The short answer
Most people pay nothing for Medicare Part A, the hospital insurance, because they or a spouse worked about ten years; others pay up to $565 a month in 2026. Nearly everyone pays for Part B, the medical insurance: the standard premium is $202.90 a month, more for individuals with income above $109,000 or couples above $218,000. Part B has a $283 yearly deductible, after which you usually pay 20 percent of the approved amount. A hospital stay under Part A costs a $1,736 deductible per benefit period, then $434 a day after day 60. Drug coverage under Part D adds its own premium, with yearly out-of-pocket drug costs capped at $2,100. Original Medicare has no overall limit on what you pay, which is why many people add a Medigap policy or choose a Medicare Advantage plan, whose 2026 in-network limit is no more than $9,250.
The four kinds of cost
Medicare charges in four ways: a monthly premium, a deductible, a share of each bill once the deductible is met, and the full cost of anything it does not cover. Part A and Part B set each of them differently.
Swipe sideways to see the whole table.
| Cost | Part A (hospital) | Part B (medical) |
|---|---|---|
| Monthly premium | $0 for most people; $311 or $565 without enough work | $202.90 standard; more at higher incomes |
| Deductible | $1,736 per benefit period | $283 per year |
| After the deductible | $0 for days 1 to 60 in the hospital; $434 a day for days 61 to 90 | Usually 20 percent of the Medicare-approved amount |
| Skilled nursing facility | $0 for days 1 to 20; $217 a day for days 21 to 100 | Not covered by Part B |
| Yearly limit on what you pay | None | None |
Part D drug plans and Medicare Advantage plans add costs of their own, set by each plan within federal limits; both are covered below.
Part A: free for most, not for everyone
You get Part A without a premium if you or your spouse worked and paid Medicare taxes for at least 40 quarters, about ten years. Otherwise you can buy it: in 2026 the premium is $311 a month with 30 to 39 quarters of work and $565 with fewer than 30. Signing up late for premium Part A can add 10 percent to that premium, for twice the number of years you could have had it but did not.
The deductible is where Part A surprises people. It is $1,736 in 2026, and it applies to each benefit period, not each year. A benefit period starts the day you are admitted as an inpatient and ends once you have gone 60 days in a row without inpatient hospital or skilled nursing care. Someone admitted three times in a year, with gaps of more than 60 days between stays, can pay it three times.
Within a benefit period, days 1 to 60 in the hospital cost nothing more after the deductible. Days 61 to 90 cost $434 a day. After day 90 you can draw on 60 lifetime reserve days at $868 a day, and once those are used you pay all costs. Skilled nursing care after a qualifying hospital stay is free for 20 days and $217 a day for days 21 to 100. Hospice care is covered with little or no cost to you.
Part B: the premium nearly everyone pays
The standard Part B premium is $202.90 a month in 2026, up from $185 in 2025. If you receive Social Security, it is usually taken from your benefit before the deposit, so it shows up as a smaller payment rather than a bill; otherwise Medicare bills you. One protection applies to most people who have it deducted: if the yearly rise in the premium would be larger than their cost-of-living increase, the premium rise is limited so their Social Security payment does not go down. It does not cover people new to Medicare, people paying the income surcharge or people whose state pays the premium.
Higher incomes pay more. The surcharge, called IRMAA, starts above $109,000 of modified adjusted gross income for an individual or $218,000 for a married couple filing jointly, and it is set from the tax return two years earlier, so 2026 premiums follow 2024 income. At the top it lifts Part B to $689.90 a month. Our guide to IRMAA and how to appeal it covers the brackets and what to do if your income has fallen, and you can estimate your Part B premium from the income on your return.
Once you meet the $283 yearly deductible, you usually pay 20 percent of the Medicare-approved amount for doctor visits, outpatient care, tests and equipment. Most preventive services, such as screenings and the yearly wellness visit, cost nothing when the provider accepts the approved amount as full payment. A doctor who does not accept it can charge up to 15 percent more, and you owe the difference.
The bill with no ceiling
For a budget, this is the line that matters most. Original Medicare has no yearly limit on your share. Twenty percent of a $10,000 outpatient treatment is $2,000, and twenty percent of a year of cancer treatment or dialysis can be far more.
Most people close that gap in one of three ways. Retiree coverage from a former employer or union may pay much of it. A Medigap policy, sold by private insurers, pays some or all of the deductibles and coinsurance in exchange for its own premium; the safest time to buy one is the six months starting when you are 65 and enrolled in Part B, when insurers cannot turn you down or charge more because of your health. Or you can choose a Medicare Advantage plan, which caps yearly out-of-pocket costs, in 2026 at no more than $9,250 for in-network care, but uses networks and often requires approval before care. Our guide to Original Medicare and Medicare Advantage weighs that choice.
Medicare Advantage changes the shape of the bills rather than removing them. You still pay the Part B premium, and some plans charge a premium of their own while others charge none. In place of 20 percent coinsurance, plans usually set copayments, such as a fixed amount for a doctor visit or a daily charge in the hospital, and the yearly limit caps what you pay for covered care in the network. Going outside the network can cost more or, in many plans, is not covered at all except in an emergency.
Original Medicare also leaves out most routine dental care, eye exams for glasses and hearing aids, which you pay for in full unless other coverage helps; our guide to dental, vision and hearing coverage sets out the options.
Drug coverage: Part D
Original Medicare does not cover most prescriptions you fill at a pharmacy. For those you join a Part D plan, or a Medicare Advantage plan that includes drug coverage, and pay its premium, which varies by plan. In 2026 a plan's deductible can be no more than $615, and once your out-of-pocket spending on covered drugs reaches $2,100 for the year, you pay nothing more for them. Higher incomes pay a surcharge on the Part D premium too. Our guide to the Part D drug cost cap explains how the cap works through the year.
A year of Medicare, priced
A hypothetical year under Original Medicare
Joan is 68 and has Original Medicare with no supplement, and her income is below the surcharge threshold. Her Part B premium is $202.90 a month, or $2,434.80 for the year. In March she has outpatient surgery with a Medicare-approved amount of $4,000: she pays the $283 deductible and 20 percent of the remaining $3,717, about $743. In October she spends four days in the hospital, so she pays the $1,736 Part A deductible, plus 20 percent of her doctors' bills there, which fall under Part B.
Before those doctors' bills and her drugs, her year comes to about $5,200: $2,434.80 in premiums, $1,026 under Part B and $1,736 under Part A. A Medigap policy could have paid much of the $2,762 in deductibles and coinsurance in return for its own premium; whether that saves money depends on the policy's price and how much care she needs in a given year.
Income would have changed the first number. Had Joan's 2024 income been above $109,000, her Part B premium alone would have been at least $284.10 a month.
Penalties that last
Two costs come from timing rather than care. If you do not sign up for Part B when you are first eligible, and you do not have coverage from current work, the premium rises 10 percent for each full 12 months you went without it, for as long as you have Part B. The Part D penalty adds 1 percent of the national base premium, $38.99 in 2026, for each full month without creditable drug coverage. Neither penalty applies if you delayed because you or your spouse had a job-based plan from current work, as long as you sign up within eight months after that job or coverage ends. Our guide to when to sign up for Medicare shows how to avoid both.
Ways to pay less
- Apply for a Medicare Savings Program if your income is limited. These state programs pay the Part B premium and, at the lowest incomes, deductibles and coinsurance, and anyone in them also gets Extra Help with drug costs. Our guide to who qualifies has the limits.
- Check whether you also qualify for Medicaid. For people with both, Medicaid pays most of what Medicare leaves; our guide to Medicare and Medicaid explains how the two fit together.
- Ask for a new IRMAA decision after your income falls. Retirement, divorce or the death of a spouse can lower the surcharge if you file Form SSA-44.
- Compare drug and Medicare Advantage plans every fall. Between October 15 and December 7 you can switch plans for the next year, and the cheapest plan for your prescriptions often changes.
- Choose providers who accept assignment. They cannot bill you above the Medicare-approved amount.
Official sources
Building Medicare into your budget
Start with the three numbers that arrive every year whether or not you see a doctor: the Part B premium, your drug plan's premium and any Medigap or Medicare Advantage premium. Then set aside the most you could owe in a bad year, which in Original Medicare without a supplement has no upper limit. The figures here are 2026's national ones; plan premiums depend on the plan and where you live, and Medicare's plan finder shows the plans available to you.
