One of the biggest surprises about turning 65 is that Medicare is not free. Most people pay nothing for Part A, but Part B, drug coverage, and supplemental plans all carry costs, and higher earners pay more. Because there is no single āwhat Medicare costsā number, this guide breaks down each piece so you can estimate your own total. All figures reset every January, so verify current amounts before relying on them.
The Short Answer
Most people pay $0 for Part A if they or a spouse worked about ten years. The main recurring cost is Part B, about $202.90 a month in 2026, plus a $283 annual deductible. On top of that, most people add a drug plan and either a Medigap policy or a Medicare Advantage plan, so total monthly cost varies widely.
Part A: Usually Free
Part A, hospital insurance, is premium-free for about 99% of beneficiaries, meaning those who or whose spouse paid Medicare taxes for roughly ten years. If you have fewer than ten years of work, you may pay a monthly premium. Part A does carry an inpatient deductible, about $1,736 per benefit period in 2026, and it is per benefit period, not per year, so two separate hospital stays could mean paying it twice.
Part B: The Main Monthly Cost
Part B, medical insurance, has a standard premium of about $202.90 a month in 2026 and an annual deductible of about $283. After the deductible, you generally pay 20% coinsurance for most services, and, importantly, Original Medicare has no annual out-of-pocket cap. That uncapped 20% is a major reason people add a Medigap policy or choose Medicare Advantage.
Part D and the IRMAA Surcharge
Part D drug plan premiums vary by plan, with no single national figure. Higher earners pay an income-based surcharge called IRMAA on both Part B and Part D, based on the tax return from two years earlier. For 2026, IRMAA begins above about $109,000 for a single filer or $218,000 for a couple, and it rises in tiers. IRMAA is a cliff, not a gradual phase-in, so a single dollar over a threshold moves you into the next tier.
Medigap vs Medicare Advantage
Here you choose between two paths. Original Medicare plus Part D plus a Medigap policy means higher, predictable monthly premiums but low and known costs when you get care, with access to any Medicare provider. Medicare Advantage often has a low or $0 plan premium, though you still pay the Part B premium, in exchange for network restrictions and copays capped by an annual out-of-pocket maximum. Neither is universally cheaper; it depends on your health and preferences.
A Rough Monthly Estimate
A common baseline is the Part B premium of about $202.90, plus a Part D premium, plus either a Medigap premium or Medicare Advantage copays. There is no single correct number, which is exactly why comparing plans matters.
How to Plan and Avoid Penalties
Enroll during your 7-month Initial Enrollment Period around your 65th birthday to avoid lifelong late-enrollment penalties on Part B and Part D. Use the Medicare Plan Finder to compare drug, Advantage, and Medigap options. And if a life change like retirement lowered your income, you can appeal an IRMAA surcharge using the appropriate Social Security form.
Breaking Down the Costs by Part
Medicareās cost at 65 comes from several parts. Understanding each helps you budget.
Part A is premium-free for most people but has hospital deductibles. Part B has a monthly premium and an annual deductible. Part D, for drugs, has its own premium. And Medicare Advantage or Medigap plans have separate premiums. Together these make up your total cost.
Ways to Lower Your Costs
You have some control over what you pay. A few choices make a difference.
Compare plans each year during open enrollment, since costs change. Consider whether Medigap or Medicare Advantage fits your needs and budget. Review your Part D plan against the drugs you take. Shopping carefully can save real money over the year.
Help for Lower Incomes
If Medicare costs strain your budget, help exists. Several programs lower what you pay.
Medicare Savings Programs can cover premiums and other costs for people with limited income. The Extra Help program lowers drug costs. Medicaid may help if your income is low enough. It is worth applying, since many who qualify never sign up.
Medicare Cost FAQs
Is Part A really free?
It is premium-free if you or your spouse have about ten years of Medicare-taxed work.
What will Part B cost in 2026?
About $202.90 a month for most people, and more if you are a higher earner.
What is IRMAA?
An income-based surcharge on Parts B and D for higher earners, based on your income from two years earlier.
Is there a cap on what I pay?
Not under Original Medicare. Medicare Advantage plans have an annual out-of-pocket maximum.
Do I have to buy Part D?
It is not required, but skipping it without other creditable drug coverage risks a lifelong late penalty.
Is Medigap or Advantage cheaper?
Advantage usually has lower premiums, while Medigap has higher premiums but more predictable costs and provider freedom.
