Medicare Costs & IRMAA
Understanding premiums, deductibles, coinsurance, and income-based surcharges (IRMAA) so you can plan your healthcare budget with confidence.
2026 Standard Medicare Costs
These are the baseline costs for Original Medicare (Parts A and B) before any supplemental coverage.
Part A — Hospital Insurance
| Item | Amount | Notes |
|---|---|---|
| Monthly Premium | $0 (most people) | Free if 40+ quarters of Medicare taxes paid; $278 for 30–39 quarters; $505 for fewer than 30 quarters |
| Inpatient Deductible (per benefit period) | $1,736 | Applies each time you begin a new benefit period |
| Days 1–60 Hospital Copay | $0 | After deductible is met |
| Days 61–90 Hospital Copay/day | $434 | Per day for days 61–90 in a benefit period |
| Lifetime Reserve Days (days 91+) | $868/day | 60 lifetime reserve days total |
| Skilled Nursing Facility Days 1–20 | $0 | After qualifying 3-day hospital stay |
| SNF Days 21–100 Copay/day | $217 | Per day; no coverage after day 100 |
Part B — Medical Insurance
| Item | Amount | Notes |
|---|---|---|
| Standard Monthly Premium | $202.90 | Higher-income individuals pay more (see IRMAA below) |
| Annual Deductible | $283 | You pay 100% of costs until you meet this |
| Coinsurance After Deductible | 20% | You pay 20% of Medicare-approved amount |
| Annual Out-of-Pocket Maximum | None (Original Medicare) | No cap — consider Medigap or Medicare Advantage for protection |
| Preventive Services | $0 copay | Annual Wellness Visit, flu shots, colonoscopies, etc. |
Part D — Prescription Drug Coverage (2026)
| Phase | Threshold / Cost | What You Pay |
|---|---|---|
| Annual Deductible (max allowed) | Varies by plan; Maximum $615 (2026) you pay 100% until met | May not be for all services |
| Initial Coverage Phase | After deductible up to $2,100 in total drug costs | Copays or coinsurance per plan tier |
| Catastrophic Coverage (2026) | After $2,100 in true out-of-pocket costs | $0 or small copay for covered drugs |
| 2025 Change | $2,000 annual out-of-pocket cap (new!) | The coverage gap/"donut hole" is eliminated in 2025 |
IRMAA — Income-Related Monthly Adjustment Amount
What is IRMAA?
IRMAA (Income-Related Monthly Adjustment Amount) is an additional surcharge added to your Medicare Part B and Part D premiums if your income exceeds certain thresholds. The Social Security Administration uses your Modified Adjusted Gross Income (MAGI) from 2 years ago to determine if IRMAA applies. For 2026 coverage, SSA uses your 2026 tax return.
If your income has significantly decreased due to a life-changing event (retirement, divorce, death of a spouse), you can request a review using SSA Form SSA-44 to use more recent income information.
2026 IRMAA — Part B Premium Surcharges
Based on 2026 Modified Adjusted Gross Income (MAGI)
| Individual MAGI | Joint MAGI | IRMAA Surcharge | Total Monthly Part B |
|---|---|---|---|
| $109,000 or less | $218,000 or less | No surcharge | $202.90 |
| $109,001 – $137,000 | $218,001 – $274,000 | +$81.20 | $284.10 |
| $137,001 – $171,000 | $274,001 – $342,000 | +$202.90 | $405.80 |
| $171,001 – $205,000 | $342,001 – $410,000 | +$324.60 | $527.50 |
| $205,001 – $500,000 | $410,001 – $750,000 | +$446.30 | $649.20 |
| $500,001 or more | $750,000 or more | +$487.00 | $689.90 |
2026 IRMAA — Part D Premium Surcharges
Added to your Part D plan premium (varies by plan)
| Individual MAGI | Joint MAGI | IRMAA Surcharge Added to Plan Premium |
|---|---|---|
| $109,000 or less | $218,000 or less | No surcharge |
| $109,001 – $137,000 | $218,001 – $274,000 | +$14.50/month |
| $137,001 – $171,000 | $274,001 – $342,000 | +$37.50/month |
| $171,001 – $205,000 | $342,001 – $410,000 | +$60.40/month |
| $205,001 – $500,000 | $410,001 – $750,000 | +$83.30/month |
| $500,001 or more | $750,000 or more | +$91.00/month |
Important IRMAA Planning Note
IRMAA is determined on a per-person basis — each spouse's income is assessed independently. If you have a Roth conversion, large capital gain, or other one-time income event that pushes your MAGI above a threshold, you may face IRMAA for 2 years (the year of the event plus the 2-year lookback). Proactive income planning with a financial advisor can help you manage or avoid IRMAA surcharges.
Real-World Cost Examples
See how Medicare costs play out in different health scenarios.
Scenario 1: Routine Year (Healthy)
Scenario 2: Major Surgery (No Supplement)
A Medigap Plan G would have covered $12,000 + $1,736 of this. See plan comparison.
Want Help Minimizing Your Medicare Costs?
David Marsh can review your income, coverage needs, and medication list to identify the plan combination that minimizes your total annual healthcare costs.