Florida Medicare Costs Explained — Premiums, Deductibles, and Out-of-Pocket 2026

By the Florida Plan Finder Team · Licensed Florida Health Insurance Producer · NPN #21249133 · Last Updated: May 2026

Medicare is often described as a government health program that covers most healthcare costs for seniors. In reality, Medicare has a complex cost-sharing structure that can expose beneficiaries to significant out-of-pocket expenses — particularly those who stay on Original Medicare without supplemental coverage.

This guide breaks down every major Medicare cost category for 2026: Part A premiums and deductibles, Part B premiums and coinsurance, IRMAA income-based surcharges, Medicare Advantage out-of-pocket maximums, and the fundamental cost comparison between Medigap and Medicare Advantage. Understanding these numbers is the foundation of smart Medicare planning in Florida.

Medicare Part A Costs in 2026

Medicare Part A covers inpatient hospital stays, skilled nursing facility care, hospice, and limited home health services. Most beneficiaries pay no Part A premium, but there are still significant cost-sharing requirements when you use Part A benefits.

Medicare Part B Costs in 2026

Medicare Part B covers outpatient medical services: doctor visits, specialist appointments, lab tests, imaging, durable medical equipment, and preventive services. Part B has both a premium and a deductible, and its coinsurance structure creates potentially unlimited out-of-pocket exposure without supplemental coverage.

The absence of an out-of-pocket cap under Original Medicare Part B is one of the most dangerous features of the program for heavy users of healthcare. If you have a major illness requiring extensive outpatient treatment — chemotherapy, dialysis, physical therapy — your 20% coinsurance share can run into tens of thousands of dollars with no ceiling. This is why either a Medigap policy or Medicare Advantage (which has a mandatory MOOP) is considered essential for most beneficiaries.

IRMAA Surcharges for Higher-Income Beneficiaries

IRMAA — the Income-Related Monthly Adjustment Amount — adds a monthly surcharge to your Medicare Part B and Part D premiums if your income exceeds certain thresholds. IRMAA is based on your Modified Adjusted Gross Income (MAGI) from two years prior. For 2026 costs, Social Security looks at your 2024 tax return.

Part D IRMAA surcharges add an additional $13.70 to $85.80 per month depending on the same income tiers. These are assessed in addition to your Part D plan premium.

If you recently retired and your income has decreased, or you experienced a life-changing event (divorce, death of a spouse, loss of income-producing property), you can request IRMAA reconsideration by filing SSA Form SSA-44 with your local Social Security office. IRMAA is not permanently fixed — it is reassessed each year based on updated income data.

Medicare Advantage Out-of-Pocket Costs

Medicare Advantage plans replace Original Medicare (Parts A and B) with private insurance that includes a mandatory annual out-of-pocket maximum — a protection Original Medicare does not provide. CMS sets maximum allowable MOOP limits each year; individual plans may set lower MOOPs as a competitive benefit.

2026 CMS MOOP Limits

• HMO plans (in-network only): $9,350 maximum MOOP
• PPO plans (in-network + out-of-network combined): $14,000 maximum MOOP

Many Florida Medicare Advantage plans in competitive markets set their actual MOOP well below these CMS limits. MOOPs of $3,000–$6,000 are common among higher-rated plans in South Florida, Tampa Bay, and Orlando metro areas. Once you reach the MOOP, your plan pays 100% of all covered services for the remainder of the calendar year.

Common MA Cost-Sharing Structure

Note that Part D drug costs under an MA-PD plan do not count toward the medical MOOP. Drug costs are subject to their own separate cost-sharing rules under the plan's drug benefit.

Medigap vs Medicare Advantage: Cost Comparison

The choice between Medigap (Medicare Supplement) and Medicare Advantage is the central cost decision for most Florida Medicare beneficiaries. Neither is universally better — the right answer depends on your health, your finances, and how you use healthcare.

Original Medicare + Medigap Plan G

• Monthly premium: $185 (Part B) + $100–$200 (Plan G) = approximately $285–$385/month total
• Annual Part B deductible: $257 (you pay; Plan G covers everything else)
• Doctor/specialist freedom: Any provider that accepts Medicare nationwide — no networks, no referrals
• Predictability: Very high — your costs are largely fixed and knowable in advance
• Best for: Those with chronic conditions, frequent specialist care, or who travel extensively

Medicare Advantage (typical Florida $0-premium plan)

• Monthly premium: $185 (Part B) + $0 (MA premium) = $185/month
• Point-of-care costs: Copays at each service use; adds up with frequent utilization
• Annual MOOP protection: Yes — costs capped once MOOP reached
• Doctor network: Must use in-network providers (HMO) or pay more (PPO)
• Extra benefits: Often includes dental, vision, hearing, fitness, OTC allowance
• Best for: Relatively healthy beneficiaries who value low premiums and extra benefits

What Medicare Does NOT Cover

Even with the best supplemental coverage, certain costs fall entirely outside Medicare's scope:

• Long-term care and custodial care: Medicare covers skilled nursing facility care only short-term (up to 100 days after a qualifying hospital stay). Permanent custodial care — help with bathing, dressing, daily activities — is not covered by Medicare. Long-term care insurance or Medicaid (for those who qualify) must cover these costs.
• Routine dental, vision, and hearing: As detailed in our separate guide, Original Medicare explicitly excludes these services.
• Overseas medical care: Medicare does not cover medical care received outside the United States except in very limited circumstances near the Canadian or Mexican border. Medigap Plans C, D, F, G, M, and N include limited foreign travel emergency coverage (80% after $250 deductible, up to $50,000 lifetime).
• Cosmetic surgery: Not covered unless medically necessary to correct an injury or defect.
• Private-duty nursing: Not covered if the care is custodial rather than skilled.
• The 20% coinsurance under Part B (for Original Medicare without Medigap): This is technically "covered" by Medicare in the sense that Medicare sets the rate, but the 20% patient share is unlimited and falls entirely on you without supplemental coverage.

Frequently Asked Questions