What does Medicare cost in 2026?
The standard Part B premium is $202.90 a month per person in 2026, with an annual deductible of $283 (CMS, 2026). Part A hospital coverage is premium-free for anyone with about 10 years of Medicare-covered work, directly or through a spouse. Part D drug plan premiums vary by plan around a national base premium of $38.99 a month, and since 2025 out-of-pocket spending on covered drugs is capped; the cap is $2,100 in 2026 (CMS). A one-month supply of each covered insulin costs no more than $35, with no deductible (Medicare.gov). A Medigap policy or a Medicare Advantage plan comes on top, and its price depends on your state, age and plan.
For higher-income retirees, the standard premium is only the floor. Part B and Part D both carry an income-related surcharge, and for many readers of this page it is the largest Medicare cost they can actually influence.
What are IRMAA surcharges, and who pays them?
IRMAA, the income-related monthly adjustment amount, is an extra premium for Part B and Part D charged when modified adjusted gross income passes $109,000 on a single return or $218,000 on a joint return in 2026. Modified adjusted gross income here means adjusted gross income plus tax-exempt interest, so municipal bond income counts. There are five surcharge tiers, and the top one adds $487.00 a month to Part B alone.
| Single return | Joint return | Part B total | Part D add-on | Extra per couple per year |
|---|---|---|---|---|
| Up to $109,000 | Up to $218,000 | $202.90 | $0 | $0 |
| $109,001 to $137,000 | $218,001 to $274,000 | $284.10 | $14.50 | $2,297 |
| $137,001 to $171,000 | $274,001 to $342,000 | $405.80 | $37.50 | $5,770 |
| $171,001 to $205,000 | $342,001 to $410,000 | $527.50 | $60.40 | $9,240 |
| $205,001 to $499,999 | $410,001 to $749,999 | $649.20 | $83.30 | $12,710 |
| $500,000 or more | $750,000 or more | $689.90 | $91.00 | $13,872 |
Source: CMS 2026 Part B and Part D premium fact sheet. The Part D add-on is paid on top of your plan's premium. The last column assumes both spouses are on Medicare with Part D. Married couples filing separately who lived together face only two tiers: $649.20 above $109,000 and $689.90 at $391,000 or more.
The two-year lookback
Social Security sets your 2026 IRMAA from the tax return you filed for 2024, the most recent one the IRS provides (SSA). Two consequences follow. Income from age 63 onward affects your premiums at 65, so Roth conversions, a business sale or a large capital gain in the year you turn 63 all count. And the year you retire, your premiums are still based on your working income from two years before.
That second case has a remedy. If your income has fallen because of a life-changing event, you can ask Social Security to use a more recent year by filing form SSA-44 (SSA). The qualifying events are marriage, divorce or annulment, death of a spouse, work stoppage, work reduction, loss of income-producing property, loss or reduction of a pension, and an employer settlement payment. Retirement counts as a work stoppage. A drop in investment income, or a one-time Roth conversion, does not qualify.
How to keep IRMAA in check
Each tier is a cliff, not a slope. One dollar over a threshold triggers the full surcharge for that tier for the whole year, and the top tier costs a couple about $13,872 a year more than the standard premium. The practical moves are about timing income, not avoiding it:
- Do most Roth conversions before 63, or size later conversions to stop just below a threshold. Our RMD calculator explains how conversions before RMD age shrink the forced income later.
- From 70½, give to charity through qualified charitable distributions of up to $111,000 a year (2026). A QCD never enters adjusted gross income, so it lowers IRMAA income in a way a deductible gift cannot.
- Spread large capital gains across tax years where you can, and remember that a home sale gain above the exclusion counts as income for IRMAA two years later.
- Plan for the widow's step. A surviving spouse moves from the joint thresholds to the single ones, exactly half, usually on similar income.
Our Medicare enrollment and IRMAA guide covers the enrollment windows and late-enrollment penalties as well.
How much does long-term care cost, and who pays for it?
A private nursing home room had a national median cost of $129,575 a year in 2025, and a year of full-time care at home cost about $80,080, according to the CareScout Cost of Care Survey (CareScout, 2026). Costs vary widely by state and city, and most settings rose 1% to 5% from the year before.
| Setting | Per month | Per year |
|---|---|---|
| Nursing home, private room | $10,798 | $129,575 |
| Nursing home, semi-private room | $9,581 | $114,975 |
| Assisted living community | $6,200 | $74,400 |
| In-home care, 44 hours a week | $6,673 | $80,080 |
| Adult day health care, 5 days a week | $2,058 | $24,700 |
CareScout Cost of Care Survey 2025, released March 2, 2026. Monthly figures for in-home and adult day care are the annual medians divided by 12.
Someone turning 65 has almost a 70% chance of needing some long-term care, and women need it longer on average (3.7 years) than men (2.2 years) (Administration for Community Living). Many people need only a few months of help at home; a smaller group needs years in a facility, and that group drives the financial risk.
Medicare does not pay for it
Medicare, and Medigap, do not cover custodial care: help with bathing, dressing, eating and the other daily activities that make up most long-term care (Medicare.gov). Medicare pays for a limited stay in a skilled nursing facility after a qualifying hospital stay and for skilled home health care, not for ongoing custodial care. Medicaid does pay for nursing home care, but only after assets are spent down to state limits, and transfers made within 60 months of applying can trigger a penalty period (Medicaid.gov). The rules vary by state; an elder law attorney in your state is the right source for specifics.
Three ways to pay
Self-insure. With a portfolio of a few million dollars, most households can absorb even a multi-year nursing home stay, particularly because other spending falls when care begins. Earmark a reserve, often the home equity, rather than leaving it implicit.
Traditional long-term care insurance. It pays a daily or monthly benefit for a set period. Premiums are lowest in your 50s and early 60s, underwriting gets harder with age, and insurers have raised premiums on existing policies in the past, so budget for increases.
Hybrid life and long-term care policies. A life insurance or annuity contract with a long-term care rider pays for care if needed and a death benefit if not, usually for a single premium or a fixed number of payments. It costs more for the same care benefit, but the premium is typically guaranteed.
Our guide to long-term care planning compares the options in detail.
How this estimator treats long-term care
The Long-Term Care Risk Reserve above is a simple probability-weighted figure for each person: the 2025 national median for assisted living ($74,400 a year) multiplied by a 3-year average need among people who use long-term care and a 70% chance of needing it (ACL). It is a budgeting placeholder, not a worst case. For a stress test, price the outcome you would actually plan around.
Illustrative example: the people and figures below are hypothetical, not real clients. Numbers are calculated from the stated assumptions.
Carol, 72 and widowed, has $2.1 million invested and a paid-off house worth $650,000. Three years in a private nursing home room at the 2025 median would cost about $389,000 before inflation. Her Social Security and IRA withdrawals continue during that time, and her home is empty, so she could sell it or rent it to cover much of the bill. She decides to self-insure, names the house as her care reserve in her plan, and keeps enough in bonds to cover the first year without selling stocks in a downturn.
Price your own area