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Medicare is not free. That surprises a lot of people who have paid Medicare taxes their whole working lives and assume 65 means zero health bills. It does not. You will pay premiums, a deductible, and cost sharing, and the total depends on which parts you take and how much income you have.
Here is what each piece costs for 2026, using the official figures the Centers for Medicare and Medicaid Services released last fall.
Part A: usually $0
Part A covers hospital stays, skilled nursing facilities, hospice, and some home health care. If you or your spouse worked and paid Medicare taxes for at least 10 years (40 quarters), your Part A premium is $0. Almost everyone qualifies. If you do not have enough work credits, you can buy Part A, and it is expensive, which is one more reason to check your earnings record before you turn 65.
Part B: $202.90 a month, standard
Part B covers doctor visits, outpatient care, preventive services, and medical equipment. The standard premium for 2026 is $202.90 a month, up from $185 in 2025. Part B also has a $283 annual deductible. After you meet the deductible, you typically pay 20 percent coinsurance on covered services.
Most people pay the standard amount. But if your income is above a set threshold, you pay more. The surcharge is called IRMAA, and it is based on your tax return from two years earlier. For 2026, Medicare looks at your 2024 income. Single filers with income over $109,000 and joint filers over $218,000 pay an extra $81.20 to $487 a month on top of the standard premium, depending on the bracket. At the top tier, the Part B premium reaches $689.90 a month.
If your income dropped since that tax year, because you retired, for example, you can file an appeal with Social Security and ask for the surcharge to be recalculated.
Part D: depends on the plan
Part D is prescription drug coverage, sold by private insurers. Premiums vary by plan and by state. In 2026, plans can charge a deductible of up to $615, and there is a hard cap on what you pay for covered drugs: $2,100 for the year. Once your out-of-pocket spending on covered drugs hits that cap, you pay $0 for the rest of the year.
One rule worth knowing: insulin is capped at $35 a month under Part D, in every coverage phase, no deductible required first.
Medigap or Medicare Advantage: the extra layer
Original Medicare leaves you with 20 percent coinsurance and no out-of-pocket maximum. That is why most people add one more piece.
A Medigap supplement plan fills in the gaps of Original Medicare. Premiums vary a lot by plan letter, your age, and your zip code, and you pay it on top of your Part B premium. In exchange, plans like G and N cover most or all of the deductible and coinsurance, so your medical costs become predictable.
A Medicare Advantage plan (Part C) replaces Original Medicare with a private plan. Many Advantage plans charge a $0 premium beyond what you already pay for Part B, but they come with copays, networks, and an annual out-of-pocket maximum set by the plan.
Putting it together
A typical 65-year-old with average income on Original Medicare plus a supplement and a drug plan might pay the $202.90 Part B premium, a Medigap premium, and a Part D premium each month, plus the $283 Part B deductible over the year. Someone on a $0-premium Advantage plan pays the Part B premium plus copays as they use care, with the plan’s out-of-pocket maximum as the worst case.
Neither setup is automatically cheaper. The right one depends on how much care you use, which doctors you want to keep, and how much uncertainty you can afford. If you want a walkthrough of what each part covers before you price anything, start with Medicare Parts A, B, C, and D explained.
