Medicare costs vary significantly by state, a Plan G that costs $120/month in Nebraska could cost $280/month in Florida or $320/month in New York. The federal portions of Medicare (Part A and Part B premiums and deductibles) are the same everywhere, but Medicare Supplement premiums, Medicare Advantage plan options, and Part D drug costs differ dramatically based on where you live.
According to CMS data, the average Medicare beneficiary spends between $3,000 and $10,000 per year on premiums, deductibles, and cost-sharing, but your actual cost depends on your state, your plan choice, and how much healthcare you use. This guide breaks it all down.
Which Medicare Costs Are the Same in Every State?
These federal costs are identical regardless of where you live in 2026:
| Cost | 2026 Amount | Notes |
|---|---|---|
| Part B monthly premium | $202.90 | Higher with IRMAA surcharges for incomes above $106,000 |
| Part A deductible | $1,736 | Per benefit period (not per year) |
| Part B deductible | $283 | Once per calendar year |
| Part B coinsurance | 20% | No out-of-pocket maximum with Original Medicare |
| Part D out-of-pocket cap | $2,100 | New annual maximum, drugs are free after this |
The critical point: Original Medicare has no out-of-pocket maximum. That 20% Part B coinsurance is uncapped. A $200,000 cancer treatment means $40,000 in coinsurance. This is why virtually everyone needs either a Medicare Supplement or Medicare Advantage plan.
How Do Medicare Supplement Premiums Compare by State?
This is where geography matters most. Medicare Supplement plans are standardized (Plan G covers the same things everywhere), but premiums are set by private insurance companies and vary dramatically by state.
Estimated Plan G monthly premiums for a 65-year-old non-smoking female (2026):
| State | Plan G Range | Cost Category |
|---|---|---|
| Ohio | $90 to $130 | Low cost |
| Michigan | $95 to $140 | Low cost |
| Nebraska | $120 to $160 | Low cost |
| Missouri | $100 to $145 | Low cost |
| Kansas | $105 to $150 | Low cost |
| Iowa | $115 to $155 | Low cost |
| Texas | $130 to $200 | Moderate |
| Illinois | $140 to $210 | Moderate |
| Georgia | $135 to $195 | Moderate |
| Virginia | $140 to $200 | Moderate |
| Florida | $180 to $280 | High cost |
| California | $190 to $300 | High cost |
| New York | $200 to $350 | High cost |
| Connecticut | $210 to $320 | High cost |
*Estimates based on publicly available rate filings and industry data. Actual premiums vary by carrier, exact age, gender, zip code, and tobacco use.
The Kaiser Family Foundation reports that Medigap premiums are influenced by state insurance regulations, local healthcare costs, carrier competition, and the health of the enrolled population.
How Does Medicare Advantage Availability Vary by Location?
Medicare Advantage plans vary by county, not just state. According to CMS, 99% of Medicare beneficiaries have access to at least one Medicare Advantage plan, but the number of options ranges from 2 to 3 in rural areas to 50+ in major metros.
- Urban areas (30+ plans): Miami, Houston, Los Angeles, Phoenix, Omaha, strong carrier competition drives $0-premium options with rich benefits
- Suburban areas (15 to 30 plans): Most mid-size metros, good selection with some $0 options
- Rural areas (2 to 10 plans): Limited choices, potentially higher out-of-pocket costs and narrower networks
A key finding: the KFF reports that Medicare Advantage enrollment is highest in states with many plan options, Florida (54% of beneficiaries), Minnesota (51%), and Oregon (49%) lead the nation.
How Do Part D Drug Plan Costs Differ by State?
Part D premiums range from $0 to $100+/month, with the national average base premium at $36.78 in 2026. However, the right plan depends entirely on which medications you take, a plan that's cheapest for one person might be the most expensive for another.
Geographic factors affecting Part D costs:
- Number of plans available: More competition generally means lower premiums
- Pharmacy networks: Plans with preferred pharmacy agreements (e.g., Costco, Walmart) can offer lower copays
- State assistance programs: Some states (like New York's EPIC program) offer additional prescription drug assistance
The biggest change for 2026: the new $2,100 out-of-pocket cap applies everywhere, nationwide. This eliminates the catastrophic costs that previously devastated beneficiaries taking expensive specialty medications. Read our complete Part D guide for details.
What Is the Total Annual Medicare Cost by Plan Type?
Here's what a typical 65-year-old can expect to pay per year in total Medicare costs (using moderate-cost state estimates):
| Plan Type | Healthy Year | Major Health Event |
|---|---|---|
| Original Medicare + Plan G + Part D | $4,500 to $5,500 | $4,800 to $5,800 |
| Original Medicare + Plan N + Part D | $3,800 to $4,800 | $4,200 to $5,400 |
| Original Medicare + HD Plan G + Part D | $3,200 to $3,800 | $5,800 to $6,500 |
| Medicare Advantage ($0 premium) | $2,500 to $3,200 | $6,000 to $11,300 |
The key insight: Medicare Supplement plans cost more in healthy years but protect you in bad years. Medicare Advantage is cheaper month-to-month but can cost significantly more when you actually need healthcare. Read our full Supplement vs. Advantage comparison.
Which States Are Best and Worst for Medicare Costs?
Based on total Medicare costs (premiums, healthcare utilization, and cost of living):
Most affordable states for Medicare: Ohio, Michigan, Kansas, Nebraska, Iowa, Missouri, lower Medigap premiums, competitive Advantage markets, and lower healthcare costs generally.
Most expensive states for Medicare: Connecticut, New York, New Jersey, California, Florida, Massachusetts, higher Medigap premiums, higher healthcare costs, and higher cost of living.
For Nebraska-specific cost data, see our detailed Medicare costs guide for Nebraska in 2026.
Frequently Asked Questions About Medicare Costs by State
Why do Medicare Supplement premiums vary so much by state?
Three main factors: state insurance regulations (some states require community rating), local healthcare costs (which affect claims experience), and carrier competition (more carriers = more competitive pricing). States with higher healthcare costs and fewer carriers tend to have the highest Medigap premiums.
If I move to a different state, do my Medicare costs change?
Part B premiums stay the same. But Supplement premiums can change significantly, you may need to apply for a new plan in your new state, potentially facing medical underwriting. Medicare Advantage plans are county-specific, so you'll need a new plan in your new area (moving is a qualifying event for a Special Enrollment Period).
Do higher-income earners pay more for Medicare in every state?
Yes, IRMAA surcharges apply nationwide. If your income exceeds $106,000 (individual) or $212,000 (married filing jointly), you'll pay higher Part B and Part D premiums regardless of where you live.
Is Medicare Advantage better in some states than others?
Yes. Urban areas with high carrier competition (South Florida, Texas metros, Phoenix) tend to have the richest Advantage plans with the most extra benefits. Rural areas may have limited options with narrower networks and fewer perks.