Quick answers
- What is the Part B premium in 2026?
- $202.90 a month for most people, with a $283 yearly deductible. People with higher incomes pay more (IRMAA).
- What is the Part A deductible in 2026?
- $1,736 for each benefit period. Most people pay no Part A premium because they or a spouse paid Medicare taxes for 40 quarters, and most North Carolina public jobs are covered by Social Security and Medicare.
- Is there a cap on drug costs?
- Yes. In 2026 you pay no more than $2,100 out of pocket for covered Part D drugs, and the old coverage gap no longer exists.
- Does North Carolina's state income tax change IRMAA?
- No. IRMAA uses the modified adjusted gross income on your federal tax return. Your North Carolina return isn't used.
- Who helps North Carolinians pay Medicare costs?
- NC Medicaid's Medicare Savings Programs, called MQB (MQB-Q, MQB-B and MQB-E), applied for through ePASS or your county Department of Social Services, and Extra Help through Social Security.
Every amount below is for calendar year 2026, from CMS and Social Security. Medicare's costs are federal, so they're the same in Charlotte, Raleigh, Asheville, Wilmington, Boone or Murphy. About 2,328,318 North Carolinians had Medicare in July 2026, and every one of them pays by the same national rules. Jump to: Part A · Part B · Paying your premium · IRMAA · Part D · Medicare Advantage · Medigap · Extra Help · MQB premium help · 2025 vs 2026 · By county
What does Part A cost in 2026?
| Part A cost | 2026 |
|---|---|
| Premium with 40 or more quarters of Medicare-covered work (yours or a spouse's) | No premium |
| Premium with 30 to 39 quarters | $311 a month |
| Premium with fewer than 30 quarters | $565 a month |
| Inpatient deductible (each benefit period) | $1,736 |
| Hospital days 61 to 90 | $434 a day |
| Lifetime reserve days (60 in a lifetime) | $868 a day |
| Skilled nursing facility days 21 to 100 | $217 a day |
Hospital days 1 to 60 and skilled nursing days 1 to 20 have no coinsurance after the deductible. A benefit period ends after 60 days in a row without inpatient or skilled nursing care, so a second hospital stay later in the year can mean a second deductible.
North Carolina public employees and Part A. North Carolina is one of the states where most public workers are covered by Social Security: in 2023, 92.7% of the state's state and local government employees had Social Security coverage, according to the Congressional Research Service. Those jobs pay the Medicare tax too, so teachers, state employees and local government workers usually earn the 40 quarters for Part A with no premium the same way private-sector workers do. See Part A.
What does Part B cost in 2026?
| Part B cost | 2026 |
|---|---|
| Standard monthly premium | $202.90 |
| Yearly deductible | $283 |
| Coinsurance for most services | 20% of the Medicare-approved amount |
| Late enrollment penalty | 10% of the standard premium for each full 12 months you delayed |
The State Health Plan requires Part A and Part B to be in effect for its group Medicare Advantage options (the Base Plan and the Enhanced Plan). A retiree on the 70/30 Plan without Part B has claims paid as if Part B had paid, which leaves the retiree with the part Medicare would have covered. Retiree coverage isn't coverage from current work, so it doesn't protect you from the Part B late penalty either. More on Part B and State Health Plan retirees and Medicare; estimate a penalty with the penalty calculator.
How do you pay the premium in North Carolina?
If you get Social Security or Railroad Retirement benefits, your Part B premium is usually taken out of your monthly payment. Because most North Carolina public jobs are covered by Social Security, that includes most retired teachers and state and local workers who collect Social Security. If you don't get those benefits yet, for example because you're delaying Social Security past 65, Medicare sends a premium bill.
- How often: every 3 months if you have only Part B (including any Part B IRMAA), and every month if you also pay a Part A premium or a Part D IRMAA. Medicare bills are due on the 25th of the month.
- How to pay: online through your Medicare account; Medicare Easy Pay, which takes the premium from your bank account each month (it can take 6 to 8 weeks to start); your bank's online bill pay; or by mail with the payment coupon.
- Your Plan premium is separate: any premium you pay for State Health Plan coverage, a Medigap policy or a Medicare Advantage plan is paid on top of the Part B premium, not instead of it.
IRMAA: who pays more for Part B and Part D?
If your modified adjusted gross income (MAGI) on your 2024 federal tax return was above the first threshold, you pay more for Part B and Part D in 2026. The Part D amount is added to your plan's premium and paid to Medicare. The brackets are cliffs: one dollar into a higher bracket means the whole higher amount applies.
| 2024 MAGI, single | 2024 MAGI, married filing jointly | 2026 Part B premium (monthly) | Part D surcharge (monthly) |
|---|---|---|---|
| $109,000 or less | $218,000 or less | $202.90 | None |
| $109,001 to $137,000 | $218,001 to $274,000 | $284.10 | $14.50 |
| $137,001 to $171,000 | $274,001 to $342,000 | $405.80 | $37.50 |
| $171,001 to $205,000 | $342,001 to $410,000 | $527.50 | $60.40 |
| $205,001 to under $500,000 | $410,001 to under $750,000 | $649.20 | $83.30 |
| $500,000 or more | $750,000 or more | $689.90 | $91 |
Married people who lived with their spouse at some point during the year and file separate returns have their own brackets:
| 2024 MAGI, married filing separately | 2026 Part B premium (monthly) | Part D surcharge (monthly) |
|---|---|---|
| $109,000 or less | $202.90 | None |
| $109,001 to under $391,000 | $649.20 | $83.30 |
| $391,000 or more | $689.90 | $91 |
North Carolina's income tax doesn't enter into it. Social Security sets IRMAA only from the MAGI the IRS reports from your federal return: adjusted gross income plus tax-exempt interest. Deductions or exclusions on your North Carolina return don't lower it. What does count is federal taxable income such as a TSERS or LGERS pension, Social Security that is taxable, withdrawals from the NC 401(k) or NC 457 plans or an IRA, required minimum distributions, Roth conversions and capital gains.
A one-time gain, such as selling a business, farmland, timber or a second home in the mountains or at the coast, counts in the year it happens and can raise your premiums two years later. If your income has fallen because of a life-changing event such as retirement, ask Social Security to recalculate with Form SSA-44; see how to lower IRMAA after you retire. Try the IRMAA calculator.
What does Part D cost in 2026?
| Part D amount | 2026 |
|---|---|
| Maximum yearly deductible a plan can charge | $615 |
| Yearly cap on your out-of-pocket drug costs | $2,100 |
| Most you pay for a month's supply of each covered insulin | $35 |
| National base beneficiary premium (used to figure the late penalty) | $38.99 a month |
Plans set their own premiums and can have a lower deductible or none. Once your out-of-pocket costs for covered drugs reach the cap, you pay nothing more for covered Part D drugs for the rest of the year; the old coverage gap ended in 2025. The Part D late enrollment penalty is 1% of the national base beneficiary premium for each month you went without creditable drug coverage. You can spread drug costs across the year with the Medicare Prescription Payment Plan. North Carolina has no state drug-assistance program for seniors, so Extra Help (below) is the main help with Part D costs. More on Part D in North Carolina, or use the drug cap calculator.
What are the Medicare Advantage out-of-pocket limits?
| Medicare Advantage limit | 2026 maximum |
|---|---|
| In-network services (HMO and PPO) | $9,250 |
| In- and out-of-network services combined (PPO) | $13,900 |
These are the highest limits Medicare allows for Part A and Part B services; each plan sets its own limit at or below them. Drug costs count toward the separate Part D cap. You still pay the Part B premium with a Medicare Advantage plan, including the State Health Plan's group Medicare Advantage options. More on Medicare Advantage in North Carolina.
Which Medigap amounts does Medicare set?
Insurance companies set Medigap premiums. North Carolina lets them use any rating method, but a company that prices by attained age (rising as you get older) must disclose that and show a 10-year illustration of how premiums may rise (G.S. 58-54-25). Medicare sets a few amounts for the standardized plans:
| Medigap amount | 2026 |
|---|---|
| High-deductible Plan G (and Plan F for those eligible before 2020) deductible | $2,950 |
| Plan K yearly out-of-pocket limit | $8,000 |
| Plan L yearly out-of-pocket limit | $4,000 |
| Plan N copays | Up to $20 for some office visits, up to $50 for emergency room visits that don't lead to admission |
North Carolina has no Medigap birthday rule or annual switching right, so outside your six-month Medigap open enrollment period or a guaranteed-issue right, a company can usually review your health before selling you a policy. More on Medigap in North Carolina.
How much does Extra Help save on drugs?
Extra Help (the Part D Low-Income Subsidy) lowers drug plan premiums, deductibles and copays. For 2026:
| Extra Help | Individual | Married couple |
|---|---|---|
| Yearly income limit (150% of the federal poverty level) | $23,940 | $32,460 |
| Resource limit | $16,590 | $33,100 |
| Resource limit if you expect to use some for burial | $18,090 | $36,100 |
| Most you pay per prescription with Extra Help in 2026 | Generic | Brand name |
|---|---|---|
| Most people with Extra Help | $5.10 | $12.65 |
| People with full NC Medicaid and income at or below 100% of the poverty level | $1.60 | $4.90 |
Your home, one car and certain other things don't count as resources. Apply through Social Security at ssa.gov/extrahelp or 1-800-772-1213. If you have full NC Medicaid, an MQB program or Supplemental Security Income, you qualify automatically. See Extra Help in North Carolina.
What are North Carolina's MQB limits?
North Carolina calls its Medicare Savings Programs MQB (Medicare Qualified Beneficiary). They are part of NC Medicaid, and your county Department of Social Services (DSS) decides who qualifies. NC Medicaid publishes the monthly income limits in its chart MA-2252, effective April 1, 2026; they are set as percentages of the federal poverty level:
| NC program (federal name) | Monthly income limit | What it pays |
|---|---|---|
| MQB-Q (QMB) | Up to 100% of the federal poverty level | Part A and Part B premiums, deductibles, copays and coinsurance |
| MQB-B (SLMB) | Over 100% up to 120% | Part B premium |
| MQB-E (QI) | Over 120% up to 135% | Part B premium |
| Resource limit, all three | $9,950 single, $14,910 couple | Countable savings and property |
North Carolina keeps an asset test at the federal limit shown above. For the dollar amount that matches your household size, see NC Medicaid's MA-2252 income and reserve chart; the monthly figures Medicare.gov shows for these programs are a little higher because they build in a standard income disregard. Your home and one car don't count as resources. Apply online through ePASS (NC Medicaid's application calls it "Medical Assistance"), or in person, by phone or by mail through your county DSS. The NC Medicaid Contact Center, 1-888-245-0179, can help you find your DSS. Check your numbers with the savings programs screener, and read Medicare Savings Programs in North Carolina.
What changed from 2025 to 2026?
| Amount | 2025 | 2026 | Change |
|---|---|---|---|
| Part B standard premium (monthly) | $185 | $202.90 | +$17.90 |
| Part B deductible | $257 | $283 | +$26 |
| Part A deductible | $1,676 | $1,736 | +$60 |
| Part D out-of-pocket cap | $2,000 | $2,100 | +$100 |
| First IRMAA threshold, single | $106,000 | $109,000 | +$3,000 |
| First IRMAA threshold, married filing jointly | $212,000 | $218,000 | +$6,000 |
CMS announces the next year's Part A and Part B amounts each fall. What CMS has already published for 2027 (Part D, Medicare Advantage limits, Medigap amounts, Extra Help copays) is on Medicare costs in 2027.
Do costs differ by North Carolina county?
Original Medicare costs the same in all 100 counties. Your plan choices don't: for 2027, CMS lists 57 Medicare Advantage plans open to everyone in Guilford County but 11 in Carteret County, and 11 standalone Part D plans statewide. Each plan sets its own premium, deductible and copays. Every county still has regular Medicare Advantage plans in 2027, but some plans are ending, and at least 30,654 North Carolinians must choose new coverage; see North Carolina plans ending in 2027 and your county on the county list.
Where can North Carolinians get help paying Medicare costs?
MQB programs
MQB-Q, MQB-B and MQB-E pay the Part B premium, and MQB-Q also pays Part A premiums, deductibles and coinsurance. Apply through ePASS or your county DSS. Learn more.
Extra Help
Lowers Part D premiums, deductibles and copays, and comes automatically with MQB, full NC Medicaid or SSI. Others apply through Social Security. Extra Help in North Carolina.
Full NC Medicaid
People with Medicare and full Medicaid are served through NC Medicaid Direct, which pays after Medicare for covered services. NC Medicaid and Medicare.
A licensed insurance agent
To see how plans from the companies they work with handle these costs, at no cost to you, you can request a call from a licensed insurance agent.
To compare coverage, see plans for your ZIP code.
Sources
- CMS — 2026 Medicare Parts A & B premiums and deductibles
- Medicare.gov — Medicare costs
- Medicare.gov — Pay Medicare premiums (Medicare Easy Pay, premium bills)
- Social Security — Premiums: rules for higher-income beneficiaries
- Social Security POMS HI 01101.010 — Modified adjusted gross income and the tax year used for IRMAA
- Congressional Research Service — Social Security Coverage of State and Local Government Employees (R46961), Table 1
- Social Security — Mandatory Medicare coverage for state and local government employees
- State Health Plan — Retiring and Medicare presentation, 2026 (Parts A and B requirements)
- NC Department of State Treasurer — NC 401(k) and NC 457 plans
- N.C. General Statutes Chapter 58, Article 54 — Medicare supplement insurance (G.S. 58-54-25)
- CMS — CY2026 resource and cost-sharing limits for the Low-Income Subsidy
- Medicare.gov — Medicare Savings Programs
- NC Medicaid — MA-2252 Non-MAGI income and reserve limits, effective April 1, 2026 (PDF)
- NC Medicaid — How to apply (ePASS and county DSS)
- CMS — CY2027 Medicare Advantage and Part D Landscape files (North Carolina plan counts)
Every question in this guide
Frequently asked questions
Does Social Security take the Part B premium out of my check?
Usually, yes. If you get Social Security or Railroad Retirement benefits, the Part B premium is normally deducted from your monthly payment. Most North Carolina state and local jobs are covered by Social Security, so most North Carolina public retirees who collect Social Security have Part B taken out this way.
How do I pay my Medicare premium if I don't get Social Security?
Medicare sends you a premium bill, every 3 months if you have only Part B and every month if you pay a Part A premium or a Part D IRMAA. You can pay online through your Medicare account, sign up for Medicare Easy Pay to have it taken from your bank account each month, use your bank's bill pay, or mail a payment.
Does Original Medicare have an out-of-pocket maximum?
No. Original Medicare has no yearly out-of-pocket limit for Part A and Part B. Medicare Advantage plans must have one, up to $9,250 for in-network services in 2026, and Part D has its own $2,100 cap. Many people with Original Medicare add a Medigap policy to limit their costs.
How much does Medicare pay for a skilled nursing facility stay?
After a qualifying inpatient hospital stay of at least three days, Part A pays the full cost of days 1 to 20 in a Medicare-certified skilled nursing facility. For days 21 to 100 you pay $217 a day in 2026, and after day 100 you pay all costs.
Do Medicare costs change from one North Carolina county to another?
Not for Original Medicare. The Part A and Part B premiums, deductibles and coinsurance are federal and the same in every county. What changes by county is your choice of Medicare Advantage plans, and each plan sets its own premium and copays.
How much did Medicare go up from 2025 to 2026?
The standard Part B premium rose from $185 to $202.90 a month, the Part B deductible from $257 to $283, the Part A deductible from $1,676 to $1,736, and the Part D out-of-pocket cap from $2,000 to $2,100.
Medicare in your North Carolina county
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