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The 2026 Medicare Cost Components
Medicare costs come from four main sources: Part B premiums (the main monthly charge), IRMAA surcharges for higher incomes, supplemental coverage (Medigap or Medicare Advantage), and Part D drug coverage. Understanding each component lets you accurately budget for healthcare in retirement.
Part B Premium: $185.00/Month Standard
The standard 2026 Part B premium is $185.00/month ($2,220/year) per person. This covers doctor visits, outpatient services, and preventive care. It's automatically deducted from your Social Security check if you receive benefits; otherwise paid directly to Medicare. This is the baseline everyone starts from — but higher incomes pay more through IRMAA.
IRMAA: When Income Raises Your Premium
Medicare uses your income from two years prior to determine if you owe IRMAA surcharges. In 2026, surcharges begin at $106,000 MAGI (single) or $212,000 (married filing jointly). The income brackets and monthly costs per person:
| Single Income | Married Income | Part B/mo | Annual / Person |
|---|---|---|---|
| ≤$106,000 | ≤$212,000 | $185.00 | $2,220 |
| $106K–$133K | $212K–$266K | $259.00 | $3,108 |
| $133K–$167K | $266K–$334K | $370.00 | $4,440 |
| $167K–$200K | $334K–$400K | $481.10 | $5,773 |
| >$500K | >$750K | $628.90 | $7,547 |
IRMAA also applies to Part D premiums, adding $13.70–$85.80/month depending on income tier. For a couple where both individuals are at the second IRMAA tier ($259/month Part B each), they pay $6,216/year in Part B alone — vs. $4,440 for the same couple without IRMAA.
Medigap: Filling the Gaps in Original Medicare
Original Medicare pays 80% of approved costs after deductibles. The 20% coinsurance has no annual cap — a $200,000 medical event could leave you with $40,000 in bills. Medigap closes most of these gaps. The two most popular plans in 2026:
- Plan G: Covers everything except the Part B annual deductible ($257). Monthly premiums range from $130 (age 65) to $250+ (age 75+) depending on insurer and state. Total annual cost at 65: approximately $1,800–$2,500/year in premiums + $257 deductible = ~$2,000–$2,800/year for essentially unlimited coverage.
- Plan N: Similar to Plan G but you pay $20 copay for doctor visits and $50 for ER visits. Lower premium — roughly $100–$180/month. Better value if you have few doctor visits; similar to Plan G if you use it frequently.
Medigap premiums increase with age. A Plan G that costs $160/month at 65 may cost $240/month at 75 with the same insurer. Shopping plans annually (after the guaranteed issue period) can save money.
Part D: Drug Coverage
Part D average premium is $55–$65/month in 2026. The annual deductible is $590. Since 2025, out-of-pocket drug costs are capped at $2,000/year under the Inflation Reduction Act — a major improvement. Higher-income beneficiaries pay IRMAA surcharges on Part D as well (adding $13.70–$85.80/month).
Total Annual Medicare Costs: Real Examples
| Scenario | Annual Premium Cost |
|---|---|
| Standard income, Medicare Advantage ($0 premium) + standard Part D | $840–$1,860 |
| Standard income, Original Medicare + Medigap Plan N + standard Part D | $3,600–$5,000 |
| Standard income, Original Medicare + Medigap Plan G + standard Part D | $4,200–$6,000 |
| IRMAA Tier 2 ($133K–$167K single), Plan G + standard Part D | $6,700–$8,200 |
| IRMAA Tier 4 ($200K–$500K single), Plan G + standard Part D | $10,500–$12,000 |
Out-of-pocket costs add $1,000–$4,000/year on top of premiums for doctor visits, dental, vision, and prescriptions beyond the formulary. For a couple, multiply individual estimates by two.
To fund these Medicare costs tax-efficiently, your HSA balance can cover all Medicare premiums tax-free after age 65. See using your HSA as a retirement account for the strategy. For a full Medicare primer, read what is Medicare.
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Frequently Asked Questions
How much does Medicare cost per month in 2026?
Standard Part B: $185.00/month. Medigap Plan G adds $130–$250+/month. Part D adds $15–$100/month. Total for standard-income person on Original Medicare + Plan G + Part D: approximately $330–$540/month in premiums. Medicare Advantage with $0 premium: just the standard $185 Part B + Part D.
What is IRMAA?
IRMAA adds to standard Part B and Part D premiums for incomes above $106,000 (single) or $212,000 (married). Based on income from 2 years prior. Ranges from +$74/month to +$443.90/month for Part B, plus additional Part D surcharges. Can be appealed if income dropped due to a qualifying life event like retirement.
How much does Medicare cost for a couple per year?
A couple both on standard-income Original Medicare + Medigap Plan N + standard Part D typically pays $7,200–$10,000/year combined in premiums. With Plan G: $8,400–$12,000/year. Higher-income couples with IRMAA surcharges can pay $20,000+/year in premiums alone.
How can I reduce my Medicare costs?
Strategies: (1) Keep 2-years-prior income below IRMAA thresholds — use Roth withdrawals (not counted as MAGI) in high-income years. (2) Appeal IRMAA if retired and income dropped (Form SSA-44). (3) Compare Medigap vs. Medicare Advantage based on your expected healthcare use. (4) Use HSA funds for Medicare premiums tax-free. (5) Shop Part D plans annually during open enrollment (Oct 15–Dec 7).
Can HSA funds pay for Medicare?
Yes. After age 65, HSA withdrawals are tax-free for Medicare Part B, Part D, and Medigap premiums. Medicare Advantage premiums also qualify. This makes HSA funds one of the most efficient ways to fund Medicare costs — they go in pre-tax and come out tax-free for healthcare in retirement.