Medicare is the vital healthcare program that covers most older Americans. It is a complicated program.  

Medicare Overview 

Medicare is the federal health insurance program that covers people sixty-five (65) and older and some younger adults with permanent disabilities and certain medical conditions. When Medicare was established in 1965 about half of American seniors had no health insurance. Today, virtually all Americans over age 65 have at least some health coverage through Medicare. Approximately three (3) million Pennsylvania residents receive benefits through Medicare. 

Medicare does not cover all health care services. For example, Medicare generally does not pay for long-term care services, regular eye exams and eyeglasses, hearing aids, or routine dental care. 

Medicare coverage is divided into four parts – Part A, Part B, Part C (Medicare Advantage), and Part D. 

Part A (Hospital Insurance) covers inpatient hospital care, some limited skilled nursing facility stays, inpatient rehabilitation, hospice care, and some home health care.  

Part B covers physician services, outpatient hospital care, and some home health visits. It also covers laboratory and diagnostic tests, such as X-rays and blood work; durable medical equipment, such as wheelchairs and walkers; certain preventive services and screening tests, such as mammograms and prostate cancer screenings; outpatient physical, speech and occupational therapy; outpatient mental health care; and ambulance services. 

Part D is prescription drug coverage. 

Part C (Medicare Advantage) allows beneficiaries to choose to receive their Part A, B, and D services through a private managed care insurance plan rather than traditional/original Medicare. 

Medicare Part A Premium and Deductible 

Approximately 99% of Medicare beneficiaries do not have a Part A premium because they have worked forty (40) quarters of Medicare-covered employment.  The Medicare Part A inpatient hospital deductive will be $1,736 in 2026, a $60 increase from 2025. Part A inpatient hospital deductible covers share of costs for the first 60 days of Medicare-covered inpatient hospital care in one benefit period. In 2026, there will be a $434 per day coinsurance amount for days 61 through 90 of a hospitalization (up from $419 in 2025) in a benefit period. If the beneficiary is in a skilled nursing facility, the daily coinsurance for days 21 through 100 will be $217.00 in 2025, up from $209.50 in 2025. 

Medicare Part B Premiums and Deductible 

Part B generally pays 80% of the approved amount for covered services in excess of the annual deductible ($283 in 2026, up from $257 in 2025). The beneficiary is liable for the remaining 20%. Many beneficiaries purchase a Medicare Supplement (Medigap) policy to cover that exposed 20%. 

Part B coverage is not free. You pay a premium each month for your Part B coverage. If you get Social Security, Railroad Retirement Board, or Office of Personnel Management benefits, your Part B premium is deducted from your benefit payment. If you don’t get these benefit payments, you’ll get a bill. 

The Centers for Medicare and Medicaid Services (CMS) has recently announced that the standard Part B premium for 2026 will be $202.90 per month. This is an increase of $17.90 over the 2025 amount. Some beneficiaries will pay substantially more while those with low incomes and limited resources can get help paying the premiums through several programs.   

Since 2007, a beneficiary’s Part B monthly premium has been based on his or her income. Income-related monthly adjustment amounts affect roughly 8% of people with Medicare Part B. The 2026 Part B total premiums for high-income beneficiaries with full Part B coverage are set forth on the CMS website. For example, beneficiaries who file joint tax returns with modified adjusted gross income greater than $218,000 and less than or equal to $274,000 will have an income-related monthly adjustment of $81.20, with a total monthly premium of $284.10.   

Medicare Part D 

Since 2011, a beneficiary’s Part D monthly premium has been based on his or her income. For example, beneficiaries who file individual tax returns with modified adjusted gross income greater than $137,000 and less than $171,000 will have a $37.50 income-related Part D costs. There will be a Part D out-of-pocket of $2,100 (up from $2,000 in 2025), and a permanent cap of $35 per month for insulin costs.  

Beginning in 2026, if you participate in the Medicare Prescription Payment Plan (MPPP), you will be automatically re-enrolled the next year unless you opt out. There will be a separate renewal notice after the annual election period ends; the notice will contain the payment plan’s upcoming terms.