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WGIUPD GENERAL INFORMATION SYSTEM DIVISION: Office of Health Insurance Programs 2/13/2026 PAGE 2 GIS 26 MA/05

If an individual’s Social Security benefit does not increase enough for them to pay the $202.90 without their benefit decreasing, the “hold harmless” provision will limit the Part B premium increase to the amount of their 2026 Social Security benefit increase. The “hold-harmless” provision does not apply to all beneficiaries. The Medicare Part B premium for individuals in the following categories will increase to $202.90 (or higher) in 2026:

● Individuals whose income is above $109,000, or a married individual when the couple’s combined income is over $218,000, will pay the standard premium and an Income Related Monthly Adjustment Amount (IRMAA);

● New Medicare Part B beneficiaries since these individuals did not pay the Medicare Part B premium in 2025; and ● Individuals who do not have the Medicare Part B premium deducted from their Social Security benefit, including individuals who are enrolled in the Medicare Savings Program. These individuals will not be directly affected as the increased premium will be paid by Medicaid. If an individual has chosen to pay the Medicare Part B premium to reduce a spenddown obligation, the actual premium that is paid must be used in calculating the individual’s budget.

Family Member Allowance As a result of the increase in the FPLs, the amount used in the Family Member Allowance (FMA) formula increased to $2,705.00 and the maximum monthly FMA increased to $902. All spousal impoverishment cases involving a family member entitled to the family member allowance, with a budget effective date of January 1, 2026 or later and which were budgeted using the 2025 Family Member Allowance, must be re-budgeted using the 2026 Family Member Allowance. If a district determines that a previously budgeted case with a “From” date of January 1, 2026 or greater, has been negatively affected due to use of 2025 FPL, or if a case is brought to the district’s attention, the case should be re-budgeted using the revised FPLs. If eligible, covered medical expenses paid by an individual as a result of an improper calculation must be reimbursed pursuant to 10 OHIP/ADM-9, “Reimbursement of Paid Medical Expenses Under 18 NYCRR §360-7.5(a).” Congregate Care Medicaid eligibility for SSI-related consumers is determined by comparing income, after appropriate deductions, to the MNIL or the Medicaid Standard (and MBL Living Arrangement Chart as appropriate), and applying whichever income level is most beneficial. Special Income Standard for Housing Expenses

The special income standard for housing expenses that is available to certain individuals who enroll in the Managed Long-Term Care program (See 12 OHIP/ADM-5 and GIS 14 MA/017 for further information) varies by region. The 2026 amounts for each region have been updated based on the FPLs for 2026.