Medicare Costs in 2026: What You'll Actually Pay

If you're approaching 65 or already enrolled in Medicare, you've probably noticed that healthcare costs don't stand still. Each year, the Centers for Medicare & Medicaid Services (CMS) announces new premiums and deductibles, and 2026 brings several changes you need to know about.

The good news? Understanding exactly what you'll pay and why can help you plan ahead and potentially reduce your costs. The challenge? Medicare pricing isn't one-size-fits-all, especially when your income affects what you owe.

Let's break down the 2026 Medicare costs, explain how the income-related adjustments work, and give you practical strategies to manage these expenses in retirement.

Medicare Part B covers doctor visits, outpatient care, medical equipment, and preventive services. For 2026, most beneficiaries will pay a standard monthly premium of $185, which represents an increase from the 2025 premium of $174.70.

Additionally, you'll face an annual deductible of $257 before Medicare begins covering its share of Part B services. This is up from $240 in 2025. Once you've met this deductible, you typically pay 20% of the Medicare-approved amount for most services.

Here's what this looks like in real numbers:

• Monthly premium: $185 (for standard enrollees)
• Annual premium cost: $2,220
• Annual deductible: $257
• Total baseline cost before services: $2,477 per year

Keep in mind, this is just for Part B. You'll also need to budget for Part A (usually premium-free if you or your spouse paid Medicare taxes for 10+ years), Part D prescription drug coverage, and potentially a Medigap or Medicare Advantage plan.

Here's where Medicare costs get more complicated. If your modified adjusted gross income (MAGI) exceeds certain thresholds, you'll pay an Income-Related Monthly Adjustment Amount (IRMAA) on top of the standard premium.

IRMAA affects both Part B and Part D premiums, but we'll focus on Part B here. The Social Security Administration determines your IRMAA based on the income reported on your tax return from two years prior. For 2026 Medicare premiums, they'll look at your 2024 tax return.

This catches many retirees off guard. You might be living on a modest fixed income in 2026, but if you had a high-income year in 2024 (perhaps from selling a business, taking a large IRA distribution, or realizing significant capital gains), you'll pay more for Medicare.

The IRMAA brackets for 2026 are adjusted annually for inflation. Here's what beneficiaries can expect to pay based on their 2024 income:

For Individual Tax Filers:

• Income up to $106,000: Standard premium of $185/month
• Income $106,001 to $133,000: $259/month ($74 IRMAA)
• Income $133,001 to $167,000: $370/month ($185 IRMAA)
• Income $167,001 to $200,000: $481/month ($296 IRMAA)
• Income $200,001 to $500,000: $592/month ($407 IRMAA)
• Income above $500,000: $629/month ($444 IRMAA)

For Joint Tax Filers:

• Income up to $212,000: Standard premium of $185/month
• Income $212,001 to $266,000: $259/month ($74 IRMAA)
• Income $266,001 to $334,000: $370/month ($185 IRMAA)
• Income $334,001 to $400,000: $481/month ($296 IRMAA)
• Income $400,001 to $750,000: $592/month ($407 IRMAA)
• Income above $750,000: $629/month ($444 IRMAA)

As you can see, high earners in the top bracket pay more than three times the standard premium. A couple filing jointly with income over $750,000 would pay $1,258 monthly ($629 each) just for Part B coverage.

While you can't avoid Medicare costs entirely, several strategies can help you minimize what you pay, especially if you're concerned about IRMAA.

1. Plan Major Income Events Strategically

If you're planning to sell a business, convert a traditional IRA to a Roth, or take a large distribution, consider the timing carefully. Spreading these events across multiple years rather than concentrating them in one year can help you avoid jumping into higher IRMAA brackets.

2. Appeal Your IRMAA Determination

If you've experienced a life-changing event that reduced your income (retirement, loss of spouse, divorce, loss of income-producing property), you can request a redetermination. File Form SSA-44 with the Social Security Administration to have them consider your current income rather than what you earned two years ago.

Qualifying life-changing events include:

• Work stoppage or reduction
• Loss of income-producing property due to disaster or other event
• Loss of pension income
• Employer settlement payment received due to closure or bankruptcy

3. Consider Qualified Charitable Distributions (QCDs)

If you're 70½ or older, you can donate up to $105,000 annually (as of 2024, indexed for inflation) directly from your IRA to charity. This counts toward your Required Minimum Distribution but doesn't increase your MAGI, helping you avoid or reduce IRMAA.

4. Manage Your Investment Income

Capital gains, dividends, and interest all count toward your MAGI. Work with a tax professional to harvest losses strategically, consider tax-efficient investments, and time the realization of gains to smooth out your income over multiple years.

5. Explore Medicare Savings Programs

If you have limited income and resources, you might qualify for Medicare Savings Programs (MSPs) that help pay Medicare premiums, deductibles, and coinsurance. Eligibility varies by state, but these programs can provide significant relief for those who qualify.

IRMAA doesn't just affect Part B. If you're subject to IRMAA, you'll also pay higher premiums for Medicare Part D prescription drug coverage. The same income brackets apply, with additional monthly charges ranging from $12.90 to $81 per month in 2026, depending on your income level.

This means a high-income beneficiary could pay the standard Part D premium (which varies by plan) plus the IRMAA surcharge. Combined with Part B IRMAA, the total impact on your budget can be substantial.

When planning your retirement healthcare budget for 2026, remember that Medicare Part B premiums are just one piece of the puzzle. A comprehensive Medicare budget should include:

• Part B premium: $185-$629/month depending on income
• Part B deductible: $257 annually
• Part D premium: Varies by plan, plus potential IRMAA
• Medigap premium: If you choose supplemental coverage (varies widely by plan and location)
• Out-of-pocket costs: 20% coinsurance for most Part B services after deductible

Alternatively, if you choose Medicare Advantage instead of Original Medicare plus Medigap, you'll pay the Part B premium plus your plan's monthly premium (sometimes $0), but with different out-of-pocket maximums and network restrictions.

Fidelity estimates that a 65-year-old couple retiring in 2024 will need approximately $315,000 to cover healthcare costs throughout retirement. With Medicare costs rising annually, planning for these expenses is critical to maintaining your financial security.

If you're new to Medicare in 2026, remember these key dates:

• Initial Enrollment Period: 7-month window around your 65th birthday (3 months before, your birthday month, and 3 months after)
• General Enrollment Period: January 1 - March 31 each year (if you missed your initial enrollment)
• Annual Enrollment Period: October 15 - December 7 each year (to make changes for the following year)

Most people have their Part B premiums deducted directly from their Social Security checks. If you're not yet receiving Social Security, you'll receive a bill from Medicare quarterly.

Important note: If you're still working at 65 and have creditable coverage through your employer (generally companies with 20+ employees), you may be able to delay Medicare enrollment without penalty. However, the rules are complex, so consult with your HR department or a Medicare counselor before making this decision.

Disclaimer: This article is for informational purposes only and does not constitute financial or medical advice. fidser. is not a certified financial planning firm. Medicare rules are complex and individual circumstances vary. Always consult with a licensed financial advisor, tax professional, or Medicare counselor before making decisions about your healthcare coverage and retirement planning.

Understanding your Medicare costs for 2026 helps you budget accurately and avoid surprises. Whether you're paying the standard premium or navigating IRMAA surcharges, knowing what to expect puts you in control of your retirement healthcare expenses. The key is planning ahead, understanding how your income affects your premiums, and taking advantage of strategies to minimize costs where possible.