Medicare costs rise almost every year, but most people only find out when they see a smaller Social Security deposit in January. This page lays out what’s confirmed for the year already underway, what’s projected for next year, and — more importantly — how each cost actually hits your wallet depending on your situation. The numbers are only half the story. Where they bite hardest, and what you can legally do about it, is what most guides skip.
Key Answers — The Questions We Hear Most
Most Medicare confusion comes from mixing up what’s confirmed, what’s projected, and what applies only to certain people. These answers separate all three.
The standard Part B premium for the current year is $202.90 per month, confirmed by the Centers for Medicare & Medicaid Services (CMS) in November 2025. That’s up $17.90 from the prior year’s $185. Most people have it deducted directly from their Social Security check, so the increase meant a smaller January payment. If your income is above $109,000 as a single filer (or $218,000 filing jointly), you pay more — see the IRMAA section below. If you have a Medicare Advantage plan, your plan may charge a separate premium on top of, or instead of, Part B — those vary by insurer.
Medicare Part A covers hospital care, but it is not free. The inpatient hospital deductible is $1,736 per benefit period in 2026 — not per year. A benefit period begins the day you’re admitted and ends 60 days after you’ve been discharged. If you go home, recover, and are admitted again more than 60 days later, a brand-new $1,736 deductible applies. Days 1–60 cost you only that deductible. Days 61–90 run $434 per day. After day 90, you’re spending down a one-time pool of 60 lifetime reserve days at $868 per day. Once those are gone, Medicare pays nothing. In our review of hospital billing cases, this “benefit period” reset is the most commonly misunderstood rule — people assume they’ve hit their annual deductible and are surprised when a second hospitalization brings a second bill.
Yes — this is brand new and significant. Starting in 2025 (the first year ever), Medicare Part D has a hard out-of-pocket cap. In 2026 that cap is $2,100. Once your out-of-pocket spending on covered drugs reaches that number, you pay nothing more for covered Part D medications for the rest of the calendar year. For next year, the cap rises to $2,400. Before this change, there was no ceiling — people could spend $10,000 or more in a single year on prescriptions. The cap resets every January 1, so timing expensive prescriptions strategically within a calendar year can matter.
The Medicare Trustees Report projects the standard Part B premium will rise to approximately $209.50 per month — an increase of about $6.60 from the current $202.90. That’s a much gentler increase than what happened this year (which was nearly 10%). This number is a projection, not final. CMS typically announces official rates in mid-November. Some private actuarial forecasters have put the number slightly higher, between $215 and $219, noting that the Trustees have underestimated actual premiums in several recent years. Plan for a range rather than a single number when budgeting.
Medicare covers skilled nursing facility (SNF) care after a qualifying hospital stay of at least 3 consecutive days. The first 20 days are fully covered — no cost to you. Starting day 21, you owe $217 per day in coinsurance for 2026 (up from $209.50 in 2025). After day 100, Medicare pays nothing at all. This is one of the most financially punishing surprises in Medicare for families dealing with recovery after surgery or a stroke. Most people assume they’ll be covered. They won’t be, past day 100. A Medigap supplement or Medicare Advantage plan may cover some or all of the $217/day gap.
If you’re in a Medicare Part D plan and you take one of the 15 newly negotiated drugs, yes. The lower prices become effective January 1 of next year and apply at the point of sale — you’ll see the difference when you pick up your prescription. The savings are substantial: Ozempic, Wegovy, and Rybelsus drop from a list price of $959/month to $274/month. Janumet drops from $526 to $80. Trelegy Ellipta (for asthma and COPD) drops from $654 to $175. These negotiated prices represent a 38%–85% cut depending on the medication. If you take any of these drugs, your plan’s formulary will reflect the new pricing automatically — you don’t need to do anything special to access it.
If your income (technically your modified adjusted gross income from two years ago) exceeds the thresholds below, you pay an IRMAA surcharge on top of the standard Part B and Part D premiums. For 2026, the threshold for single filers is $109,000 and for married couples filing jointly it’s $218,000. About 8% of Medicare beneficiaries pay IRMAA. The critical thing most people miss: it’s a cliff, not a ramp. One extra dollar of income crossing a bracket boundary can add over $1,000 per year per person. If you had a one-time income spike in your lookback year — a Roth conversion, a property sale, an inheritance — you can appeal using SSA Form SSA-44 if your income has since dropped. We’ve seen this appeal succeed repeatedly for people who didn’t know it existed.
Not exactly. Medicare Advantage (Part C) plans replace Original Medicare and set their own cost-sharing rules — copays, deductibles, and out-of-pocket maximums differ by plan. Many charge $0 monthly premiums but collect your Part B premium regardless. The annual out-of-pocket maximum for Medicare Advantage plans is capped by CMS: for in-network care it’s $9,350 in 2026, and $14,000 for combined in-network and out-of-network. Original Medicare has no such maximum (which is why Medigap policies exist). Advantage plans often have narrower networks, prior authorization requirements, and referral rules that Original Medicare doesn’t. The $0 premium is real, but the full picture is worth reading before enrolling.
Current Confirmed Rates, Part by Part
These are official CMS figures currently in effect. They apply to Original Medicare (Parts A and B). Part D and Medicare Advantage costs vary by plan.
About 99% of Medicare beneficiaries pay no Part A premium because they (or their spouse) have at least 40 quarters — 10 years — of Medicare-covered employment. If you have 30–39 quarters, you pay $285/month; fewer than 30 quarters, $518/month. The premium-free Part A is one of Medicare’s most misunderstood features — many people assume they’re paying for it their whole working life and will owe nothing, which is largely correct but not universal.
Part B covers doctor visits, outpatient care, preventive services, durable medical equipment, and some home health care. The $202.90 standard premium applies to people with annual income at or below $109,000 (single) or $218,000 (joint). There is an annual deductible of $283 for 2026 — after you meet that, Medicare pays 80% of approved costs and you pay 20% with no cap unless you have a Medigap or Advantage plan. CMS attributed the increase this year partly to projected growth in program spending and noted it would have been $11 higher without payment reforms to skin substitute billing. When we tracked 2026 costs against Social Security COLA, many beneficiaries on fixed income absorbed roughly half their cost-of-living raise in this single premium increase.
Part D is sold through private insurers, so monthly premiums vary by plan and location. What is uniform: the standard deductible ceiling is $615 in 2026 (no plan can charge more), and the out-of-pocket cap is a firm $2,100 — after which covered drugs cost you nothing for the rest of the year. The “donut hole” that used to exist between initial coverage and catastrophic coverage was eliminated in 2025. The Medicare Prescription Payment Plan (introduced in 2025 and continuing through next year) lets you spread Part D drug costs into equal monthly installments across the year rather than paying large amounts all at once — particularly useful for people on expensive specialty medications early in January. Premium stabilization subsidies that held some plan premiums artificially low expire after this year, so some standalone Part D plans may see meaningful premium increases when rates reset.
Rate-by-Rate Comparison — Now vs. Next Year
Confirmed 2026 figures alongside the best available projections for next year. The final numbers will be announced by CMS in November. Treat projected figures as planning estimates, not commitments.
| Cost Item | 2025 (prior year) | 2026 (confirmed) | Next Year (projected) | Status |
|---|---|---|---|---|
| Part B standard premium | $185.00/mo | $202.90/mo | ~$209.50/mo | Projected (Trustees) |
| Part B annual deductible | $257 | $283 | ~$292 (est.) | Projected |
| Part A hospital deductible | $1,676 | $1,736 | ~$1,800 (est.) | Projected |
| Part A days 61–90 coinsurance | $419/day | $434/day | ~$450/day (est.) | Projected |
| Part A lifetime reserve coinsurance | $838/day | $868/day | ~$900/day (est.) | Projected |
| Skilled nursing facility (days 21–100) | $209.50/day | $217/day | ~$225/day (est.) | Projected |
| Part D max deductible | $590 | $615 | $700 | ✅ Confirmed |
| Part D out-of-pocket cap | $2,000 | $2,100 | $2,400 | ✅ Confirmed |
| IRMAA threshold — single filer | $106,000 | $109,000 | ~$112,000 (est.) | Projected (CPI-adjusted) |
| IRMAA threshold — married, joint | $212,000 | $218,000 | ~$224,000 (est.) | Projected (CPI-adjusted) |
Big Drug Price Cuts Taking Effect Next Year
Medicare negotiated prices for 15 widely used, high-cost Part D medications under the Inflation Reduction Act. These are the first negotiations of their kind in Medicare’s history. Prices go into effect January 1 of next year — no action required on your part if you’re already enrolled in Part D.
More than 5.3 million Part D enrollees used at least one of these 15 drugs in 2024, spending a combined $1.7 billion out of pocket. CMS projects beneficiaries will save $685 million per year in out-of-pocket costs once the new prices are in effect, and Medicare itself saves approximately $12 billion annually. For someone on Ozempic for diabetes, the negotiated price drops from a list price of $959 per 30-day supply to $274 — a cut of more than 71%. That’s before the $2,400 annual cap applies on top, further limiting total exposure.
| Drug Name | Used For | Old List Price (30-day) | Negotiated Price | Savings |
|---|---|---|---|---|
| Ozempic / Wegovy / Rybelsus | Diabetes · weight loss · heart disease | $959/mo | $274/mo | 71% off |
| Janumet / Janumet XR | Type 2 diabetes | $526/mo | $80/mo | 85% off |
| Tradjenta | Type 2 diabetes | $488/mo | $78/mo | 84% off |
| Trelegy Ellipta | Asthma · COPD | $654/mo | $175/mo | 73% off |
| Linzess | Irritable bowel syndrome | — | $136/mo | Negotiated |
| Ibrance | Breast cancer | $15,741/mo | $7,871/mo | 50% off |
| Otezla · Xtandi · Vraylar · others | Psoriasis · prostate cancer · depression | — | 38%–71% off | Negotiated |
The savings above are measured against the undiscounted list price — what Medicare was paying before confidential rebates. Medicare’s actual net price for Ozempic before negotiations was around $428/month (after rebates), so the real saving versus the prior payment is roughly $154/month, not $685. That still amounts to real money. The key question for you personally is what your plan’s formulary shows as your copay for each drug — and that may change in next year’s plan year even before these negotiations, which is one reason to review your plan during the annual enrollment window in October–November.
IRMAA — The Income Surcharge Most People Don’t See Coming
IRMAA (Income-Related Monthly Adjustment Amount) is a surcharge on top of standard Part B and Part D premiums for people whose income exceeds certain thresholds. It affects about 8% of beneficiaries — but that 8% often feels blindsided because the notice arrives months before the coverage year begins.
Medicare uses your income from two years ago to set your IRMAA surcharge. Your 2026 Medicare premium was determined by your 2024 tax return. Your 2027 premium (once confirmed) will use your 2025 tax return. This two-year lag creates problems for people who had a one-time income spike — selling a home, doing a Roth conversion, taking a large required minimum distribution — and then returned to normal income. The surcharge can stick around a full year past when it seems justified.
IRMAA is not a gradual phase-in. It jumps in hard tiers. In 2026, once your income as a single filer crosses $109,000, your Part B premium jumps from $202.90 to $289.10 per month — a difference of $1,030 per year. Cross the next bracket at $137,000 and the total goes to $413/month. For a married couple where both spouses are on Medicare, each person pays the surcharge separately, so a dollar that pushes household income past $274,000 can cost the couple over $2,000 per year in added premiums. People planning Roth conversions or large asset sales before turning 65 sometimes deliberately keep income below these thresholds to avoid a two-year penalty.
| Single Filer (2024 MAGI) | Married, Joint (2024 MAGI) | Total Monthly Part B Premium | Added vs. Standard |
|---|---|---|---|
| $109,000 or less | $218,000 or less | $202.90 | $0 (standard) |
| $109,001 – $137,000 | $218,001 – $274,000 | $289.10 | +$86.20/mo |
| $137,001 – $171,000 | $274,001 – $342,000 | $413.00 | +$210.10/mo |
| $171,001 – $205,000 | $342,001 – $410,000 | $536.90 | +$334.00/mo |
| $205,001 – $500,000 | $410,001 – $750,000 | $660.80 | +$457.90/mo |
| Over $500,000 | Over $750,000 | $702.10 | +$499.20/mo |
Part D also has IRMAA surcharges at the same income thresholds, ranging from $14.50 to $91.00 per month added on top of your plan premium. Source: CMS 2026 Medicare Parts A & B fact sheet; SSA POMS HI 01101.020.
Find Your Situation
Your Initial Enrollment Period opens 3 months before your 65th birthday month and closes 3 months after. Enroll in Part B during this window or you’ll pay a permanent penalty of 10% per year for each 12-month period you were eligible but didn’t enroll. Once enrolled, you’ll owe the $202.90 Part B premium starting the first month of coverage, and the $283 annual Part B deductible applies before Medicare pays its 80%. Don’t assume employer coverage protects you automatically — it depends on your company’s size. If your employer has fewer than 20 employees, Medicare is supposed to be primary even if you’re still working, and not enrolling on time can create coverage gaps and lifetime penalties.
If she had a qualifying inpatient hospital stay of at least 3 consecutive days (not counting the discharge day), Medicare Part A covers skilled nursing facility care. Days 1–20 cost her nothing. Starting day 21, she owes $217 per day for 2026. After day 100, Medicare stops paying entirely. A 45-day stay would cost her approximately $5,415 out of pocket for days 21–45 alone. If she has a Medigap Plan C, D, F, G, or N, that $217/day gap is covered or significantly reduced depending on the plan. If she’s in a Medicare Advantage plan, check the plan’s SNF cost-sharing — it varies widely and some plans cap total SNF spending. Make sure her hospital admission is documented as an inpatient stay, not “observation status,” which does not count toward the 3-day qualifying requirement.
Very likely, yes — and the notice may have already arrived from Social Security. Because Medicare uses your income from two years prior, a large capital gain or property sale can trigger IRMAA for the following two calendar years, depending on timing. The good news is that you can appeal using SSA Form SSA-44 if you’ve experienced a life-changing event that reduced your income since the lookback year — retirement, divorce, death of a spouse, or significant work reduction all qualify. A one-time asset sale does not automatically qualify as a “life-changing event” under SSA’s definition, but a tax advisor who specializes in Medicare planning may be able to structure future transactions to avoid future surcharges. Do not ignore an IRMAA determination notice — you have 60 days to file a reconsideration request.
It should — but the path isn’t automatic. The negotiated price of $274/month takes effect January 1 of next year through Medicare Part D. Whether you see the full benefit depends on your plan’s formulary and your tier placement. During the annual enrollment window (October 15 – December 7), review your plan’s drug costs for next year specifically for Ozempic. Some plans may restructure cost-sharing in response to the new negotiated price. If your plan moves Ozempic to a lower tier, your copay may drop further below $274. Also note: if your total Part D spending hits the $2,400 annual cap next year, Ozempic costs you nothing for the rest of that calendar year — even at the negotiated price, someone taking it all year would hit that cap partway through the year if no other Part D costs exist.
Yes. Several programs exist specifically for this. The Medicare Savings Programs (run by each state Medicaid program) can pay your Part B premium, deductible, and coinsurance if your income and assets fall below certain thresholds. At lower income levels, they’ll pay your Part B premium and the hospital deductible too. The Extra Help program (also called the Low Income Subsidy) handles Part D costs — it can reduce or eliminate your drug plan premium, deductible, and most copays. In our experience working with Medicare counselors, these programs are severely underused because they require a separate application and most people don’t know they exist. Call your State Health Insurance Assistance Program (SHIP) — it’s free — and ask specifically about Medicare Savings Program eligibility.
It depends on your health situation, and the answer deserves more than a premiums comparison. Advantage plans often advertise $0 premiums, but you still pay Part B. What matters is the total cost of care for your particular health needs — not just the monthly line item. If you take expensive brand-name medications, are frequently hospitalized, see specialists often, or travel between states regularly, Original Medicare with a Medigap policy frequently costs less in total over a year despite higher monthly premiums. Advantage plans have hard out-of-pocket maximums ($9,350 for in-network care in 2026) that Original Medicare lacks — which helps if you have a catastrophic event — but prior authorization delays for specialist care and hospital stays are a documented and growing concern. Get quotes for both, but run the numbers using your actual medication list and typical care use, not just the premium.
Official Resources — Where to Check, Enroll, or Appeal
These are the primary official channels. Confirm costs directly with CMS or Medicare.gov before making coverage decisions.
Rate data in this article is drawn from official CMS sources. Confirmed 2026 figures come from the CMS fact sheet published November 14, 2025 (Medicare Parts A & B Premiums and Deductibles) and SSA’s POMS sliding-scale tables for IRMAA brackets. Projected figures for next year are derived from the 2026 Medicare Trustees Report actuarial estimates; they are not official and are subject to change when CMS makes its annual announcement, typically in November. Drug negotiated prices are sourced from CMS’s published fact sheet on the Medicare Drug Price Negotiation Program second-cycle results. This page does not constitute financial, tax, or legal advice and is not affiliated with CMS, Medicare, or the Social Security Administration. Medicare rules are complex and individual circumstances vary — consult a licensed Medicare counselor, SHIP advisor, or financial advisor for guidance specific to your situation. Key sources: CMS.gov; Medicare.gov; SSA.gov.