How Much Does Medicare Pay? Your Costs vs. Medicare's Share in 2026

The 80/20 Split: What Medicare Pays for Doctor Visits and Outpatient Care

Medicare Part B covers doctor visits, outpatient services, lab tests, durable medical equipment, and many preventive services. For most of these, here is how the math works in 2026: first you pay the annual Part B deductible of $283. After that, for each covered service Medicare pays 80% of the Medicare-approved amount and you pay the other 20%. That 20% is called coinsurance.

For example, if a covered outpatient service has a Medicare-approved amount of $200, Medicare pays $160 and you pay $40 (assuming you have already met your deductible for the year). The 'Medicare-approved amount' is the figure Medicare sets, which may be less than what a provider would otherwise charge.

Does Medicare ever pay 100%? Yes, but only in specific cases. Many preventive and screening services covered by Part B, such as a yearly wellness visit and certain vaccines and screenings, are covered at no cost to you when you see a provider who accepts assignment. Outside of those, plan on the 80/20 rule for most Part B care.

What You Pay Monthly: Premiums and Deductibles in 2026

Your ongoing Medicare costs start with premiums (your monthly bill to stay enrolled) and deductibles (what you pay before Medicare's share kicks in).

• Part B standard premium: $202.90 per month for most people in 2026. Higher earners pay more (see the IRMAA section below).
• Part B deductible: $283 per year. You pay this once per calendar year before Medicare's 80% share begins.
• Part A premium: $0 per month if you or your spouse paid Medicare taxes for at least 40 quarters (about 10 years) of work. If you have 30-39 quarters, the premium is $311 per month. With fewer than 30 quarters, the full premium is $565 per month.
• Part A deductible: $1,736 per benefit period (not per year). A new benefit period can begin if you are admitted again after being out of a hospital or skilled nursing facility for 60 days in a row, which means you could owe this deductible more than once in a year.

How Much Medicare Pays for a Hospital or Skilled Nursing Stay

Part A inpatient hospital coverage works in day-based stages within each benefit period. After you pay the $1,736 deductible, Medicare's share changes the longer you stay:

• Days 1-60 in the hospital: Medicare pays the full covered cost after your deductible. You pay $0 in daily coinsurance for these days.
• Days 61-90: you pay $434 per day in coinsurance; Medicare pays the rest.
• Beyond day 90: you can tap up to 60 'lifetime reserve days,' for which you pay $868 per day. These are a one-time-use lifetime supply, not refilled each benefit period.
• Skilled nursing facility (SNF) care, when you qualify: Medicare pays the full cost for days 1-20. For days 21-100, you pay $217 per day in coinsurance. After day 100 in a benefit period, you pay all costs.

The Big Catch: Original Medicare Has No Yearly Out-of-Pocket Limit

Here is one of the most important facts about Medicare costs: Original Medicare (Parts A and B) has no annual cap on what you pay out of pocket. Your 20% coinsurance and any hospital coinsurance keep adding up no matter how high your medical bills go in a year.

There are two main ways people protect themselves from this open-ended exposure. A Medigap (Medicare Supplement) policy can pay some or most of the deductibles and coinsurance that Original Medicare leaves to you. Alternatively, a Medicare Advantage (Part C) plan replaces how you get Parts A and B and is required to include a yearly out-of-pocket maximum, after which the plan pays 100% of covered in-network care.

Costs and rules vary widely from plan to plan and by where you live, so compare specific plans carefully before deciding. No single option is best for everyone.

How Much Medicare Pays for Prescription Drugs (Part D)

Prescription drug coverage comes from Part D plans, which are sold by private insurers, so premiums and copays vary by plan. One rule applies across all Part D plans in 2026, though: there is a $2,100 yearly cap on what you pay out of pocket for covered drugs. Once your out-of-pocket spending on covered drugs reaches $2,100 for the year, your plan pays 100% of covered drug costs for the rest of the year.

Part D also has a 'national base beneficiary premium' of $38.99 per month in 2026. This is not necessarily what you pay; it is a benchmark figure Medicare uses to calculate the late enrollment penalty (described below) and the income-related surcharge for higher earners.

Higher-Income Surcharges (IRMAA) and Late Penalties

Two things can raise your Medicare costs above the standard amounts: your income, and signing up late.

IRMAA (Income-Related Monthly Adjustment Amount): If your modified adjusted gross income from your 2024 tax return was above $109,000 (single) or $218,000 (joint), you pay more than the standard premiums in 2026. With IRMAA added, the total Part B premium ranges from $284.10 up to $689.90 per month depending on your income, and a Part D surcharge of $14.50 to $91.00 per month is added on top of your Part D plan premium.

• Part B late enrollment penalty: if you delay Part B without other creditable coverage, your premium goes up 10% for each full 12-month period you were eligible but not enrolled. This penalty is usually permanent, lasting as long as you have Part B.
• Part D late enrollment penalty: 1% of the $38.99 national base premium for each full month you went without creditable drug coverage after your enrollment window, rounded to the nearest $0.10 and added to your premium for life.