Parts A, B, C and D
Four letters, four jobs. A is the hospital. B is the doctor. C bundles A and B into one private plan. D is the pills.
Part A
The hospital half
Part A pays when you are formally admitted to a hospital. It also covers skilled nursing care after a qualifying hospital stay, hospice care, and some home health care.
What it costs in 2026
- Premium: $0 for most people. Ten years of Medicare payroll taxes, yours or a spouse’s, already paid for it.
- Hospital deductible: about $1,736, and it applies per benefit period, not per year.
- Days 1 to 60: nothing more after the deductible.
- Days 61 to 90: a daily amount, then a higher one for lifetime reserve days.
Ask whether you are admitted
You can spend two nights in a hospital bed and still be an outpatient on observation status. Then Part B pays instead, at 20% with no ceiling, and those nights do not count toward the three inpatient days Medicare requires before it will cover a nursing home stay. Ask, out loud: “am I admitted as an inpatient?”
Part B
The doctor half
Everything that happens outside an inpatient admission: office visits, blood tests, X-rays and scans, outpatient surgery, chemotherapy, mental health care, ambulance rides, durable medical equipment like a walker or a wheelchair, and a long list of preventive services.
What it costs in 2026
- Premium: $202.90 a month for most people, usually deducted from your Social Security payment. Higher incomes pay more, which is IRMAA.
- Deductible: $283 for the year.
- Then: you pay 20% of the Medicare-approved amount for most services, with no annual ceiling.
Preventive care is the happy exception. An annual wellness visit, most vaccinations, and several cancer screenings cost you nothing at all: no deductible, no 20%.
Part C
Medicare Advantage: A and B in one private package
A Part C plan is sold by a private company and approved by Medicare. It must cover everything Parts A and B cover. Most also include Part D drug coverage, and many add dental, vision, hearing, a gym membership or an over-the-counter allowance.
You keep paying your Part B premium. The plan may charge nothing on top, which is where the “$0 premium” advertising comes from. You then pay copays as you use it.
The trade, stated honestly
| Original Medicare plus Medigap | Medicare Advantage | |
|---|---|---|
| Which doctors | Any in the country who takes Medicare | The plan’s network, usually local |
| Referrals | Never needed | Often needed on HMO plans |
| Approval in advance | Rare | Common for scans, surgery, rehab |
| Monthly cost | Higher: Part B plus a supplement plus a drug plan | Lower: often just Part B |
| Cost when you are ill | Very predictable | Copays until you reach the yearly ceiling |
| Yearly ceiling | Effectively yes, through the supplement | Yes, set by the plan |
| Dental and vision | Not included | Often included, with annual limits |
| Changing later | Easy to leave, harder to rejoin | Easy to switch each fall, but a supplement may then ask health questions |
Part D
The pill half
Part D is sold by private companies. Each plan publishes a formulary: the list of drugs it covers and the tier each one sits in. Two plans with identical premiums can differ by thousands of dollars a year for the same prescriptions.
What changed, and it is good news
- Since 2025 there is a hard ceiling on what you pay for covered drugs. In 2026 it is $2,100. After that, nothing more for the rest of the year.
- The old coverage gap, the one everyone called the doughnut hole, is gone.
- You can ask your plan to spread what you owe across monthly bills instead of paying it all at the counter. That is the Medicare Prescription Payment Plan, and you have to ask.
- Insulin is capped at $35 a month, and recommended adult vaccines cost nothing.
The penalty is permanent
Go without creditable drug coverage after you are eligible and Medicare adds 1% of the national base premium for every month you waited, for as long as you have Part D. A cheap plan you barely use is insurance against that.
Which combination fits you?
It depends on four things: your doctors, your prescriptions, whether you travel, and how much uncertainty you can live with. Twenty minutes on the phone settles it.