Around October 8, a one-time $90 deposit started appearing in the bank accounts of roughly 20.8 million people on Original Medicare Part B. For many households it raised more questions than it answered. One spouse received it. The other did not. Some people thought their Social Security check had been reduced. Others wondered whether their Medicare premium had just dropped permanently.
It is none of those things.
The $90 is a one-time Medicare Improvement Fund Premium Rebate. CMS confirmed the details in a fact sheet on October 2. Most eligible people received it by direct deposit. Paper checks are going out later in October for those without direct deposit. It offsets roughly one month of the higher 2026 Part B premium for people who qualify. Then it is gone. The standard Part B premium remains $202.90 a month.
Who gets the $90
You generally receive it if you are on Original Medicare Part B, live in the United States, are not receiving Medicaid help with your Part B premium, and are not paying IRMAA (the income-related monthly adjustment amount).
You generally do not receive it if you are enrolled in a Medicare Advantage plan, if Medicaid is paying your premium, or if you are subject to IRMAA. A missing deposit does not automatically mean something went wrong. If you are unsure, 1-800-MEDICARE can confirm your status.
Why the IRMAA cliff matters here
Your 2026 Medicare premium is generally based on your 2024 modified adjusted gross income. Tax-exempt interest counts. A Roth conversion counts in the year you convert it. The first IRMAA threshold for 2026 is $109,000 for single filers and $218,000 for married couples filing jointly.
Cross that line by one dollar and the surcharge applies for the full year. The first tier adds $81.20 a month to Part B. If you also have Part D, there is a separate $14.50 monthly surcharge. Together that is about $1,148 for the year. If both spouses are on Medicare, the same tax return can set both premiums.
The $90 rebate is generally not available if you are paying IRMAA. That means one dollar over the threshold can cost you both the surcharge and the rebate. We will cover the two-year lookback and Form SSA-44 in more detail in a November episode. For now, know that the cliff exists and that this week’s deposit is one more reason to know which side of it you are on.
Open enrollment is a separate decision
Medicare open enrollment runs from October 15 through December 7. Changes you make during this window take effect January 1, 2027. You can switch Medicare Advantage plans, move between Original Medicare and Medicare Advantage, or join, drop, or switch a stand-alone Part D plan.
What you cannot do in this window is change last year’s tax return. Open enrollment is about which plan covers your doctors and prescriptions next year. IRMAA is about income from two years ago. They are related only in the sense that both affect what you pay. They are not the same decision.
Before December 7, review the Annual Notice of Change from your current plan. Premiums, deductibles, drug formularies, and networks can shift. Compare your actual prescriptions and providers, not just the monthly premium. If you are considering moving from Medicare Advantage back to Original Medicare, check whether you still have a guaranteed-issue right for a Medigap policy in your state. Rules vary. Connecticut has its own.
The second clock
The income you report for 2026 is generally what Medicare will use for your 2028 premium. A Roth conversion can be a useful lifetime tax move and still raise your Medicare premium two years later. A qualified charitable distribution can satisfy part or all of a required minimum distribution without adding to adjusted gross income, which can matter for a future IRMAA cliff. Neither strategy is automatically right. The numbers have to line up for your situation.
What to do this week
Check whether the $90 arrived, or whether you were never eligible.
Open the plan notices already in the mail or online.
Mark December 7 on your calendar.
If your 2024 income was close to $109,000 single or $218,000 joint, note that the IRMAA cliff is real. The deeper conversation on Form SSA-44 is coming next month.
The $90 is a one-time offset. Open enrollment is a real decision window. The IRMAA cliff is the one that keeps costing you if you never look at it.
Listen to the full episode on Apple Podcasts or Spotify, and watch it on the YouTube channel.
If you’d like to model how the $90 rebate, IRMAA, and open enrollment choices affect your specific numbers, you can book a complimentary 15-minute Fit Call on the calendar at LeonardiFamilyWealthcare.com.
You can also download the Roth IRA Conversion Playbook and the Smart Retirement Tax Shield Playbook under the Books and Guides tab on the site.
Education only, not tax or Medicare advice. Please refer to the website for full disclosures.
LeonardiFamilyWealthcare.com