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.
In This Guide
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.
| Part A Cost Item | 2026 Amount |
|---|---|
| Premium (40+ quarters of Medicare taxes) | $0/month |
| Premium (30–39 quarters) | $278/month |
| Premium (fewer than 30 quarters) | $505/month |
| Inpatient hospital deductible (per benefit period) | $1,676 |
| Hospital coinsurance, days 1–60 | $0 (deductible applies) |
| Hospital coinsurance, days 61–90 | $419/day |
| Hospital lifetime reserve days (up to 60 days) | $838/day |
| SNF coinsurance, days 1–20 | $0 |
| SNF coinsurance, days 21–100 | $209.50/day |
| SNF coverage beyond day 100 | $0 (no coverage) |
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.
| Part B Cost Item | 2026 Amount |
|---|---|
| Standard monthly premium | $185.00/month |
| Annual deductible | $257 |
| Coinsurance after deductible | 20% (you pay) / 80% (Medicare pays) |
| Annual out-of-pocket cap under Original Medicare alone | None |
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 — 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.
| 2024 MAGI (Individual) | 2024 MAGI (Joint) | Part B IRMAA Add-On/Month | Total Part B Premium |
|---|---|---|---|
| $106,000 or less | $212,000 or less | $0 | $185.00 |
| $106,001–$133,000 | $212,001–$266,000 | +$74.00 | $259.00 |
| $133,001–$167,000 | $266,001–$334,000 | +$187.00 | $372.00 |
| $167,001–$200,000 | $334,001–$400,000 | +$300.00 | $485.00 |
| $200,001–$500,000 | $400,001–$750,000 | +$374.20 | $559.20 |
| Above $500,000 | Above $750,000 | +$443.90 | $628.90 |
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 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.
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.
| Service | Typical MA Cost-Sharing (Florida, 2026) |
|---|---|
| Primary care visit | $0–$10 copay |
| Specialist visit | $30–$50 copay |
| Inpatient hospital stay (per day or per admission) | $295–$400/day for first 5–7 days |
| Emergency room (non-admitted) | $90–$120 copay |
| Outpatient surgery | $150–$300 copay or 20% coinsurance |
| Diagnostic lab/imaging | $0–$40 copay |
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.
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.
Even with the best supplemental coverage, certain costs fall entirely outside Medicare's scope:
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What is the Medicare Part B premium for 2026 in Florida?
The standard Medicare Part B premium for 2026 is $185.00 per month. This applies to most Florida Medicare beneficiaries. Higher-income individuals may pay more due to IRMAA (Income-Related Monthly Adjustment Amount) surcharges based on income reported to the IRS from two years prior.
What is the Medicare Part A deductible for 2026?
The Medicare Part A deductible for 2026 is $1,676 per benefit period. This is not an annual deductible — it resets each time you begin a new benefit period (a new illness or hospitalization after 60+ days without inpatient care). You could potentially pay the Part A deductible more than once in a calendar year if you have multiple hospitalizations.
How does the IRMAA surcharge affect my Medicare costs?
IRMAA adds a monthly surcharge to your Part B and Part D premiums if your Modified Adjusted Gross Income (MAGI) from two years ago exceeded $106,000 for individuals or $212,000 for married couples filing jointly. Surcharges range from $74 to $443.90 per month for Part B, plus $13.70 to $85.80 per month for Part D. If your income has since dropped due to retirement, divorce, or death of a spouse, you can request reconsideration using SSA Form SSA-44.
What is the out-of-pocket maximum for Medicare Advantage plans in Florida?
CMS sets a maximum allowable MOOP (Maximum Out-of-Pocket) for Medicare Advantage plans. For 2026, the CMS MOOP limit is $9,350 for in-network services in HMO plans and $14,000 combined in-network/out-of-network for PPO plans. However, many Florida MA plans set their actual MOOP much lower — commonly $3,000–$6,000 — as a competitive benefit. Once you hit the MOOP, the plan covers 100% of covered services for the rest of the year. Part D drug costs do not count toward the MOOP.
Is Medigap or Medicare Advantage cheaper in Florida?
It depends on your health usage. Medicare Advantage plans typically have $0 or very low premiums but involve cost-sharing (copays, coinsurance) at the time of care. Medigap Plan G has a monthly premium of roughly $100–$200 in Florida (depending on age) but covers most Medicare cost-sharing after the $257 Part B deductible. For healthy beneficiaries who rarely use healthcare, a $0-premium MA plan is often cheaper. For those with chronic conditions or frequent specialist visits, Medigap Plan G often yields more predictable and lower total annual costs.