Medicare Costs & Deductibles
Premiums, deductibles and copays — explained calmly, with real numbers.
Medicare isn't free, but it's not a mystery either. Once you know the handful of numbers that matter — and which ones have a cap and which don't — you can budget with confidence and compare plans on your own terms.
Every Cost, In Its Place
Start with the part you're curious about — or read straight through.
Hospital and nursing-facility stays — and the estimator.
Doctors, outpatient care, and the 20% that has no cap.
Prescriptions — now with a yearly spending cap.
How Medicare Advantage and Medigap limit what you pay.
IRMAA if income is higher — help if it's limited.
Part A Hospital Insurance
Usually no monthly premium — but a deductible when you're admitted
Part A covers inpatient hospital stays, skilled nursing facility care after a hospital stay, hospice and some home health care. Most people don't pay a premium for it, because they (or a spouse) paid Medicare taxes while working.
A benefit period starts the day you're admitted to a hospital and ends once you've been out of the hospital or nursing facility for 60 days in a row. If you go back in after that, a new benefit period starts — and you can owe the Part A deductible again. That means it's possible to pay it more than once in the same year.
Enter the number of days for one benefit period. This shows only your Part A share — before any Medigap or other coverage, and not counting doctor bills (those fall under Part B).
⚠ Past this point Original Medicare stops paying, so the full cost of the extra days would be yours.
Educational estimate using 2026 amounts. Assumes all 60 lifetime reserve days are still available. Real costs depend on your situation and coverage.
Part B Medical Insurance
A monthly premium, a small deductible, then 20%
Part B covers doctor visits, outpatient surgery, lab work, imaging, durable medical equipment and preventive care. Almost everyone pays a monthly premium for it — usually taken right out of your Social Security check.
With Original Medicare alone, there's no yearly cap on your 20% share. For routine care that's manageable. For something serious — cancer treatment, dialysis, a major surgery — 20% of a large bill can add up fast. That's why most people pair Original Medicare with a Medigap policy, or choose a Medicare Advantage plan that has a yearly limit.
Your yearly "Welcome to Medicare" and wellness visits, many screenings, and recommended vaccines (like flu and COVID-19) usually cost nothing when you use a provider who accepts Medicare.
Some doctors don't accept Medicare's approved amount as full payment and can charge up to 15% more. Asking "Do you accept Medicare assignment?" before your visit helps avoid surprises.
If you didn't sign up for Part B when first eligible and didn't have qualifying work coverage, your premium can go up 10% for each full 12 months you waited — usually for as long as you have Part B. Our Social Security & Medicare page explains when it's safe to wait.
Part D Prescription Drugs
Your drug costs now have a yearly ceiling
Part D comes from private plans — either a stand-alone drug plan alongside Original Medicare, or built into most Medicare Advantage plans. Premiums, copays and which drugs are covered vary from plan to plan, so checking your own medicines is the most important step.
The Medicare Prescription Payment Plan lets you pay your drug costs in monthly amounts instead of all at once at the pharmacy — helpful if you meet the cap early in the year. It's free to join; ask your plan.
Only drugs on your plan's list (formulary) count toward the cap. Skipping Part D when you first become eligible — without other creditable drug coverage — can mean a lifelong late penalty.
Protection Limiting Your Costs
Two common ways people protect themselves from big bills
Neither is "better" for everyone. They simply handle costs differently. Here's how they compare when it comes to your money.
| Original Medicare alone | + Medigap + Part D | Medicare Advantage (Part C) | |
|---|---|---|---|
| Monthly premiums | Part B | Part B + Medigap + Part D plan | Part B + plan premium (many are $0) |
| Yearly cap on medical costs | None | Depends on the plan — some leave very little to pay | Yes — no more than $9,250 in-network in 2026; many plans set it lower |
| When you get care | Deductibles + 20% | Little or nothing, depending on the plan letter | Copays and coinsurance as you go |
| Doctors & hospitals | Any that accept Medicare | Any that accept Medicare | Usually a plan network |
| Prescription drugs | Not included | Separate Part D plan | Usually included |
| Extras (dental, vision, hearing) | Generally not covered | Generally not covered | Often included |
Plan premiums, copays and limits vary by plan and location. Medigap policies are standardized by letter (like Plan G or Plan N), but prices differ by company.
With any Medicare Advantage plan you still pay your Part B premium, plus copays when you use care. A fair way to compare plans is: yearly premiums + your likely copays + the out-of-pocket limit if a bad year happens.
Your best chance to buy a Medigap policy is during your 6-month Medigap Open Enrollment Period, which starts when you're 65 and enrolled in Part B. After that, in most states companies can use your health history to decide whether to sell you a policy and at what price.
Income Paying More or Less
Your income can raise — or lower — what you pay
If your income is higher, you pay an extra amount on Parts B and D called IRMAA. It's based on your tax return from two years earlier — so 2026 costs are based on 2024 income.
| 2024 income — single | 2024 income — married filing jointly | Part B monthly | Part D extra / month |
|---|---|---|---|
| $109,000 or less | $218,000 or less | $202.90 | $0 |
| $109,001 – $137,000 | $218,001 – $274,000 | $284.10 | +$14.50 |
| $137,001 – $171,000 | $274,001 – $342,000 | $405.80 | +$37.50 |
| $171,001 – $205,000 | $342,001 – $410,000 | $527.50 | +$60.40 |
| $205,001 – $499,999 | $410,001 – $749,999 | $649.20 | +$83.30 |
| $500,000 or more | $750,000 or more | $689.90 | +$91.00 |
2026 amounts, per person. The Part D amount is added to your plan's own premium. Married filing separately has different brackets. 2027 brackets are expected in mid-November.
If you retired, stopped working, lost a pension or had another life-changing event, you can ask Social Security to use your newer, lower income with form SSA-44.
Medicare Savings Programs (through your state) can pay your Part B premium and sometimes more. Extra Help (through Social Security) lowers your drug costs. It costs nothing to apply.
Questions Plain Answers
Part A is free for most people. Part B is not — nearly everyone pays a monthly premium ($202.90 in 2026 for most people). Drug coverage and any extra plan you choose can add their own costs.
Premium: what you pay every month to have coverage. Deductible: what you pay for care before your coverage starts paying. Copay: a set dollar amount per visit or prescription, like $20. Coinsurance: a percentage of the bill, like 20%.
No. Original Medicare by itself has no yearly limit on your share of costs. Medicare Advantage plans must have one, and Medigap policies can cover most or all of what Original Medicare leaves behind.
Your plan's 2027 premiums and copays are already in your Annual Notice of Change (ANOC). The 2027 Part A and Part B amounts are usually announced by CMS in mid-November, and your Social Security letter in December shows your exact Part B deduction.
Yes. During Open Enrollment, October 15 to December 7, you can change Medicare Advantage or Part D plans, and the new plan starts January 1. If you're in a Medicare Advantage plan, you also get a chance to switch from January 1 to March 31.
Now you know the numbers. You're ready to compare.
Learn the basics, ask your questions any time, and practice comparing plans before you choose — all free, all at your pace.
Straight from Medicare's official yearly amounts.
We refresh this page when new amounts are announced.
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