The Short Answer
Medicare isn’t free, and it isn’t one single bill — it’s a collection of premiums, deductibles, and coinsurance amounts spread across Parts A, B, C, and D, and what you actually owe depends heavily on which path you’ve chosen: Original Medicare alone, Original Medicare with Medigap, or Medicare Advantage. Most people pay a $202.90 monthly Part B premium in 2026 regardless of that choice. Beyond that, the numbers diverge sharply — Original Medicare alone has no cap on what you could owe in a bad year, Medicare Advantage caps you at $9,250 in-network, and Medigap can bring your real costs close to $0 once you’re paying a higher monthly premium for it. This guide breaks down every number so you can see exactly where your money would actually go.
Key Takeaways
- The Part B premium is $202.90/month for most people in 2026 — up roughly 40% over the last six years, and 2026 alone brought one of the steepest single-year jumps in the program’s history.
- Original Medicare alone has no yearly cap on what you could owe. That’s the single biggest cost risk in Medicare, and it’s the entire reason Medigap and Medicare Advantage exist.
- Medicare Advantage plans cap your in-network costs at $9,250 for 2026 — but you’ll still pay copays and coinsurance up to that point.
- Medigap trades a higher monthly premium for costs that are close to $0 at the point of care.
- Higher earners pay more for Part B and Part D through IRMAA — an income-based surcharge most people don’t realize applies to both.
- A hospital stay longer than 60 days, or a nursing home stay longer than 20 days, can get expensive fast under Original Medicare alone — this is where the “no cap” risk becomes real.
Part A Costs: Hospital Insurance
Most people don’t pay a monthly premium for Part A — if you or your spouse worked and paid Medicare taxes for at least 10 years (40 quarters), it’s premium-free. If you don’t meet that threshold, you’ll pay a monthly premium — $311/month in 2026 if you have at least 30 quarters of work history, or $565/month if you have fewer than 30.
Even with premium-free Part A, you’re not off the hook for costs if you’re actually hospitalized:
Part A Cost | 2026 Amount |
Inpatient hospital deductible (per benefit period) | $1,736 |
Hospital coinsurance, days 1–60 | $0 |
Hospital coinsurance, days 61–90 | $434/day |
Lifetime reserve days (days 91–150, 60 total, non-renewing) | $868/day |
Skilled nursing facility coinsurance, days 1–20 | $0 |
Skilled nursing facility coinsurance, days 21–100 | $217/day |
Skilled nursing facility, after day 100 | You pay 100% |
Paul’s Honest Take: This table is exactly why “Original Medicare has no cap” isn’t just a technicality — it’s the single biggest financial risk in all of Medicare. Run the math on a genuinely long hospital stay: the $1,736 deductible, then $434 a day from day 61 to 90 — that’s another $13,020 — and if you’re still there past day 90, you’re into lifetime reserve days at $868 each. A 100-day stay could run past $23,000 before a single doctor’s bill is even counted. This is exactly the scenario Medigap and Medicare Advantage both exist to protect you from — they just protect you in very different ways.
One important detail on “benefit periods”: Part A’s deductible and coinsurance reset with each new benefit period, not once a year. A benefit period starts the day you’re admitted as an inpatient and doesn’t end until you’ve been out of the hospital or a skilled nursing facility for 60 days in a row. That means it’s technically possible to pay the $1,736 deductible more than once in a single calendar year if you have separate hospital stays spaced more than 60 days apart.
Part B Costs: Doctor and Outpatient Insurance
Part B Cost | 2026 Amount |
Standard monthly premium | $202.90 |
Annual deductible | $283 |
Coinsurance for most covered services | 20% |
After you meet the $283 deductible, Original Medicare generally pays 80% of the Medicare-approved amount for most covered services, and you’re responsible for the remaining 20% — with no yearly cap, unless you have a Medigap policy or you’re on Medicare Advantage.
Paul’s Honest Take: That 20% coinsurance sounds manageable until you’re looking at a genuinely expensive year — a surgery, a series of specialist treatments, ongoing chemotherapy. There’s no ceiling on Original Medicare’s 20% by itself. This is the single most important number in this whole guide, because it’s the one that makes the Medigap vs. Medicare Advantage decision matter as much as it does.
The Part B Premium Has Been Climbing — Here's the Trend
The standard Part B premium doesn’t move by a fixed amount every year — some years it barely rises, and in 2023 it actually went down. But the last several years have trended upward, and 2026 brought one of the steepest single-year jumps in the program’s history:
Year | Standard Monthly Premium | Change from Prior Year |
2020 | $144.60 | — |
2021 | $148.50 | +$3.90 |
2022 | $170.10 | +$21.60 (largest dollar increase in program history at the time) |
2023 | $164.90 | –$5.20 (rare decrease) |
2024 | $174.70 | +$9.80 |
2025 | $185.00 | +$10.30 |
2026 | $202.90 | +$17.90 (about 9.7% — one of the largest increases in years) |
Paul’s Honest Take: Six years ago, the Part B premium was $144.60. It’s now $202.90 — an increase of roughly 40% in that time. That’s real money, and it’s exactly why “Medicare is expensive” isn’t an exaggeration people are making up. This is also exactly why I tell clients not to assume next year’s premium will look like this year’s. Whatever else you’re planning around Medicare costs, build in some room for this number to keep climbing.
Medicare Advantage Costs
Medicare Advantage plans replace the “no cap” risk of Original Medicare with a defined structure: usually a low or $0 monthly premium, copays and coinsurance when you use care, and a hard annual limit on what you’ll pay.
Medicare Advantage Cost | 2026 Amount |
Average monthly premium (nationwide) | ~$14 |
Plans with a $0 premium | About 2 in 3 |
Maximum in-network out-of-pocket limit | $9,250 |
Maximum combined in/out-of-network out-of-pocket limit | $13,900 |
Average actual in-network out-of-pocket limit (most plans set it lower than the max) | ~$5,400 |
You’ll still pay your Part B premium on top of whatever your Medicare Advantage plan charges. For a full breakdown of how Medicare Advantage works, see our [Medicare Advantage guide].
Medigap Costs
Medigap works differently — rather than paying as you go, you pay a higher fixed monthly premium and your out-of-pocket costs at the doctor’s office or hospital shrink dramatically, often close to $0 depending on the plan.
- Premiums vary significantly by state, insurer, age, and rating method (community-rated, issue-age-rated, or attained-age-rated) — there’s no single “average” number that means much without comparing your specific state and age.
- High-Deductible Plan G offers a lower-premium path: you pay the first $2,950 out of pocket yourself in 2026, and after that, it covers your Medicare costs in full for the rest of the year, just like standard Plan G does from day one.
- You’ll separately pay for a standalone Part D plan, since Medigap doesn’t include drug coverage.
For the full comparison and how to choose between the lettered plans, see our [Medigap guide].
Part D Costs
Part D Cost | 2026 Amount |
Maximum standard deductible | $615 |
Coinsurance during initial coverage phase | 25% |
Out-of-pocket cap before catastrophic coverage | $2,100 |
Cost after hitting the cap | $0 for covered drugs |
Once your out-of-pocket drug spending hits $2,100 for the year, your covered medications cost you nothing for the rest of the calendar year. For the full breakdown of how this works, and what’s changing for 2027, see our [Part D guide].
IRMAA: The Income-Based Surcharge Most People Forget
If your income is above certain thresholds, you’ll pay more for both Part B and Part D — an extra amount called the Income-Related Monthly Adjustment Amount (IRMAA). IRMAA isn’t a single extra fee — it’s a sliding scale with several tiers, based on your tax return from two years prior. For 2026, that means your 2024 income determines what you pay.
Here’s the full 2026 picture, per person:
2024 Income (Individual) | 2024 Income (Married, Filing Jointly) | Total Part B / Month | Part D Surcharge / Month |
$109,000 or less | $218,000 or less | $202.90 | $0.00 |
$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 and above | $750,000 and above | $689.90 | $91.00 |
Paul’s Honest Take: Two things about this table catch people off guard every time. First, notice it’s a cliff, not a gradual slope — cross a threshold by even $1 and you pay the full next tier for the entire year, on both Part B and Part D. Second, look at the top row versus the bottom: at the highest tier, you’re paying more than three times the standard Part B premium, plus a Part D surcharge on top of your regular drug plan premium. For a married couple where both spouses are enrolled, double every one of these numbers.
Paul’s Honest Take: IRMAA catches people off guard in two specific ways beyond the cliff itself. First, it’s based on your income from two years ago, so a high-earning final work year, a big Roth conversion, or a one-time home sale can trigger a surcharge two years later — often after that income is long gone. Second, it applies to Part D too, not just Part B — a lot of people have never heard that part. If your income has recently dropped due to retirement, the loss of a spouse, or certain other qualifying life-changing events, you can appeal your IRMAA determination using Form SSA-44, and I’ve helped clients successfully lower it this way.
Putting It All Together: A Real Comparison
Here’s a simplified look at how a moderately serious health year — a few specialist visits, a short hospital stay — could play out differently depending on your path, all else being equal:
Scenario | Original Medicare Alone | Original Medicare + Medigap (Plan G) | Medicare Advantage |
Monthly premium | $202.90 (Part B only) | $202.90 + Medigap premium + Part D premium | $202.90 + plan premium (often $0) |
Cost of a 5-day hospital stay | $1,736 deductible | $283 Part B deductible only (Medigap covers Part A deductible) | Copay per plan, up to your out-of-pocket max |
Cost of ongoing specialist visits | 20% of each bill, uncapped | Minimal to none | Copay per visit, up to your out-of-pocket max |
Worst-case yearly exposure | No cap | Predictable — mostly your premiums | Capped at $9,250 in-network |
Paul’s Honest Take: Numbers like these are exactly why I never tell someone Medicare Advantage or Medigap is the “right” choice in the abstract. If keeping your monthly cost low matters most, Medicare Advantage’s structure makes sense. If knowing your worst-case year in advance matters more, Medigap’s higher premium is buying you real peace of mind. Neither one is a trap—they’re just different tools for the same underlying problem: Original Medicare’s uncapped 20%.
Frequently Asked Questions
The Bottom Line
The single most important thing to understand about Medicare costs isn’t any one number on this page — it’s that Original Medicare, by itself, has no ceiling on what a bad year could cost you. Everything else in this guide — Medigap, Medicare Advantage, even High-Deductible Plan G — exists to answer that one problem in a different way. Once you understand that, the rest of the cost comparisons make a lot more sense.
If you want help running the actual numbers for your specific situation — what a real year would likely cost you under each path — that’s exactly the conversation I have with clients every day, at no cost to you.
Call 631-358-5793 or visit paulbinsurance.com to set up a time to talk it through.
Paul Barrett, CMIP, is the founder of The Modern Medicare Agency and has spent 18+ years exclusively helping people navigate Medicare — never life insurance, never annuities, just Medicare. He’s licensed in 37 states, represents more than 40 carriers, and has personally helped over 5,000 clients choose coverage that actually fits their lives.
Figures current as of 2026 and sourced from CMS and the Federal Register. Medigap premiums vary significantly by state, age, and insurer — always verify specific costs for your situation before enrolling.
