Medicare Costs

WHAT ARE THE COSTS OF MEDICARE?

The costs of Original Medicare (Part A & Part B) vary depending on factors such as how long you or your spouse paid Medicare taxes, income level, and the services you receive. Below is a detailed breakdown of the costs for 2026.
NOTE: You can eliminate most of these costs by getting a Medicare Supplement Plan (Medigap).  Call Medicare Sharks to see which Medigap plan fits your needs and budget.

🏥 Medicare Part A Costs (Hospital Insurance)

Most people get Part A premium-free, but there are other costs associated with inpatient hospital care.

✅ Part A Premium:

• $0/month – If you or your spouse worked and paid Medicare taxes for at least 10 years (40 quarters).

• $311/month – If you worked and paid Medicare taxes for 30-39 quarters.

• $565/month – If you worked and paid Medicare taxes for less than 30 quarters.

💸 Part A Deductible and Coinsurance:

• Deductible: $1,736 per benefit period in 2026.
  • A benefit period begins when you’re admitted to a hospital and ends when you’ve been out for 60 consecutive days.
• Coinsurance for Hospital Stays:

  • Days 1-60: $0 per day.

  • Days 61-90: $434 per day.

  • Days 91 and beyond: $868 per day (for up to 60 lifetime reserve days).

  • After lifetime reserve days are used: You pay 100% of the costs.

🏡 Skilled Nursing Facility (SNF) Coinsurance:

• Days 1-20: $0 per day.

• Days 21-100: $217 per day.

• Days 101 and beyond: You pay all costs.

🧡 Hospice Care:

• $0 for hospice care.

• May pay a copay of up to $5 for each prescription drug for pain and symptom management.

• Room and board are not covered if you receive hospice care in a facility.

👩‍⚕️ Medicare Part B Costs (Medical Insurance)

Part B covers doctor visits, outpatient services, preventive care, and more.

✅ Part B Premium:

• $202.90/month – Standard premium in 2025.

• Higher-income beneficiaries pay an additional amount known as IRMAA (Income-Related Monthly Adjustment Amount):

  • Single income > $109,000 or joint income > $218,000 may have higher premiums (up to $487.00 or $689.90.00/month depending on income bracket).

💸 Part B Deductible and Coinsurance:

• Deductible: $283 per year in 2026.

• Coinsurance: After meeting the deductible, you pay 20% of the Medicare-approved amount for most services.

  • Medicare covers 80%, and you’re responsible for 20% (no cap on out-of-pocket costs under Original Medicare).

🛡️ Other Part B Costs:

• Doctor’s Visits: 20% of the Medicare-approved amount after the deductible.

• Outpatient Care and Services: 20% of Medicare-approved amount.

• Durable Medical Equipment (DME): 20% of Medicare-approved amount.

• Preventive Services: Many preventive services are covered at no cost if you meet Medicare’s eligibility guidelines.

💊 Prescription Drug Costs (Part D – Optional)

• Original Medicare does not cover prescription drugs.

• You can enroll in a stand-alone Part D plan.

• Costs vary by plan but may include:

  • Monthly premiums (average around $34 in 2026, depending on the plan).

  • Annual deductible (up to $615 in 2026, but some plans waive it on higher premium plans).

  • Copayments or coinsurance for medications. Maximum out of pocket costs capped at $2,100 in 2026

⚠️ Important Notes:

• No Out-of-Pocket Maximum: Original Medicare does not have an annual cap on out-of-pocket spending, which is why many beneficiaries choose a Medigap (Medicare Supplement) plan to cover these costs.

• Late Enrollment Penalties:

  • Part B Penalty: If you don’t sign up for Part B when first eligible, you may pay a 10% penalty for each 12-month period you delayed, added to your monthly premium for as long as you have Medicare.

  • Part D Penalty: Late enrollment can result in a permanent penalty that increases your Part D premium.