Medicare Breakdown

The 2026 numbers

Item	2026 amount
Part B standard monthly premium	$202.90
Part B annual deductible	$283
Part B premium with IRMAA	$284.10 – $689.90
Part A inpatient deductible (per benefit period)	$1,736
Part A premium, 30–39 work quarters	$311
Part A premium, under 30 quarters	$565
Part D maximum deductible	$615
Part D out-of-pocket cap	$2,100
Part D standard coinsurance	25%
Part D national base beneficiary premium	$38.99

Sources: CMS 2026 Parts A & B Premiums and Deductibles and CMS Final CY2026 Part D Redesign Program Instructions.

What Part A costs you

Part A is premium-free for most people, but it is not cost-free. The $1,736 deductible applies per benefit period, not per year — a benefit period ends after 60 consecutive days out of hospital, so a bad year can trigger it more than once.

Beyond day 60 of a stay, daily coinsurance applies, and skilled nursing facility care carries its own daily coinsurance after day 20. Medigap plans cover these; Medicare Advantage plans substitute their own copay structure.

What Part B costs you

After the $283 annual deductible, Original Medicare generally pays 80% of the approved amount and you pay 20% — with no annual maximum. That uncapped 20% is the reason almost everyone adds either a Medigap policy or a Medicare Advantage plan.

Higher earners pay IRMAA on top, based on income from two years earlier, taking the premium from $284.10 to $689.90 a month. If your income has since dropped because of retirement, widowhood, or divorce, you can ask Social Security to use current income via the IRMAA reconsideration process.

The penalties

Penalty	How it's calculated	How long it lasts
Part B late enrollment	10% of the standard premium for each full 12-month period you could have had Part B but didn't	For as long as you have Part B
Part D late enrollment	1% of the national base beneficiary premium for each month you went without creditable drug coverage	For as long as you have Part D

Both are permanent, which is what makes enrollment timing the highest-stakes part of Medicare. Estimate yours with our Part B and Part D penalty tools.

The enrollment calendar

• Initial Enrollment Period — 7 months — the 3 months before your 65th-birthday month, that month, and the 3 months after.
• Annual Enrollment Period — October 15 – December 7.
• Medicare Advantage Open Enrollment — January 1 – March 31.
• General Enrollment Period — January 1 – March 31.
• Medigap Open Enrollment — the 6 months that begin the month you're 65 or older AND enrolled in Part B.

Full detail on Medicare.gov and in our enrollment periods guide.

Programmes that reduce these costs

• Medicare Savings Programs — pay the Part B premium and sometimes deductibles and coinsurance (Medicare.gov).
• Extra Help — removes the Part D premium and deductible and caps copays (Social Security).

Both are underused. New Mexicans apply through the New Mexico Health Care Authority for the first and Social Security for the second, and qualifying for one usually qualifies you for the other.

Not sure which of these fits you? A free 15-minute call with a licensed local advisor sorts it out — no pressure, and no cost to you. We do not offer every plan available in your area. For a complete list of every plan in your county, use Medicare Plan Compare or call 1-800-MEDICARE.

How these numbers change, and what no amount of money covers

Every figure on this page is set annually. CMS publishes Part A and Part B premiums and deductibles each autumn for the following year, and the Part D parameters come out alongside them. The enrollment windows and the penalty formulas are set in statute and change rarely; the dollar amounts change every single year.

That's why we re-check plans each autumn rather than assuming last year's arithmetic still holds — a plan can keep its premium and still cost you more through a formulary or network change.

Some things aren't covered at any price under Medicare:

• Long-term custodial care — the largest gap, covered only by savings, insurance, or Medicaid.
• Routine dental, vision, and hearing care, including dentures, glasses, and hearing aids.
• Most care received outside the United States.
• Cosmetic surgery and most alternative therapies.

Medicare Advantage plans add some dental, vision, and hearing benefits; Medigap adds none of them. Neither touches long-term custodial care.

Where the money actually goes in a typical year

Averages hide the thing that matters, which is variance. Two people on identical coverage can spend very differently.

• A healthy year — premiums, a wellness visit, a couple of generic prescriptions. Cost is essentially the premium.
• A moderate year — a specialist course of treatment, imaging, a brand-name drug. On Original Medicare the uncapped 20% starts to bite; on Advantage you accumulate copays toward the plan maximum.
• A bad year — a hospital admission and a specialty medication. This is where the structure of your coverage decides the outcome: Medigap absorbs almost all of it, an Advantage plan takes you to its out-of-pocket maximum, and Original Medicare alone has no ceiling at all.

Choosing coverage on a healthy year is the most common planning error. The right question is not what you'll spend if nothing happens, but what you'd spend if something did — and whether you could absorb it.

Two people, same coverage, different outcomes

An illustration makes the structure clearer than any table. Take two New Mexicans, both 68, both on Original Medicare with a Plan G supplement and a Part D plan.

The first has a quiet year: a wellness visit, one specialist consult, two generic prescriptions. She pays her Part B premium, her supplement premium, her drug plan premium, and the Part B deductible. Her supplement covers the coinsurance on the specialist visit. Her total exposure beyond premiums is the deductible and a few dollars in copays.

The second is admitted to hospital in February, readmitted in September, and starts a specialty medication. Under Original Medicare alone he would face the Part A deductible twice, uncapped 20% coinsurance on every outpatient service, and drug costs running to the annual cap. With Plan G, the supplement absorbs both Part A deductibles and the Part B coinsurance entirely, and his drug spending stops at the Part D out-of-pocket cap.

Same premiums, wildly different claims — and that gap is precisely what the supplement was bought for. Someone on a Medicare Advantage plan would have seen a third pattern: lower premiums all year, then copays accumulating toward the plan's out-of-pocket maximum. None of the three is wrong; they simply distribute the same risk differently.

Why every number here is sourced

Every figure here is published by CMS or the Social Security Administration, and every one of them is checkable. We link the primary source rather than a summary, because plan-year numbers circulate widely in outdated form and a figure from last year looks identical to one from this year.

If you see a Medicare cost quoted anywhere — including here — and it isn't accompanied by a year and a source, treat it as unverified until you can trace it. The Part B premium, the Part D cap, and the deductibles all change annually, and the enrollment penalties are calculated against whatever the current figure is rather than the one in force when you were late.