You're on Medicare, or about to be, and you want a real number for what it costs in a year. Medicare is not free and it does not cover everything — and the biggest thing it leaves out, long-term custodial care, is the one that can reshape a family's finances.
What Medicare costs in 2026
| Cost | 2026 figure |
|---|---|
| Part A premium | $0 if you or your spouse paid Medicare taxes for at least 10 years; otherwise $311 or $565 a month |
| Part A hospital deductible | $1,736 per benefit period (not per year), covering days 1–60 of a stay |
| Part A hospital coinsurance | $434 a day for days 61–90; $868 a day for up to 60 lifetime reserve days; all costs after that |
| Skilled nursing facility, after an inpatient stay of at least 3 days | $0 for days 1–20; $217 a day for days 21–100; all costs after day 100 |
| Part B premium | $202.90 a month (standard) |
| Part B deductible | $283 a year, then you pay 20% of the Medicare-approved amount for most services |
| Part D premium | Set by your plan; the plan deductible is at most $615 |
| Part D out-of-pocket cap | $2,100 a year on covered drugs |
The Part B premium comes out of your Social Security check when you receive one; otherwise Medicare bills you. Original Medicare sets no yearly limit on the 20% coinsurance — that is the gap Medigap policies fill, and the reason the choice in Original Medicare + Medigap vs Medicare Advantage matters.
IRMAA: the higher-income surcharge
IRMAA, the income-related monthly adjustment amount, is added to your Part B and Part D premiums when the modified adjusted gross income on your tax return from two years earlier is above the threshold. For 2026 the test uses your 2024 return: at $109,000 or less on an individual return, or $218,000 or less on a joint return, you pay the standard $202.90; above that, the Part B premium starts at $284.10 and rises in tiers with income. Part D carries its own tiered add-on.
What Original Medicare doesn't cover
| Not covered by Part A or Part B | What it means for you |
|---|---|
| Long-term care | Help with bathing, dressing, eating or supervision — at home, in assisted living or in a nursing home — is not covered |
| Most dental services | Cleanings, fillings, crowns and dentures come out of pocket; the exceptions tie to specific medical treatments such as transplants or cancer care |
| Eye exams for glasses, and eyeglasses | Out of pocket, apart from narrow exceptions after certain surgeries |
| Hearing aids and fitting exams | Out of pocket |
| Routine physical exams, cosmetic surgery, massage therapy, concierge fees | Out of pocket |
Some Medicare Advantage plans add vision, hearing and dental benefits. None of them, and no Medigap policy, covers long-term custodial care.
The biggest gap: long-term custodial care
Medicare pays for skilled care aimed at recovery: after a hospital stay of at least 3 days in a row, Part A covers up to 100 days of skilled nursing facility care per benefit period — days 1–20 at $0 and days 21–100 at $217 a day in 2026. Once the need is ongoing help with daily living rather than skilled treatment, coverage stops. The bill then runs to thousands of dollars a month, paid from savings or long-term-care insurance until (and unless) you meet your state's Medicaid asset and income limits. What elder care actually costs puts numbers on it.