Medicare Costs Breakdown

IRMAA, the Income-Related Monthly Adjustment Amount, is a surcharge added to your Part B and Part D premiums when your income is above certain thresholds. It's based on your modified adjusted gross income from the tax return two years prior — so 2026 surcharges look at 2024 income. Most people don't pay it. If your income recently dropped because of retirement or another life event, you can ask Social Security to reconsider. We can estimate whether IRMAA is likely to apply to you. (Verify current figures on Medicare.gov.)

It varies by person. Part A is usually $0 if you earned premium-free coverage. Part B has a standard monthly premium set each year, plus an IRMAA surcharge for higher incomes. Then any plan you add — Part D, a Medicare Supplement, or a Medicare Advantage plan — has its own premium, though some Advantage plans charge $0. So your monthly total is the Part B premium plus your chosen coverage. We map your specific numbers before you enroll. (Verify current figures on Medicare.gov.)

For 2026, Part D limits what you pay out of pocket for covered prescription drugs to roughly $2,100 per year. Once you hit that ceiling, covered drugs cost you $0 for the rest of the year, and the old "donut hole" coverage gap no longer applies. It's significant protection for anyone on costly medications, turning an open-ended drug bill into a predictable maximum. We factor this cap in when comparing the drug coverage in the plans we offer. (CMS PY2026; verify current figures on Medicare.gov.)

The 2026 standard Part D deductible is $615 — the amount you pay yourself before the plan begins sharing your drug costs. Some plans set it lower, often around $300 to $350, or waive it on certain drug tiers. After you meet the deductible, you pay a share of costs until your out-of-pocket spending reaches the roughly $2,100 cap, then covered drugs are $0 for the rest of the year. We compare deductibles across the plans we offer. (CMS PY2026; verify current figures on Medicare.gov.)

No. Most people pay the standard Part B premium, but higher earners pay more through the IRMAA surcharge, which is based on income from two years prior. A smaller group with limited income may pay less or nothing through a Medicare Savings Program. So the same "standard" premium isn't universal — it's the baseline, adjusted up for high incomes and potentially down for those who qualify for assistance. We can help estimate which applies to you. (Verify current figures on Medicare.gov.)

A premium is what you pay monthly just to have coverage, whether or not you use care. A deductible is what you pay yourself before the plan starts paying — for example, a Part B or drug deductible each year. A copay (or coinsurance) is your share each time you actually get a service or fill a prescription. Medicare Advantage plans also add a yearly out-of-pocket maximum that caps total copays. Together these four numbers determine your real annual cost, not premium alone.

No. A $0 plan premium means there's no extra monthly premium beyond the Part B premium you already pay — but you can still owe copays, a drug deductible, and costs up to the plan's annual out-of-pocket maximum. Two $0 plans can differ by thousands of dollars in real-world cost depending on your health and prescriptions. With 22 plans in Minnehaha County and 28 in Sioux County, Iowa (CMS PY2026; verify current plans on Medicare.gov), we compare total expected cost, not just the premium line.

Every Medicare Advantage plan has a yearly maximum out-of-pocket — a ceiling on what you pay in-network for covered medical care. Once your copays and coinsurance reach it, the plan pays 100% of covered medical costs for the rest of the year. Original Medicare alone has no such cap, which is one reason people add a Medigap policy. The out-of-pocket max varies by plan, so we compare it alongside premiums and copays on the plans we offer. (Verify current figures on Medicare.gov.)

Several programs help. Extra Help (the Low-Income Subsidy) lowers your Part D premium, deductible, and copays. The Medicare Savings Programs can pay your Part B premium and other costs. Full Medicaid, if you qualify, coordinates with Medicare and may unlock a $0-premium Dual Special Needs Plan. Many people who'd qualify never apply simply because they don't know these exist. We can help you check your eligibility and, if you qualify, match you to a plan we offer that fits.

Because only part of your cost is fixed. The Part B premium, the $615 Part D deductible, and the $2,100 drug cap are federal (CMS PY2026; verify current figures on Medicare.gov), but plan premiums, copays, drug tiers, networks, and out-of-pocket maximums all differ from one plan to the next. With roughly 22 to 28 plans available across our counties, the difference between a well-matched plan and a poorly-matched one can be substantial. We compare total expected cost across the plans we offer so you don't overpay.