63+ days without credible prescription drug coverage, you’ll face a permanent penalty added to your Part D plan premium.

👔 Still Working Past 65?

If you or your spouse are still working and covered by credible group employer insurance, you may qualify for a penalty exemption, allowing you to delay Medicare without extra cost later.

🧭 Need Help? That’s Why I’m Here.

I’m William Gray, The Medicare Dude, serving The Villages and all of Central Florida.

✔️ Over 29 years of experience
✔️ Medicare specialist — it’s ALL I do
✔️ Independent broker with multiple carriers
✔️ Local, personalized support

I help you understand your options, avoid unnecessary penalties, and make sure you’re not overpaying for your Medicare coverage.

👉 Consultations are always free — and you never pay for my services.

📞 Call or Text: (352) 283-7623

If you’re turning 65 in The Villages, reach out today and let The Medicare Dude make Medicare simple and stress-free.

11/29/2025

Understanding IRMAA: How Your Income Affects Medicare & Social Security Costs — And How to Avoid Surprises

By William Gray – “The Medicare Dude”
29-Year Medicare Specialist | Nationwide Medicare Broker
Phone: 904-460-8120 | TheMedicareDude.com

When planning for retirement, most people focus on their Social Security benefits, Medicare coverage, and savings. What many don’t realize is that their Medicare costs can rise significantly because of something called IRMAA — the Income-Related Monthly Adjustment Amount.

IRMAA is an additional charge added to your Medicare Part B and Part D premiums if your income rises above certain levels. Understanding how IRMAA works can save retirees hundreds—even thousands—of dollars each year.

---

What Is IRMAA?

IRMAA is a surcharge added to your monthly Medicare premiums when your income exceeds specific thresholds set by Medicare.

Medicare always uses a two-year look-back.

Your 2026 Medicare premiums are based on your 2024 tax return.

This means financial decisions you made two years ago directly affect your Medicare costs today.

---

How IRMAA Impacts Your Social Security Check

If you receive Social Security benefits, Medicare deducts your Part B and Part D premiums automatically.

When IRMAA applies, your monthly Social Security deposit becomes smaller, because Medicare takes the additional IRMAA surcharge directly out of your benefit.

You may see:

A reduced monthly Social Security payment

A notice explaining the increased premium

Occasional double deductions when IRMAA begins mid-year

---

What IRMAA Applies To

IRMAA only affects:

Medicare Part B premiums

Medicare Part D (drug plan) premiums

It does not affect:

Medicare Supplement (Medigap) premiums

Medicare Advantage plan premiums

Taxes or tax brackets

---

What Counts as Income for IRMAA (MAGI)?

IRMAA is based on Modified Adjusted Gross Income (MAGI) — and Medicare counts a lot more than people expect.

Here’s what’s included:

1. Home Sales

Profits above the IRS home-sale exclusion count toward MAGI.
Downsizing often triggers a one-year IRMAA spike.

2. Sales of Stocks, Bonds, Mutual Funds

Capital gains — even if reinvested — are included. This includes:

Selling stocks or bonds

Rebalancing portfolios

Moving between mutual funds

Even routine investment changes can push someone into IRMAA.

3. Withdrawals From Retirement Accounts

Taxable withdrawals from:

IRAs

401(k), 403(b), TSP

Lump sums used to pay off loans, buy vehicles, remodel a home, etc.

All of these count toward IRMAA.

4. Required Minimum Distributions (RMDs)

Once RMDs start, they can easily push retirees above IRMAA thresholds.

5. Rental or Business Income

Continuing to manage a property or side business affects your Medicare costs.

6. Interest, Dividends & CD Income

Passive income still counts toward your total.

---

2026 IRMAA Surcharge Ranges

These are the typical IRMAA tiers added to your regular Part B & D premiums:

IRMAA Tier Extra Part B (Monthly) Extra Part D (Monthly) Approx Annual Increase

Tier 1 +$69.90 +$12.90 ~$990/yr
Tier 2 +$174.70 +$33.30 ~$2,500/yr
Tier 3 +$279.50 +$53.80 ~$4,000/yr
Tier 4 +$384.30 +$74.20 ~$5,500/yr
Tier 5 +$419.30 +$81.00 ~$6,000+/yr

For couples, these numbers double.

Over a 20-year retirement, IRMAA can increase costs by $60,000 or more if not planned for.

---

How to Avoid or Reduce IRMAA

1. Spread Out Large Withdrawals

Instead of taking a $50,000–$100,000 lump sum, spread withdrawals across several years.

2. Use Roth Accounts

Roth IRA withdrawals do not count toward IRMAA.
Converting before age 63 can protect you later.

3. Time Your Home Sale Strategically

Selling during a year with lower income can avoid triggering a two-year IRMAA penalty.

4. Manage Capital Gains

Avoid selling investments in the same year you take RMDs or large withdrawals.

5. Use Qualified Charitable Distributions (QCDs)

At age 70½ or older, sending IRA money directly to charity:

Reduces taxable income

Satisfies RMDs

Helps avoid IRMAA

6. Appeal IRMAA When Eligible

Medicare allows appeals for qualifying “life-changing events,” such as:

Retirement (work stoppage)

Death of a spouse

Divorce

Loss of income-producing property

Many retirees win these appeals, reducing their premiums.

---

Final Thoughts — From The Medicare Dude

IRMAA is one of the biggest hidden costs in retirement, and most retirees don’t realize they triggered it until they see their Social Security check shrink.

With proper planning, you can:

Reduce or avoid IRMAA

Protect your Social Security income

Lower your Medicare costs for life

If you want help reviewing your IRMAA exposure or planning around taxes and income, I’m here to help.

William Gray
The Medicare Dude, LLC
29-Year Medicare Specialist
Phone: 904-460-8120
Website: TheMedicareDude.com

I am an independent licensed insurance agent specializing in Medicare Insurance Solutions. I will answer your questions and clarify the insurance options you have. I will help you avoid common misconceptions and late enrollment penalties. My clients are located all across Florida and the USA, giving...

11/27/2025

🍁🦃 Happy Thanksgiving from The Medicare Dude! 🦃🍁

Today, I’m especially thankful for the clients, families, and community who trust me to guide them through Medicare with clarity, patience, and care.
Whether you’re navigating your options for the first time or reviewing your plan for the coming year, it’s an honor to serve you.

This season reminds us what truly matters — peace of mind, good health, and people who have your back. I’m grateful to be part of that journey with you.

Wishing you and your loved ones a warm, joyful, and blessed Thanksgiving!
— William Gray, The Medicare Dude
29 Years Medicare Specialist | Nationwide Medicare Broker
TheMedicareDude.com
📞 904-460-8120

I am an independent licensed insurance agent specializing in Medicare Insurance Solutions. I will answer your questions and clarify the insurance options you have. I will help you avoid common misconceptions and late enrollment penalties. My clients are located all across Florida and the USA, giving...

11/22/2025

Switching From Medicare Advantage to Original Medicare & a Supplement (Jan 1 – Mar 31)

Each year, Medicare beneficiaries have a special opportunity to make important changes to their coverage. From January 1 through March 31, the Medicare Advantage Open Enrollment Period (MA-OEP) allows anyone currently enrolled in a Medicare Advantage (Part C) plan to switch back to Original Medicare and, if they choose, enroll in a Medicare Supplement (Medigap) and a stand-alone Part D drug plan.

This window is especially valuable for people who found that their Medicare Advantage plan didn’t fit their needs, had unexpected out-of-pocket costs, or prefer the flexibility of Original Medicare.

---

What You Can Do During January 1 – March 31

If you're enrolled in a Medicare Advantage plan as of January 1, you may:

✔ Return to Original Medicare (Part A & Part B)

You can disenroll from your Advantage plan and go back to federally managed Medicare.

✔ Enroll in a Stand-Alone Part D Prescription Plan

Since Original Medicare does not cover prescription drugs, you’ll want to add a Part D plan to avoid gaps in coverage and late-enrollment penalties.

✔ Apply for a Medicare Supplement (Medigap) Plan

Medigap helps cover the 20% coinsurance and other costs that Original Medicare does not pay.
Important: In most states—including Florida—Medigap is health-underwritten unless you're in a guaranteed-issue situation. Your approval will be based on your health history unless you qualify for a special circumstance.

---

Why People Switch Back to Original Medicare

Many beneficiaries decide to move away from Medicare Advantage for reasons such as:

High out-of-pocket costs during the year

Network restrictions or difficulty seeing preferred doctors

Referrals or prior authorizations becoming inconvenient

Desire for nationwide coverage without network rules

Better predictability with Medigap’s fixed, stable costs

Original Medicare paired with a Medigap plan often provides more freedom and lower risk, especially for people who travel, have complex medical needs, or want the ability to see specialists without limitations.

---

When Changes Take Effect

Any change made during this period becomes effective on the first day of the next month after the plan receives your request.
For example:

If you switch on February 10 → Your new coverage starts March 1.

---

Medigap Enrollment Considerations

While you may return to Original Medicare without restriction, Medigap has its own rules:

You must have Parts A & B active to enroll.

Most applicants will undergo medical underwriting unless they qualify for a trial right, plan termination, or another guaranteed-issue situation.

Approval is not automatic, so working with an experienced broker is essential.

---

Why Work With an Independent Medicare Broker

Switching from Medicare Advantage back to Original Medicare involves multiple moving parts:

Disenrollment timing

Part D plan coordination

Medigap underwriting

Making sure you avoid any coverage gaps

An independent broker—like William Gray, The Medicare Dude—can walk you through each step, compare all major carriers, and ensure your transition is smooth and cost-effective.

11/20/2025

Switch Back to Medicare & A Supplement:
Why It Makes More Sense for Your Healthcare

Many Medicare beneficiaries start with a Medicare Advantage plan for the low or $0 monthly premium — but later discover limits, restrictions, and unpredictable out-of-pocket costs. That’s why so many people eventually choose to switch back to Original Medicare paired with a price-controlled Medicare Supplement (Medigap).

Here’s why this combination is often the smartest, most predictable, and most doctor-friendly coverage available.

1. Nationwide Access to More Doctors and Hospitals

One of the biggest benefits of Original Medicare + a Supplement is true nationwide freedom.

You can see any doctor, specialist, or hospital in the United States that accepts Medicare, including top-tier medical centers like:

Mayo Clinic

Cleveland Clinic

MD Anderson

Johns Hopkins

Leading heart, cancer, and orthopedic specialists across the country

No networks.
No referrals.
No out-of-network penalties.
No insurance company telling you where you can or can’t go.

2. Price-Controlled Coverage That Never Changes

Medicare Supplements are standardized and federally regulated. That means:

Plan G is Plan G everywhere in the country

Benefits don’t change year-to-year

Companies cannot reduce or alter coverage

You get rock-solid stability long-term

Compared with Medicare Advantage plans—which can change every year in copays, premiums, provider networks, drug coverage, and out-of-pocket limits—Medigap offers consistency you can rely on.

3. No Prior Authorizations or Denied Treatments

Medicare Advantage plans often require prior authorization for:

MRIs

CT scans

Surgeries

Inpatient rehab

Specialist treatments

With Medicare + a Supplement:

If Medicare approves it, your supplement pays it.
No delays.
No hoops.
No denials.

4. Protection From High, Unexpected Medical Bills

Even $0 premium Medicare Advantage plans come with:

Specialist copays

Hospital per-day charges

High cancer treatment costs

Annual out-of-pocket limits of $5,000–$9,500

One accident, one surgery, or one hospital stay can cost more than an entire year of Medigap premiums.

With a Supplement:

Costs are predictable

Risk is low

Most medical expenses are fully covered after the small Part B deductible

5. Yes, There Is an Additional Premium — But Your Total Cost of Care Is More Predictable

A Medicare Supplement does require a monthly premium. But what you’re buying is predictability, protection, and peace of mind.

You're trading:

A low or $0 monthly premium + unpredictable bills
for. A monthly premium + controlled, stable, predictable healthcare spending

You know your premium.
You know the Part B deductible.
And that’s almost your entire annual healthcare cost.

No surprise copays.
No big hospital bills.
No guessing.

6. Perfect for Travelers, RVers, and Snowbirds

If you split time between states or travel frequently, a Medicare Supplement is the only option that gives you full nationwide coverage with no network restrictions.

Medicare Advantage ties you to a local network.
Medigap travels with you everywhere.

7. Best for Chronic or Complex Health Conditions

If you see doctors or specialists often, Medigap provides the best long-term value:

No referrals

No limited networks

No yearly plan changes

No prior authorizations

Full flexibility to choose any Medicare doctor in the country

You stay in control.

8. Bottom Line: Control, Predictability, and True Freedom

Switching back to Medicare + a Supplement gives you:

✔ Access to more doctors and hospitals
✔ Stable, price-controlled benefits
✔ Predictable, controlled yearly costs
✔ Nationwide coverage
✔ No prior authorizations
✔ No network restrictions
✔ No surprises

Yes, you pay a premium —
but you’re buying freedom, stability, and financial protection.

For many people, it’s the smartest long-term Medicare decision you can make.

Contact for Help Switching Back

William Gray
29-Year Medicare Specialist
Owner of The Medicare Dude, LLC
Nationwide Medicare Broker
📞 904-460-8120

Call anytime for free, unbiased Medicare guidance.

11/16/2025

What’s Changing for Medicare in 2026

Premiums & Deductibles

The standard monthly premium for Part B will be $202.90 in 2026, up from $185.00 in 2025.

The annual deductible for Part B will rise to $283 in 2026 (up from $257 in 2025).

For Part A (hospital insurance): the inpatient deductible (for each benefit period) is projected to increase to $1,716 in 2026 (from $1,676 in 2025).

Copayment/day for days 61‑90 under Part A is projected ~$429 in 2026 (from ~$419 in 2025).

Skilled‑nursing facility copayments (days 21‑100) are also expected to rise (projected ~$214.50/day in 2026).

Out‑of‑pocket caps for Medicare Advantage and prescription drug coverage are also shifting:

The in‑network out‑of‑pocket limit for Medicare Advantage is projected to drop slightly from $9,350 (2025) to about $9,250 in 2026.

The annual cap on out‑of‑pocket for Part D (prescription drugs) is expected to increase from $2,000 (2025) to about $2,100 in 2026.

IRMAA (Income‑Related Monthly Adjustment Amount)

IRMAA is the extra amount higher‑income Medicare beneficiaries pay in addition to the standard premium for Part B (and Part D in many cases).

For 2026, the IRMAA brackets and surcharges are based on your 2024 tax return (MAGI = Modified Adjusted Gross Income).

Example projected 2026 brackets (single vs. married filing jointly):

No IRMAA if income ≤ ~$109,000 for single; ≤ ~$218,000 for joint.

Next tiers: e.g., income > ~$109k up to ~$137k single (or >$218k up to ~$274k joint) may have a surcharge tier.

The standard premium of $202.90 applies before surcharges; with IRMAA the total monthly payment can be much higher.

---

What This Means for Medicare Beneficiaries

If you’re on Original Medicare (Parts A & B), plan for higher out‑of‑pocket costs in 2026: the deductible for Part B increases, and even though the Part A deductible applies only when you’re hospitalized, it also rises.

If you have Medicare Advantage or Part D drug coverage, even if your premium appears modest, your total cost may increase via higher deductibles, copays, or out‑of‑pocket limits.

If you have higher income (per MAGI in 2024), you need to check whether you’ll fall into an IRMAA tier—because that surcharge will add significantly to your monthly premium.

The annual Open Enrollment Period (October 15 – December 7) is the critical time to review your plan, compare alternatives, and ensure your 2026 coverage still makes sense.

---

Action Steps to Take Now

Review your 2024 tax return (or estimate your MAGI for 2024) to see if you may be subject to IRMAA in 2026.

Check your current plan’s deductible, copays, and out‑of‑pocket limits and compare with other options for 2026.

If you expect hospital stays or expensive outpatient care, factor in higher deductibles when budgeting for next year.

For those with fixed income, plan ahead for the premium increase in Part B and possible surcharges.

Stay attentive to plan notifications (“Notice of Change”) from your Medicare Advantage or Part D plan to catch changes in benefits, premiums, or formularies.