The $90 Part B rebate that starts landing on or around October 8 is not reaching every Medicare household. Three groups are written out of it by the rules: members of Medicare Advantage plans, people whose Part B premium is already paid through Medicaid, and people who pay the income-related surcharge known as IRMAA. Because the rebate is counted per beneficiary, a married couple can split down the middle, with one spouse seeing a deposit and the other seeing nothing.
Medicare Advantage: the plan card decides, not the red-white-and-blue Medicare card
The Centers for Medicare & Medicaid Services drew the first line in plain words in its October 3 fact sheet on the Medicare Improvement Fund premium rebate: “Beneficiaries enrolled in Medicare Advantage are not eligible.” The same document counts the people the rebate is built for as the 20.8 million Americans in Original Medicare Part B. A member of a private Medicare Advantage plan still holds a Medicare card, which is why so many households assume the rebate applies, but the test CMS applies is which kind of coverage the person is enrolled in.
The practical sign for a household is simple. Someone in an Original Medicare arrangement, usually with a separate drug plan or a supplement, is inside the group the rebate targets. Someone whose coverage comes through an insurer-run Medicare Advantage plan is outside it, however long that person has paid into Medicare. In a household where one spouse chose a Medicare Advantage plan and the other stayed with Original Medicare, only the second spouse is in the pool.
Medicaid premium assistance: when the state already pays the Part B bill
The second exclusion covers people who get Medicaid premium assistance. CMS lists it as a bar to eligibility, and the White House fact sheet of October 2 phrases it from the premium side: those “whose premiums are already paid by Medicaid” do not qualify. The check memo CMS describes for paper payments reads “Medicare Improvement Fund Payment; $90 Payment to Offset October Premium,” which ties the rebate to a premium the recipient is responsible for.
The state-run help that pays Part B premiums is the family of Medicare Savings Programs. Medicare.gov describes three of them: Qualified Medicare Beneficiary, Specified Low-Income Medicare Beneficiary and Qualifying Individual. Qualified Medicare Beneficiary helps with Part A premiums for those who owe them and with Part B premiums, deductibles, coinsurance and copayments, while the other two help with Part B premiums only and require both Part A and Part B. The page lists 2026 monthly income limits for individuals of $1,350, $1,616 and $1,816 for the three programs in that order, and $1,824, $2,184 and $2,455 for couples. It says the programs are run by each state and that applicants should contact their state. CMS’s fact sheet speaks of “Medicaid premium assistance” without naming programs, so the match between that phrase and these programs is the household’s to confirm with the state office that pays the premium.
IRMAA: $109,000 single, $218,000 joint, and a tax return from two years back
The third exclusion is the one most likely to catch a retired couple off guard, because the test is not the current year’s paycheck or pension. The Social Security Administration’s Medicare premium page for higher-income beneficiaries sets the 2026 threshold at a modified adjusted gross income above $109,000 for a single filer and above $218,000 for married couples filing jointly. SSA says the figure generally comes from the tax return filed in 2025 for tax year 2024, with the 2023 return as the fallback when the 2024 return is not available.
The surcharge is a charge on top of the standard Part B premium, which Medicare.gov puts at $202.90 a month for 2026, with higher premiums for higher incomes. SSA describes six Part B tiers running from $81.20 to $487.00 above the standard premium, and it says the amount is deducted from the monthly Social Security payment. A household that sees a Part B deduction larger than the standard premium on its benefit statement is therefore looking at the IRMAA line, and CMS says people paying that adjustment are not eligible for the rebate.
SSA also names the route for people whose income has dropped since the tax return in question. The Form SSA-44, the Medicare Income-Related Monthly Adjustment Amount life-changing event form, covers events such as marriage, divorce, a change in employment or a change in a pension plan. The CMS fact sheet does not say whether a surcharge reduced after an SSA-44 request would bring a household into the rebate, so that question has no published answer in the documents read for this report.
What each household should see on the calendar
For households inside the rebate, CMS says “the vast majority” will be paid by direct deposit from the Social Security Administration, on or around October 8. People without direct deposit are to receive a Treasury check later in October at the mailing address registered with Medicare. CMS also says beneficiaries will receive an email or a letter from the President in mid-October.
For households outside it, the quiet is the outcome: no deposit, no check and no memo line. The two phone numbers in CMS’s fact sheet cover the questions that follow. 1-800-MEDICARE, at 1-800-633-4227, handles eligibility and delivery status, and the Social Security Administration’s line, 1-800-772-1213, takes payment-status calls beginning October 15. CMS adds that recipients must live in the United States, a fourth condition that sits next to the three exclusions.
Where the $90 comes from
The money is drawn from the Medicare Improvement Fund, which CMS says was created by Sec. 7002 of the Supplemental Appropriations Act of 2008 and which Congress has withdrawn from roughly 20 times before. The White House fact sheet gives the amount allocated this time as $2 billion by Congress. Neither fact sheet describes a partial rebate for the excluded groups, and CMS’s wording on Medicare Advantage is categorical: not eligible.
The Part B bill that stays on the benefit statement
The rebate rules leave three kinds of households with their Part B premium exactly as it was: Medicare Advantage members, people already getting state premium help, and IRMAA payers whose surcharge is taken out of Social Security. For the households that might fit a Medicare Savings Program, the unfinished job is finding out how that state applies its own income limits.
The Medicare Cost & Coverage Protection Kit includes 51 state Medicare cost-help packs and a medication and cost tracker, so a household can look up its state’s version of that help and keep its drug costs in one place.
Look up state Medicare cost help in The Medicare Cost & Coverage Protection Kit →
This piece was drafted with AI assistance; the figures were checked against the CMS rebate fact sheet, the White House fact sheet, SSA’s Medicare premium page and Medicare.gov.
