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How are Medicare benefits changing for 2026?
Changes to 2025 Medicare coverage include a $2,000 cap on Part D out-of-pocket costs, small reductions in the average premium for Medicare Advantage and Part D plans, increases for Medicare Part B and Part A premiums and cost-sharing, and adjustments to income-related premium surcharges for Part B and Part D.
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What is the income-related monthly adjusted amount (IRMAA)?
For 2025, high-income beneficiaries – earning over $106,000 a year – pay an IRMAA surcharge that’s added to their Part B and Part D premiums and determined by income from their income tax returns two years prior.

primary care provider

What is a primary care provider?

primary care provider infographic

What is a primary care provider?

Your primary care provider (PCP) is the medical provider (usually a physician, physician’s assistant, or nurse practitioner) who can assess a wide range of medical conditions, coordinate care with specialists, and be your first point of contact when a new medical condition arises.

If you have a Medicare Advantage plan, the plan may require you to get a referral from your PCP before you can see a specialist. For these plans, a PCP is essential and your plan will assign one to you if you don’t select your own. Referrals are not required by Medicare Advantage PPOs (preferred provider organizations) or Original Medicare,1 but many enrollees still choose to have a trusted PCP for their primary care and care coordination needs.

Footnotes

  1. Compare Original Medicare & Medicare Advantage” Medicare.gov. Accessed May 30, 2025