Medicare Parts A, B, C and D
Part A covers hospital stays, Part B covers doctors and outpatient care, Part C is a private plan that replaces both, and Part D covers prescription drugs. Parts A and B together are called Original Medicare, run by the federal government. Parts C and D are sold by private insurers under Medicare’s rules (Medicare & You).
What each part of Medicare does
Source: Medicare & You 2027 (CMS); CMS 2026 Parts A and B fact sheet; Medicare.gov drug coverage costs
Key facts
- The standard Part B premium is $202.90 a month in 2026, up 9.7% from $185.00 in 2025 (CMS).
- Part D out-of-pocket drug costs are capped at $2,100 in 2026 and $2,400 in 2027 (Medicare.gov).
- 55% of people with Parts A and B were in Medicare Advantage in 2026, up from 19% in 2007 (KFF).
- Original Medicare does not cover most dental care, hearing aids, routine eye exams or long-term custodial care (Medicare & You).
Who Qualifies for Medicare
You qualify for Medicare at 65, or earlier if you have received Social Security disability benefits for 24 months, have end-stage renal disease, or have ALS. Income does not matter. That is the main difference from Medicaid, which is based on income (Medicare & You).
- Age 65. If you already get Social Security or Railroad Retirement benefits, you are enrolled in Parts A and B automatically starting the first day of the month you turn 65. If not, you sign up yourself.
- Disability. You are enrolled automatically after 24 months of Social Security disability benefits.
- ALS. Coverage starts automatically the month your disability benefits begin, with no 24-month wait.
- End-stage renal disease. People with permanent kidney failure who need dialysis or a transplant must sign up; the dialysis facility helps with the paperwork.
Status rules changed. Medicare now requires that you be a U.S. citizen or national, a lawful permanent resident, a Cuban-Haitian entrant, or a Compact of Free Association migrant living here lawfully to get Parts A and B or join a Medicare plan (Medicare & You).
Premium-free Part A goes to people who worked and paid Medicare taxes for at least 40 quarters, about 10 years, or whose spouse did. Others can buy it for $311 or $565 a month in 2026, depending on how long they worked (CMS).
How Much Medicare Costs in 2026
Most people pay nothing for Part A and $202.90 a month for Part B, which comes to $2,434.80 a year. Drug and Advantage plans add their own premiums, which vary by plan and county (CMS).
- $202.90
- Standard Part B premium, per month
- $283
- Part B yearly deductible
- $1,736
- Part A hospital deductible, per benefit period
- $2,100
- Most you pay for covered drugs in a year
Hospital stays have more costs after the deductible. In 2026 you pay $434 a day for days 61 to 90 of a hospital stay, and $217 a day for days 21 to 100 in a skilled nursing facility.
Higher earners pay more for Part B. Medicare uses the income on your tax return from two years earlier, so 2026 premiums depend on 2024 income. The surcharge starts above $109,000 for a single filer and $218,000 for a married couple filing jointly.
Monthly Part B premium by income, single filers, 2026
Source: CMS, 2026 Medicare Parts A and B Premiums and Deductibles, November 14, 2025
If your income has dropped since then, for example because you retired, you can ask Social Security to use your newer income.
When and How to Sign Up
Your first chance is a 7-month window around your 65th birthday: the 3 months before, the month of, and the 3 months after. Missing it can mean a gap in coverage and a Part B penalty that lasts as long as you have Part B (Medicare & You). You sign up for Parts A and B through Social Security.
Medicare enrollment windows
- 3 months before 65 to 3 after Initial Enrollment Period Your first chance to sign up for Parts A and B, and to pick a drug or Advantage plan.
- While working, and 8 months after Special Enrollment Period If you or your spouse have job-based coverage, you can wait, then sign up without a penalty in the 8 months after the job or the coverage ends, whichever comes first.
- January 1 to March 31 General Enrollment Period If you missed your first window and have no special period, you can sign up for Part B now. Coverage starts the next month, and a penalty may apply.
- October 15 to December 7 Open Enrollment Everyone on Medicare can switch between Original Medicare and Advantage or change drug plans. Changes start January 1.
- January 1 to March 31 Advantage Open Enrollment If you are in an Advantage plan, you can switch to another one or go back to Original Medicare.
Source: Medicare & You 2027 (CMS). COBRA and retiree coverage do not count as job-based coverage for the special period.
The late penalties add up. Your Part B premium rises 10% for each full 12 months you could have had Part B but did not, for as long as you have it. The Part D penalty adds 1% of the national base premium ($38.99 in 2026) for each month without drug coverage, so 24 months without coverage adds about $9.40 a month for as long as you have Medicare drug coverage (Medicare.gov).
What to Do in Your Situation
Medicare decisions, by situation
Open the one closest to yours. For free one-on-one help, call your State Health Insurance Assistance Program (SHIP) or 1-800-MEDICARE.
I am turning 65 and still working
- Ask your employer's benefits office whether your plan is based on current work and how it works with Medicare.
- If you have job-based coverage, you can usually delay Part B without a penalty and sign up in the 8 months after the job or the coverage ends, whichever comes first.
- Most people still take premium-free Part A at 65.
- COBRA and retiree plans do not protect you from the Part B penalty. Sign up when your job-based coverage ends, not when COBRA ends.
I am choosing between Advantage and Original Medicare
- List your doctors, hospitals and prescriptions, and check each plan's network and drug list on Medicare Plan Finder.
- Compare the yearly out-of-pocket limit in Advantage plans with the cost of a Medigap policy plus a drug plan.
- Ask whether the plan requires prior approval for care you expect to need.
- Know that the best time to buy a Medigap policy is your 6-month Medigap Open Enrollment Period after you get Part B at 65 or older. Later, you may not be able to buy one, or it may cost more.
I have a low income
- Apply at your state Medicaid office for a Medicare Savings Program, which can pay your Part B premium and sometimes your copays.
- Three of the four programs (QMB, SLMB and QI) also qualify you automatically for Extra Help with drug costs.
- Apply even if you are not sure you qualify. Income and asset limits vary by state.
My drug costs are high
- Covered drug costs are capped at $2,100 in 2026. After that you pay nothing for covered drugs for the rest of the year.
- Ask your plan about the Medicare Prescription Payment Plan, which spreads your costs across the year. It does not lower your total costs.
- Covered insulin costs no more than $35 a month.
- Check each fall whether your drugs are still on your plan's list for next year.
Medicare Advantage vs. Original Medicare
Medicare Advantage bundles your coverage into one private plan with a network and a yearly spending limit, while Original Medicare lets you see any doctor who takes Medicare but has no limit unless you add supplemental coverage. Neither is cheaper for everyone; the answer depends on your health, your doctors and where you live (Medicare & You).
Original Medicare and Medicare Advantage side by side
Source: Medicare & You 2027 (CMS), At a Glance comparison
| Category | Value |
|---|---|
| 2007 | 19% |
| 2026 | 55% |
| 2034 (CBO projection, all beneficiaries) | 63% |
Source: KFF, Medicare Advantage in 2026, June 5, 2026 (35.2 million of 64.2 million people with Parts A and B). The 2034 figure is a Congressional Budget Office projection cited by KFF, and it counts all Medicare beneficiaries, not only those with Parts A and B.
What Medicare Does Not Cover
Original Medicare does not pay for most dental care, hearing aids, routine eye exams for glasses, or long-term custodial care such as help bathing and dressing in a nursing home or assisted living (Medicare & You).
- Dental. No routine cleanings, fillings, extractions or dentures. Medicare pays only for dental work tied to certain covered care, such as a heart valve repair or replacement, an organ transplant, cancer treatment or dialysis.
- Hearing aids. Neither the aids nor the exams to fit them.
- Long-term care. Medicare covers skilled nursing for a limited time after a hospital stay, not ongoing personal care. Medicaid covers long-term nursing home care for people who qualify.
- Routine physicals. Medicare covers a yearly wellness visit and many screenings, but not a traditional head-to-toe physical.
Many Advantage plans add some dental, vision and hearing benefits, but the coverage varies widely, so check the plan’s details before counting on it.
Drug Price Changes in 2025, 2026 and 2027
Medicare now caps what you pay for covered drugs and negotiates prices for some of the most expensive ones. The cap started at $2,000 in 2025, is $2,100 in 2026 and rises to $2,400 in 2027 (CMS; Medicare & You). The maximum Part D deductible is $615 in 2026 and $700 in 2027.
The first 10 negotiated prices took effect January 1, 2026. CMS estimated they would have saved 22% of net spending, about $6 billion, had they applied in 2023, and would save enrollees about $1.5 billion out of pocket in 2026 (CMS).
| Category | Value |
|---|---|
| Januvia | 79% |
| Fiasp and NovoLog insulins | 76% |
| Farxiga | 68% |
| Enbrel | 67% |
| Jardiance | 66% |
| Stelara | 66% |
| Xarelto | 62% |
| Eliquis | 56% |
| Entresto | 53% |
| Imbruvica | 38% |
Source: CMS, Medicare Drug Price Negotiation Program, negotiated prices for 2026 (August 15, 2024). 30-day supply; percentages derived from CMS's list and negotiated prices and checked against CMS's published discounts.
These are discounts on what plans pay, not what you pay at the counter. Your cost depends on your plan’s copay or coinsurance, though lower prices can lower coinsurance and help you reach the cap more slowly.
Medicare drug cost changes
As of October 14, 2026
- Out-of-pocket drug cap ($2,100 in 2026) Law
Rises to $2,400 in 2027 under the annual adjustment. (source)
- First 10 negotiated drug prices Law
In effect since January 1, 2026. (source)
- 15 more negotiated drugs Agency action
Prices announced November 25, 2025, a 44% net savings ($12 billion) by CMS's estimate; they take effect January 1, 2027. (source)
- GLP-1 Bridge for weight loss drugs Agency action
Since July 1, 2026, eligible Part D enrollees can get certain GLP-1 drugs for a $50 monthly copay. (source)
Source: CMS; Medicare & You 2027
Medicare and Medicaid Together
People who qualify for Medicare and also meet their state’s Medicaid income and asset limits can have both, and are called dual eligibles. Medicaid then helps with Medicare premiums and cost sharing and pays for care Medicare leaves out, like long-term care. Our Medicaid explainer covers who qualifies, and our Texas Medicaid guide lists the Texas limits.
Even if your income is too high for full Medicaid, a state Medicare Savings Program may pay your Part B premium. There are four: the Qualified Medicare Beneficiary program also bars providers from billing you for Medicare deductibles and copays, and anyone in the first three automatically qualifies for Extra Help with drugs. In 2027, Extra Help limits most generic drugs to $5.80 and brand-name drugs to $14.40 per fill (Medicare & You).
How Medicare Grew
Medicare began in 1965 as hospital and medical insurance for older Americans and has grown by adding people and benefits. Disability and kidney failure coverage came in 1972. A 2003 law renamed the private plans Medicare Advantage and created the Part D drug benefit, which started in 2006 (CMS).
- Medicare signed into law Parts A and B, signed July 30 (source)
- Disability and kidney failure added Coverage extended under 65 (source)
- Medicare Advantage named, Part D created Medicare Modernization Act (source)
- Part D drug benefit begins
- Drug costs capped $2,000 out of pocket for Part D (source)
- First negotiated prices 10 drugs, January 1 (source)
- 15 more negotiated drugs Cap rises to $2,400 (source)
Medicare, 1965 to 2027: 1965: Medicare signed into law (Parts A and B, signed July 30). 1972: Disability and kidney failure added (Coverage extended under 65). 2003: Medicare Advantage named, Part D created (Medicare Modernization Act). 2006: Part D drug benefit begins. 2025: Drug costs capped ($2,000 out of pocket for Part D). 2026: First negotiated prices (10 drugs, January 1). 2027: 15 more negotiated drugs (Cap rises to $2,400).
For how Medicare premiums interact with your Social Security check, see our Social Security explainer.
Common Questions
Who qualifies for Medicare?
People 65 and older, people under 65 who have received Social Security disability benefits for 24 months, and people with end-stage renal disease or ALS. People with ALS get Medicare the month their disability benefits begin. You must also be a U.S. citizen or national, a green card holder, or in one of a few other lawful groups.
What is the difference between Medicare Part C and Part D?
Part C, also called Medicare Advantage, is a private plan that replaces Original Medicare for your hospital and doctor coverage and usually includes drug coverage. Part D is drug coverage only, bought as a separate plan if you keep Original Medicare, or built into most Advantage plans.
Does Medicare cover dental?
Original Medicare does not cover most dental care, including cleanings, fillings, extractions and dentures. It pays only for dental work tied to certain covered treatments, such as a heart valve repair or replacement, an organ transplant, cancer treatment or dialysis. Many Medicare Advantage plans offer some dental coverage, and Medicaid may cover it for people on both programs.
How much does Medicare cost in 2026?
Most people pay no premium for Part A. The standard Part B premium is $202.90 a month, with a $283 deductible, and higher-income people pay more. Part D and Advantage premiums vary by plan, and Part D out-of-pocket drug costs are capped at $2,100 in 2026.
Who is eligible for both Medicare and Medicaid?
People who qualify for Medicare by age or disability and who also meet their state’s Medicaid income and asset limits. They are called dual eligibles. Medicaid then helps pay Medicare premiums and cost sharing and covers some care Medicare does not, like long-term care, and they qualify automatically for Extra Help with drug costs.
When is Medicare open enrollment?
October 15 to December 7 each year. During that window you can switch between Original Medicare and Medicare Advantage or change drug plans, and changes start January 1. People in Advantage plans get a second chance to switch from January 1 to March 31.
What You Can Do
- Mark your window. Put your Initial Enrollment Period on the calendar 3 months before you turn 65.
- Compare plans every fall. Plans change drug lists and costs each year. Use Medicare Plan Finder between October 15 and December 7.
- Get free counseling. Your State Health Insurance Assistance Program gives unbiased help at no cost; call 1-800-MEDICARE to find yours.
- Apply for help if money is tight. Ask your state Medicaid office about Medicare Savings Programs and Extra Help.
- Tell Congress what matters to you. Medicare’s drug negotiation, premiums and coverage gaps are set by law. Our letter-writing guide shows how to make your message count.