Medicare isn’t one bill — it’s a few moving parts, each with its own premium, deductible, and share of the cost. Here’s a plain-English walk through what each piece runs in 2026, so you can budget with no surprises.
A quick map of the parts
Medicare is built from four lettered parts. Most people use Part A and Part B (together called Original Medicare) and add a Part D drug plan. Here’s the 2026 snapshot:
| Part | What it covers | 2026 cost |
|---|---|---|
| Part A | Hospital, skilled nursing, hospice | $0 premium for most; $1,736 deductible |
| Part B | Doctors, outpatient care, equipment | $202.90/month; $283 deductible |
| Part D | Prescription drugs | Premium varies by plan; $2,000 yearly cap |
Let’s take them one at a time.
Part A: usually $0 a month
For most people, Part A costs $0 in monthly premiums. You earn it by working and paying Medicare taxes for at least 40 quarters — about 10 years. If you or your spouse hit that mark, you’re covered without a premium.
That doesn’t mean Part A is free to use. If you’re admitted to the hospital, you pay an inpatient deductible of $1,736 per benefit period in 2026. A benefit period isn’t the calendar year — it starts when you’re admitted and ends after you’ve been out for 60 days, so a rough year with two separate hospital stays could mean paying that deductible twice.
Part B: the premium you’ll notice
Part B is the part most people feel each month. In 2026 the standard premium is $202.90 a month, and there’s an annual deductible of $283. Once you’ve met the deductible, you generally pay 20% coinsurance on covered services — doctor visits, outpatient procedures, lab work, durable medical equipment, and the like.
Here’s the catch that surprises people: that 20% has no ceiling. Original Medicare by itself has no out-of-pocket maximum, so a serious illness can keep that 20% adding up with nothing to stop it. We’ll come back to how people fix that.
Part D: prescription drugs
Drug coverage comes through a standalone Part D plan. Premiums vary from plan to plan, built around a national base premium of $38.99 a month in 2026. Some plans cost less, some more, depending on their formulary and the area you live in.
The big improvement for 2026 is a hard limit: once your out-of-pocket spending on covered drugs reaches $2,000 for the year, you pay $0 for covered drugs the rest of the year. The old “donut hole” coverage gap is gone. On top of that, Medicare’s drug price negotiation program takes effect January 1, 2026, lowering the negotiated price on the first 10 drugs — including common ones like Eliquis and Jardiance. What you actually pay still depends on your plan and that $2,000 cap, but it’s a real step in the right direction.
Higher income? Add IRMAA
If your income is above a certain level, you’ll pay an extra surcharge called IRMAA on both your Part B and Part D premiums. It’s based on the income from your tax return two years prior, so your 2026 surcharge looks at your 2024 return. IRMAA starts once your income tops $109,000 (single) or $218,000 (married filing jointly).
Because the brackets step up at several income levels, the easiest way to see your number is to run the IRMAA Calculator with your income and filing status — it’ll show exactly what you’d add to the standard premiums above.
Capping your costs
Remember that missing out-of-pocket maximum on Original Medicare? That’s the gap most people close in one of two ways:
- Medigap (Medicare Supplement): pairs with Original Medicare and pays most of the gaps it leaves, giving you predictable costs and no networks. The premium is higher, but your surprises are smaller.
- Medicare Advantage (Part C): an all-in-one plan from a private insurer, often with a low or $0 premium, usually bundling drug coverage and extras like dental and vision. You still pay your Part B premium, and these plans do include an annual out-of-pocket maximum.
Either route turns Medicare from an open-ended bill into something you can plan around.
Putting it all together
For a quick personal estimate that adds up premiums, deductibles, and expected spending, the Medicare Cost Estimator does the math for you. And if you’d like a second set of eyes on which mix of coverage fits your budget, that’s exactly the kind of thing a short, no-pressure call can sort out — reach out anytime and we’ll walk through your numbers together.