When you're managing finances on a single income, perhaps for the first time in decades, every dollar matters. One of the most common questions about Medicare is simply this: "What will I actually have to pay?"

The answer isn't as simple as a single monthly premium. Medicare has deductibles, copayments, and coinsurance that can add up quickly if you're not prepared. The good news is that there are strategies to manage these costs, and for those with limited income, there are assistance programs specifically designed to help.

This guide will help you understand what you'll really pay, how to protect yourself from unexpected expenses, and where to turn if you need financial help.

What Original Medicare Doesn't Cover: Understanding the Gaps

Original Medicare (Parts A and B) provides strong coverage, but it doesn't pay for everything. Understanding these gaps is the first step in managing your costs.

The Part A Gap: Hospital Deductibles

While most people pay no monthly premium for Part A, you're responsible for a deductible each time you're admitted to the hospital.

In 2026, the Part A deductible is $1,716 per benefit period.

A benefit period starts the day you're admitted to a hospital and ends when you haven't received inpatient hospital care or skilled nursing care for 60 consecutive days. If you're admitted to the hospital twice in one year, several months apart, you may have to pay this deductible twice.

For days 1-60 in the hospital, you pay nothing after the deductible. For days 61-90, you pay a daily coinsurance ($429/day in 2026). For stays longer than 90 days, you begin using your "lifetime reserve days," which carry an even higher daily coinsurance ($858/day in 2026).

The Part B Gap: The 20% Coinsurance

This is the more significant ongoing cost for most people.

Part B has an annual deductible of $288 in 2026. After you meet this deductible, Part B pays 80% of the Medicare-approved amount for most services. You're responsible for the remaining 20% coinsurance.

Here's the concerning part: there is no annual limit on this 20%. If you have expensive care—cancer treatment, major surgery, ongoing specialist visits—that 20% can add up to thousands or even tens of thousands of dollars in a single year.

What's Not Covered at All

Original Medicare also does not cover:

Routine dental care (cleanings, fillings, dentures)

Routine eye exams and eyeglasses (except after cataract surgery)

Hearing aids and routine hearing exams

Long-term care (nursing home care beyond skilled nursing)

Most care outside the United States

This is why many people choose either a Medigap plan to fill the gaps, or a Medicare Advantage plan that includes these extra benefits.

Your Safety Net: Medigap (Medicare Supplement Insurance)

Medigap is private insurance designed to work alongside Original Medicare. It helps pay for the out-of-pocket costs that Medicare doesn't cover, giving you predictable expenses and protection from large medical bills.

How Medigap Works

You pay a monthly premium to a private insurance company. In exchange, when you receive care:

Medicare pays its share (usually 80%)

Your Medigap plan pays most or all of the remaining costs

You pay little to nothing at the point of service

For example, if you have a $10,000 surgery:

Medicare Part B pays $8,000 (80%)

Your Medigap plan pays $2,000 (the 20% coinsurance)

You pay $0

The Standardized Plans: Choosing the Right Letter

Medigap plans are standardized by the federal government. Each plan is identified by a letter (Plan A, Plan B, Plan C, etc.), and every insurance company's "Plan G," for instance, offers exactly the same benefits. The only difference between companies is the price and customer service.

The Most Popular Plans:

Plan G: The most comprehensive plan available to new enrollees. It covers everything except the Part B deductible ($288 in 2026). After you pay that small deductible, Plan G covers all your coinsurance, copayments, and even excess charges. This is the plan most experts recommend for comprehensive, predictable coverage.

Plan N: A lower-premium option. It covers most costs but requires small copays ($20 for doctor visits, $50 for emergency room visits that don't result in admission). It's a good middle-ground option if you want to save on premiums and are comfortable with modest copays.

Plan F: The most comprehensive plan (covers even the Part B deductible), but it's only available to people who became eligible for Medicare before January 1, 2020.

High-Deductible Plan G: A lower-premium version of Plan G. You pay a $2,870 deductible (in 2026) out of pocket before the plan begins to pay. Good for those who want catastrophic protection but are willing to pay smaller bills themselves.

What Medigap Costs

Medigap premiums vary widely based on:

Your location: Premiums in rural areas are often lower than in cities

Your age: Premiums increase as you get older

Your gender: Women often pay slightly more than men

The insurance company: Shop around—premiums for the same plan can differ by hundreds of dollars per month between companies

On average, Plan G premiums range from $125 to $250 per month, depending on these factors. Plan N is typically $100 to $200 per month.

When You Can Buy Medigap: The Golden Window

The best time to buy Medigap is during your Medigap Open Enrollment Period, which is the first six months after you enroll in Part B at age 65 or older.

During this time, insurance companies cannot:

Deny you coverage due to health conditions

Charge you more due to pre-existing conditions

Make you wait for coverage to begin

Outside of this window, you may face medical underwriting. The insurance company can ask about your health history and may deny you coverage, charge you much higher premiums, or impose waiting periods for pre-existing conditions.

For widows and widowers: If you delayed Medicare enrollment because you were on your spouse's employer plan and now need to enroll due to their passing, you have a Special Enrollment Period for Medicare. Your Medigap open enrollment period begins when your Part B coverage starts—use this time to enroll in a Medigap plan without medical underwriting.

Medigap vs. Medicare Advantage: A Quick Reminder

You cannot have both a Medigap plan and a Medicare Advantage plan. You must choose one path:

Path 1: Original Medicare + Medigap + Part D (three separate pieces)

Path 2: Medicare Advantage (all-in-one)

Once you've chosen Medicare Advantage, you can switch back to Original Medicare during certain enrollment periods, but buying a Medigap plan may be difficult or expensive outside your initial enrollment window.

Financial Assistance Programs: Help is Available

If you have limited income and resources, there are several programs designed to help pay for Medicare and prescription drugs. These are not "handouts"—they are benefits you may be entitled to, and using them can make a significant difference in your financial security.

Medicaid: Comprehensive Help for Low-Income Beneficiaries

Medicaid is a joint federal and state program that provides health coverage to people with limited income and resources. If you qualify for both Medicare and Medicaid (known as being "dual-eligible"), Medicaid can help pay for:

Medicare premiums (Part A, Part B, and sometimes Part D)

Medicare deductibles and coinsurance

Services Medicare doesn't cover, such as long-term care and dental care

Eligibility varies by state, but generally, you may qualify if your income is at or near the federal poverty level and you have limited assets. In many states, you can earn up to about $1,700/month as an individual and still qualify, though the exact threshold varies.

How to Apply: Contact your state Medicaid office or apply online at healthcare.gov. You can also call 1-800-MEDICARE for help.

Medicare Savings Programs (MSPs): Help Paying Premiums

If your income is too high to qualify for full Medicaid but you still need help, Medicare Savings Programs can pay some or all of your Medicare premiums.

There are four MSP programs, each with different income and asset limits:

Qualified Medicare Beneficiary (QMB) Program: Pays Part A and Part B premiums, deductibles, coinsurance, and copayments. Income limit for 2026: approximately $1,295/month for individuals ($1,745/month for couples) (based on 2025 guidelines adjusted for inflation).

Specified Low-Income Medicare Beneficiary (SLMB) Program: Pays Part B premiums only. Income limit for 2026: approximately $1,550/month for individuals ($2,090/month for couples) (based on 2025 guidelines adjusted for inflation).

Qualifying Individual (QI) Program: Pays Part B premiums only, with slightly higher income limits than SLMB.

Qualified Disabled and Working Individuals (QDWI) Program: Pays Part A premiums for people under 65 who are disabled and working.

Asset limits for most MSPs are around $9,430 for individuals and $14,130 for couples (excluding your home and one vehicle).

How to Apply: Contact your State Health Insurance Assistance Program (SHIP) or your state Medicaid office. Find your local SHIP at shiptacenter.org or call 1-877-839-2675.

Extra Help (Low-Income Subsidy) for Part D Prescription Drugs

The Extra Help program, also called the Low-Income Subsidy (LIS), helps pay for Part D prescription drug costs, including premiums, deductibles, and copayments.

If you qualify for Extra Help, you could pay:

$0 to $4.50 per prescription for generic drugs

$0 to $11.20 per prescription for brand-name drugs

No coverage gap ("donut hole")

No late enrollment penalty for Part D

To qualify for full Extra Help in 2026, your income must be below approximately $1,930/month for individuals ($2,610/month for couples), and your assets must be under $16,950 for individuals ($33,840 for couples) (based on 2025 guidelines adjusted for inflation).

How to Apply: Apply online at ssa.gov/benefits/medicare/prescriptionhelp, call Social Security at 1-800-772-1213, or visit your local Social Security office.

Automatic Qualification: If you receive Medicaid or Supplemental Security Income (SSI), you automatically qualify for Extra Help.

State Pharmaceutical Assistance Programs (SPAPs)

Some states offer their own programs to help residents pay for prescription drugs. These programs have different names and eligibility requirements in each state. They can work alongside Medicare Part D to reduce your costs even further.

To find out if your state offers a SPAP, visit medicare.gov/spap or call 1-800-MEDICARE.

Estimating Your Total Costs: Two Real-World Examples

Let's look at what you might actually pay in two different scenarios.

Scenario 1: Margaret Chooses Original Medicare + Medigap

Margaret is 67, widowed, and has an income of $38,000/year. She has some ongoing health needs and wants predictable costs.

Her monthly costs:

Part B Premium: $206.50

Medigap Plan G Premium: $175

Part D Premium: $30

Total Monthly Premium: $411.50

Her costs when she gets care:

Part B Deductible (annual): $288 (paid once per year)

After that: $0 for doctor visits, hospital stays, or other Medicare-covered services

Her prescriptions: $10-$30 per month in copays

Margaret's annual out-of-pocket costs: Approximately $4,938 in premiums + $288 deductible + ~$200 in drug copays = about $5,426/year, with no surprise bills.

Scenario 2: Robert Chooses Medicare Advantage

Robert is 66, widowed, and has an income of $32,000/year. He's in good health and wants to keep his fixed costs low.

His monthly costs:

Part B Premium: $206.50

Medicare Advantage Plan Premium: $0

Total Monthly Premium: $206.50

His costs when he gets care:

Primary care visit: $10 copay

Specialist visit: $40 copay

Lab work: $15 copay

Prescriptions: $5-$20 per month depending on the drug

Plan's Out-of-Pocket Maximum: $6,700 per year

Robert's annual costs in a healthy year: $2,478 in premiums + approximately $400 in copays for routine visits and prescriptions = about $2,878/year.

Robert's costs in a major medical year (e.g., surgery): $2,478 in premiums + up to $6,700 out-of-pocket maximum = up to $9,178/year, but no more.

Your Action Plan: Managing Your Medicare Costs

Here's how to take control of your Medicare expenses:

Step 1: Understand Your Options

• Know the difference between Original Medicare with Medigap and Medicare Advantage
• Understand what each path will cost you monthly and when you receive care

Step 2: Assess Your Needs

• Do you have ongoing health conditions or take expensive medications?
• Do you travel or want nationwide coverage?
• Is budget predictability or low monthly premiums more important to you?

Step 3: Apply for Assistance if Eligible

• If your income is modest, apply for Extra Help, Medicare Savings Programs, or Medicaid
• These programs are underutilized—don't leave money on the table

Step 4: Shop Around

• Use Medicare's Plan Finder at medicare.gov/plan-compare
• Compare Medigap premiums from multiple insurance companies
• Review your coverage every year during Open Enrollment

Step 5: Get Help if You Need It

• Call 1-800-MEDICARE for free, unbiased guidance
• Contact your State Health Insurance Assistance Program (SHIP) for local, in-person help
• Consider working with a licensed insurance agent (at no cost to you)

Your Peace of Mind

Managing healthcare costs on your own can feel daunting, but you now have the knowledge to make informed choices. Whether you opt for the predictability of Original Medicare with Medigap or the lower upfront costs of Medicare Advantage, you can move forward knowing you understand the financial picture.

And if money is tight, remember that help is available. Millions of Americans use Medicare assistance programs every year. There's no shame in accessing benefits designed to help you—only wisdom in protecting your financial security while getting the care you need.

Disclaimer: The information provided in this article is for general educational purposes only and should not be construed as medical, legal, or professional advice. Wings for Widows does not provide insurance counseling services or specific Medicare enrollment advice. Medicare laws and regulations are complex and subject to change. We strongly encourage readers to consult with a qualified insurance agent, Medicare counselor, or State Health Insurance Assistance Program (SHIP) regarding their specific circumstances. While we strive to provide accurate and up-to-date information, individual situations vary, and professional guidance is essential for making informed healthcare coverage decisions.

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