Most folks come into our office with the same question: "What is this actually going to cost me?" It's the right question to ask, and the answer has more moving parts than it should. Let me walk you through the real 2026 numbers — premiums, deductibles, the IRMAA surcharges that surprise high-earner retirees, and what the total picture looks like over a year.
No round numbers, no soft language. The figures here are CMS-published for 2026. We verify them every fall when CMS releases the next year's update, and we revise this article each January.
The 60-second budget
For most people, Medicare in 2026 costs the Part B premium of $202.90 per month, a small Part A inpatient deductible if you're hospitalized, plus whatever you choose for Part D drug coverage and supplemental coverage. If your household income is above certain thresholds, you'll pay an IRMAA surcharge on Part B and Part D. If you're on Original Medicare with a Supplement, you'll have a Supplement premium too. If you're on Medicare Advantage, the plan premium is often $0 (Part B will still have a cost), but you'll have copays as you use the plan.
On any "$0 plan premium" — Part B will still have a cost. The $0 refers to the plan's premium, not your total Medicare cost.That's the frame. Now the details.
2026 Part A costs
Part A is hospital insurance. Most people get Part A premium-free because they (or a spouse) worked at least 40 quarters paying Medicare taxes. If you don't qualify on work history, you can buy Part A — the 2026 premium is $311/month if you have 30–39 quarters, $565/month if you have fewer than 30. Most St. Louisans we work with qualify premium-free.
What everyone pays under Part A is the inpatient deductible if they're hospitalized:
- Hospital deductible (2026): $1,736 per benefit period.
- Days 61–90 of a hospital stay: $434 per day coinsurance.
- Days 91+: $868 per day, drawn from your 60 lifetime reserve days.
- Skilled nursing facility days 21–100: $217 per day.
A "benefit period" starts the day you're admitted and ends after 60 consecutive days with no inpatient care. If you get readmitted later in the year for a new event, the deductible can apply again. We've seen this trip people up.
2026 Part B costs
Part B covers doctor visits, outpatient care, durable medical equipment, and most preventive services.
- Standard Part B premium (2026): $202.90/month. (Higher for IRMAA-affected households — see below.)
- Part B deductible (2026): $283/year. You pay this once before Medicare starts paying its share.
- After the deductible, Original Medicare pays 80% of Medicare-approved charges. You're responsible for the remaining 20%, with no out-of-pocket cap unless you have a Medicare Supplement filling that gap.
For someone on Original Medicare without a Supplement, that "no cap" is the part to plan around. Chemotherapy, a long hospital stay, ongoing specialist visits — the 20% adds up fast. This is one of the reasons Supplement insurance exists, and one of the reasons Medicare Advantage plans build in a yearly out-of-pocket maximum.
2026 Part D costs
Part D is your prescription drug coverage. You buy it either as a stand-alone plan (paired with Original Medicare and usually a Supplement) or as part of a Medicare Advantage plan that includes drug coverage.
- Part D plan premiums vary by plan and area. Stand-alone Part D plans in the St. Louis market run from very low to higher depending on the formulary and tier structure.
- Part D deductible (2026): up to $615. Some plans waive the deductible on lower drug tiers.
- The $2,100 annual out-of-pocket cap is in effect for 2026. This is the IRA-mandated cap that ended the old "donut hole" model. The cap was $2,000 in 2025 and is indexed up to $2,100 for 2026. Once you spend $2,100 out-of-pocket on covered Part D drugs in the calendar year, the plan covers 100% of your costs for the rest of the year.
The $2,100 cap is a meaningful change for people with high-cost specialty drugs. We've already seen it shift plan recommendations for clients who used to hit catastrophic coverage in the spring.
What is IRMAA?
IRMAA stands for Income-Related Monthly Adjustment Amount. It's a surcharge that Social Security adds to your Part B and Part D premiums if your income is above certain thresholds.
Two things confuse people about IRMAA:
- It's based on your tax return from two years ago. Your 2026 IRMAA is calculated from your 2024 modified adjusted gross income (MAGI). A recently retired person who had a high-earning final year often hits IRMAA in the first year or two of Medicare even though their current income is much lower.
- It's a cliff, not a curve. Cross the threshold by $1 and you pay the full bracket surcharge — there's no gradual phase-in.
2026 IRMAA brackets
Here are the 2026 brackets.
| 2024 MAGI (single) | 2024 MAGI (joint) | Part B premium | Part D surcharge |
|---|---|---|---|
| ≤ $109,000 | ≤ $218,000 | $202.90 | $0 |
| $109,001 – $137,000 | $218,001 – $274,000 | $284.10 | +$14.50 |
| $137,001 – $171,000 | $274,001 – $342,000 | $405.80 | +$37.50 |
| $171,001 – $205,000 | $342,001 – $410,000 | $527.50 | +$60.40 |
| $205,001 – $500,000 | $410,001 – $750,000 | $649.20 | +$83.30 |
| > $500,000 | > $750,000 | $689.90 | +$91.00 |
Brackets are CMS 2026 figures and are subject to annual update. We re-verify each January.
Two-earner households should remember the brackets apply to combined MAGI. A high-earning spouse can push both partners into a higher bracket.
Appealing IRMAA — when it's worth it
IRMAA can be appealed if you've had a "life-changing event" that meaningfully reduced your income since the tax year IRMAA is based on. Social Security recognizes:
- Marriage, divorce, or death of a spouse
- Stopping or reducing work (retirement)
- Loss of pension income
- Settlement from an employer (e.g., severance) being one-time income
- Loss of income-producing property due to disaster
- Employer-sponsored pension plan losing funding
The form is SSA-44. We help clients put together the documentation when an appeal is worth filing. Recent retirees often get IRMAA reduced on the first year of Medicare because the two-year-old tax return reflects their final working year, not their retirement income.
Worked examples: what a year actually costs
Let me give three honest cost pictures.
Lower-income retiree, Original Medicare + Plan G + Part D
- Part B premium × 12$2,434.80
- Plan G Supplementget a quote
- Part D planvaries
- Part B deductible$283
- Other out-of-pocketvery little
Middle-income retiree, Medicare Advantage with $0 plan premium (Part B will still have a cost)
- Part B premium × 12$2,434.80
- Plan premium$0
- Copays through the yearvariable
- Out-of-pocket maxup to $9,250
- Drug coverageincluded
$215k single MAGI, Original Medicare + Plan G + Part D
- Part B + IRMAA × 12$7,790.40
- Plan G Supplementget a quote
- Part D + IRMAA~+$83.30/mo
- Part B deductible$283
- Bracket$205k–$500k
Across three honest scenarios, the spread is wide. That's why we don't quote "average Medicare costs" — your number depends on your income, your plan structure, and how much care you use.
Get a real quote before you assume
The biggest budgeting mistake we see in our office is people assuming they know what Medicare will cost, based on a friend's experience or a number they saw online. Friends are in different IRMAA brackets, on different plans, in different parts of the country. The number that matters is yours.
We run the real math for the plans available in your county, against your actual prescriptions and doctors. There's no fee, no pressure, no sales pitch — that's the rule of the house. We answer every call.
I've been helping people with Medicare in St. Louis since 2013, and I've sat through every annual CMS update. If something changes mid-year that affects your plan, we'll let you know.
