To estimate what Medicare will cost you for a year, add the premiums you will owe, your expected medical and prescription cost sharing, and any income-related adjustments or late-enrollment penalties. Then check the plan’s covered-service out-of-pocket limit, provider access and drug coverage. There is no single yearly Medicare total: your location, plan, medicines, providers and health-care use all affect the result.
What does Medicare cost?
The useful answer is a personalized annual estimate, not a single premium figure. A monthly premium is only one part of the bill. You may also pay deductibles, copays, coinsurance, prescription costs and, depending on your income or enrollment history, additional premium adjustments or penalties. The amounts and services covered vary by plan and by the coverage year.
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Build an estimate for each plan you are considering using the same assumptions: the same expected appointments and services, prescription list, preferred pharmacies and provider preferences. Keep two totals separate: what you reasonably expect to spend, and the most you could owe for covered services if you have a costly year. The second figure is a limit, not a forecast.
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Your Medicare coverage choices
Write down whether you are comparing Original Medicare or Medicare Advantage. If you choose Original Medicare, note whether you will add a standalone Part D prescription drug plan and whether you are considering Medigap. If you choose Medicare Advantage, record the plan’s premium, drug coverage (if included), cost-sharing rules and annual out-of-pocket limit for covered Medicare services.
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Also check whether you owe a Part A premium. Most people qualify for premium-free Part A, but people who must buy it pay a monthly amount determined by work history. Do not assume that every person pays the same amount or that Part A is necessarily free for you.
Your expected care and prescriptions
Make a realistic list of the health care you expect to use during the coverage year: regular doctor visits, specialist visits, tests, outpatient treatment, hospital care and any recurring services. Use your own history and anticipated care rather than assuming either no care or an unusually expensive year. For each item, find the deductible, copay or coinsurance that applies under each plan.
For prescriptions, use the exact medicine names, strengths or dosages, and the pharmacies you would actually use. A plan’s premium by itself cannot tell you which option has the lowest total drug cost. Formulary coverage, any deductible, your cost at a preferred pharmacy and the plan’s other pharmacy rules all matter.
Your income and enrollment circumstances
Find out whether an income-related adjustment could raise a premium, whether a late-enrollment penalty applies, and whether you may qualify for Extra Help or other assistance. Include any adjustment or penalty that applies to your own situation; do not add one simply because it might apply to someone else. Assistance can reduce premiums or cost sharing for eligible people.
Build the estimate in six steps
- Write down every monthly premium. Include Part B; a Part A premium if you must buy Part A; and the premium for Medicare Advantage or a standalone Part D plan, as applicable. Add a Medigap premium if you are comparing Original Medicare with supplemental coverage. Record income-related adjustments and penalties separately so you can see their effect.
- Convert premiums to a full-year amount. Multiply each monthly amount by the number of months you expect to have that coverage during the year. For a full 12 months, the 2026 standard Part B premium of $202.90 per month comes to $2,434.80. That is the annualized standard Part B premium alone—not a full estimate of your Medicare costs. If coverage starts or changes during the year, use the months that apply rather than treating a monthly premium as a full-year charge.
- List the cost sharing for care you expect. For every planned service, note whether you must first meet a deductible and what you would then pay as a copay or coinsurance. Apply the plan’s own rules. Under Original Medicare, Part B-covered services usually involve 20% coinsurance after the deductible; Medicare Advantage cost sharing is plan-specific. Do not assume that one plan’s visit or hospital charge applies to another.
- Price your prescriptions plan by plan. Enter your exact medicines and dosages into the official Medicare Plan Compare tool for the plans available to you. Compare the results for your pharmacies and check relevant plan documents for coverage details. Include both the plan premium and the likely drug costs; a lower monthly premium does not by itself mean lower annual prescription spending.
- Check the covered-service limit and access rules. For Medicare Advantage, record the annual limit on out-of-pocket spending for covered Medicare services and check what expenses count toward it. For Original Medicare, do not assume there is a general yearly out-of-pocket cap unless you have supplemental or other coverage. Compare provider networks and out-of-network rules, and verify whether the doctors and hospitals you want to use participate.
- Apply help, penalties and the same assumptions to every option. Include applicable assistance, income-related adjustments and penalties. Then compare each plan using the same care expectations, medicine list, pharmacies and provider preferences. Keep expected spending distinct from a plan’s maximum covered-service exposure.
Know which 2026 figures belong in the worksheet
The following are official Medicare figures for 2026. They are reference amounts for that coverage year, not a permanent price list or a personal total. Recheck the figures for the year you are estimating and use the specific plan details that apply to you.
| Cost item | 2026 figure | How to use it |
|---|---|---|
| Standard Part B monthly premium | $202.90 per month | Include it in your premium total. The amount can be higher based on income. |
| Part B deductible | $283 per year | Include it when estimating your Part B cost sharing; it is separate from the monthly premium. |
| Part A deductible | $1,736 per benefit period | Do not treat this as one annual deductible. Medicare states it applies per benefit period. |
| Part A monthly premium for people who must buy Part A | $311 or $565 per month, depending on work history | Most people qualify for premium-free Part A. If you must buy it, determine which monthly amount applies to you. |
| Maximum Part D deductible | $615 | This is the maximum; some plans have a lower deductible or none. |
| Annual out-of-pocket limit for covered Part D drugs | $2,100 | Use this as a 2026 limit for covered Part D drug costs, not as a premium or a prediction of your spending. |
These amounts play different roles in a budget. A premium is a recurring charge; a deductible is an amount you may have to pay before particular coverage begins paying under its rules; and a copay or coinsurance is your share of a covered service or prescription. The Part A deductible is defined by benefit period, while the Part B deductible is annual. Keep those distinctions in the worksheet so unlike charges do not get added or interpreted as if they were the same.
Compare Original Medicare and Medicare Advantage on the same basis
The main comparison is not simply “premium versus premium.” Consider what you pay in an ordinary year, what protection exists in an expensive year, and whether the plan lets you use the providers and pharmacies that matter to you.
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| Comparison point | Original Medicare | Medicare Advantage |
|---|---|---|
| Premiums to include | Part B, any Part A premium, any standalone Part D premium, and any Medigap premium if selected. | Part B, the plan premium if there is one, and any other applicable premium or adjustment. |
| Medical cost sharing | Estimate deductibles and coinsurance for the services you expect. Part B-covered services usually involve 20% coinsurance after the deductible. | Use the individual plan’s deductibles, copays and coinsurance for each expected service. |
| Annual out-of-pocket protection | No general annual out-of-pocket limit unless you have supplemental or other coverage. | Has an annual limit for covered Medicare services. Check the plan’s limit and which expenses count toward it. |
| Provider access | Generally broad access to providers who accept Medicare; verify that your preferred providers accept it. | May have network restrictions. Check participation and out-of-network rules for your doctors and hospitals. |
| Prescription spending | Include a separate Part D plan if you choose one, and price your drugs under that plan. | Check whether prescription coverage is included and price your drugs under the plan’s rules. |
| Supplemental coverage | Medigap can reduce some Original Medicare cost sharing but adds a premium. | Compare the plan’s own cost-sharing and limit; do not add a Medigap premium to this option unless it applies to your coverage. |
Medicare’s general guidance is that “There’s no yearly limit on what you pay out-of-pocket, unless you have supplemental coverage, like a Medicare Supplement Insurance (Medigap) policy, or you join a Medicare Advantage Plan.” For Part B-covered services, Medicare says you usually pay 20% of the Medicare-approved amount after you meet your deductible. These descriptions help frame the comparison, but your own services and plan terms determine the estimate.
Separate expected spending from a high-cost year
Expected annual spending
For each plan, total the premiums for the months you will be enrolled, expected medical cost sharing, and expected prescription costs. Add applicable income-related adjustments or penalties, and subtract assistance only when you have established that you qualify and know how it affects your costs. Label the result as an estimate: actual spending can change if your care, medicine needs, coverage or plan rules change.
Use a line for each anticipated service and medicine rather than one rough allowance for “health care.” That makes it easier to identify what is driving a difference between plans and to update the estimate if a service or medication changes. Keep plan-specific amounts beside the service they apply to, so a cost-sharing figure from one option does not accidentally carry over to another.
Covered-service exposure
Separately note the Medicare Advantage annual out-of-pocket limit for covered Medicare services, if applicable, and the conditions under which the limit applies. It is a way to assess exposure to eligible covered-service spending, not a forecast of what you will pay and not a substitute for checking premiums, prescriptions or coverage exclusions. With Original Medicare, determine whether supplemental or other coverage changes your out-of-pocket exposure; without it, there is no general yearly out-of-pocket limit.
Costs and circumstances a single total can hide
A plan can look inexpensive in a routine-use estimate while being a poor fit for a particular provider, pharmacy or service. The reverse can also be true: a higher premium may accompany cost-sharing rules or coverage that better fits your expected needs. A fair comparison therefore needs both a cost calculation and an access check. Do not assume that a provider participates, that a medicine is covered, or that a service is treated the same way across plans; confirm the details for each option.
Independent reader supportYour contribution helps us test, update, and keep practical guides available for everyone.Use Medicare Plan Compare, then verify the details
Start with Medicare’s official Plan Compare tool to review plans available for your location and enter your prescription information. The available options and their terms are local and plan-specific, so a national average or someone else’s estimate cannot replace a comparison for your circumstances.
- Set your location and coverage year. Use the place where you live and the year for which you are estimating costs so the displayed plan options are relevant.
- Enter your medicines accurately. Check each medication name and dosage, then select the pharmacies you would use. Compare the resulting drug coverage and estimated costs across plans.
- Review the full plan cost picture. Consider premiums alongside deductibles, service copays or coinsurance, prescription costs and any annual covered-service limit. Do not select on premium alone.
- Check doctors and hospitals. Look up the providers you want and review network and out-of-network rules, particularly for a Medicare Advantage option.
- Confirm material details with the plan. Before enrolling, verify the costs, coverage, network participation and other terms in the plan’s current materials or directly with the plan. Use current plan information rather than assuming a displayed or prior-year amount will remain in force.
A simple worksheet for a like-for-like comparison
Copy this structure for each option. Enter actual plan terms where available; use “not yet confirmed” in your own working notes rather than guessing. The rows force the comparison to include recurring costs, expected care, prescriptions and access.
| Worksheet line | Plan A | Plan B |
|---|---|---|
| Coverage type and plan name | ||
| Part B premium for the months covered | ||
| Part A premium, if applicable | ||
| Plan premium and standalone Part D premium, as applicable | ||
| Medigap premium, if applicable | ||
| Income adjustment or late-enrollment penalty, if applicable | ||
| Expected medical deductibles, copays and coinsurance | ||
| Expected prescription spending for listed drugs and pharmacies | ||
| Expected annual total | ||
| Annual limit for covered Medicare services, if applicable | ||
| Preferred providers and hospitals confirmed | ||
| Drug coverage and preferred pharmacies confirmed |
Check for assistance before you settle on a budget
If paying premiums or cost sharing is difficult, investigate whether you qualify for Extra Help or other assistance. Eligibility can change what you pay, so use the applicable program information to determine what help is available to you rather than assuming that the standard plan estimate is your final bill. Likewise, verify any late-enrollment penalty or income-related premium adjustment that applies to your record. Both can make the amount you owe different from the standard premium shown for a given year.
Once you have confirmed assistance and any adjustments, update the same worksheet rather than comparing a plan with assistance against another plan without it. Keep the coverage year attached to every official amount you use. Medicare’s 2026 figures are useful for a 2026 estimate; they should not be treated as guaranteed rates for a later year.
Quick Recap
Common estimating mistakes
- Counting only the premium. Add likely medical cost sharing and drug spending, too.
- Using one generic drug estimate. Check each medicine, dosage and pharmacy under each plan.
- Treating a maximum as an expected bill. An out-of-pocket limit describes a boundary for qualifying covered services, not the amount a typical enrollee should expect to spend.
- Confusing a benefit period with a calendar year. The 2026 Part A deductible is per benefit period; the 2026 Part B deductible is annual.
- Ignoring network and provider rules. A cost estimate is not useful if it assumes access to a doctor or hospital that the plan does not cover on the terms you expect.
- Applying standard figures to every person or year. Part B can be higher based on income, Part A premiums depend on work history for people who must buy Part A, and annual figures can change.
- Comparing plans with different assumptions. Use the same anticipated care, prescriptions, pharmacies and provider preferences for every option.
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