Medicare costs you money in four separate ways, and the amount depends on your income, how long you worked, and which parts you choose

Most people pay a Part A premium (hospital insurance), a Part B premium (medical insurance), a Part D premium (prescription drugs), and often a Medigap or Medicare Advantage premium. If you worked 40 quarters (10 years) under Social Security, Part A is free. Part B costs most people around $165 per month in 2024, though higher earners pay more. Part D and supplemental coverage vary widely by plan and location.

The exact amount you pay changes each year, and it depends on when you sign up, your income level, and which coverage you choose. There is no single "Medicare cost" — it is a combination of separate pieces, each with its own price.

Key Takeaways

  • Part A (hospital) is free for most people who worked 10 years under Social Security; Part B (doctor visits) costs around $165 monthly for most enrollees in 2024.
  • Higher earners pay more for Part B and Part D through an income-related surcharge called IRMAA, which can add $70 to $560+ per month depending on your income.
  • Part D (prescription drug coverage) premiums range from $5 to $100+ per month depending on the plan you choose and where you live.
  • Medigap or Medicare Advantage plans add another premium on top of Part B, ranging from $0 to $300+ per month depending on the plan and your age.
  • You can see your exact costs before you choose a plan by using the Medicare Plan Finder tool on Medicare.gov.

Part A: Hospital Insurance and Who Pays Nothing

Part A covers hospital stays, skilled nursing care after a hospital stay, hospice, and some home health services. Most people who worked at least 40 quarters (10 years) under Social Security pay nothing for Part A. If you did not work that long, you can buy Part A coverage, but the premium ranges from around $275 to $505 per month depending on how many quarters you worked.

Even if Part A is free, you still pay a deductible when you use it — around $1,600 per hospital stay in 2024. This deductible resets every 60 days without a hospital stay. Part A does not cover everything: it does not pay for private duty nursing, a private room (unless medically necessary), or most long-term care in a nursing home.

Part B: Doctor Visits and the Standard Premium

Part B covers doctor visits, outpatient care, lab tests, X-rays, and some preventive services. The standard Part B premium for 2024 is around $165 per month for most people. You also pay a yearly deductible (around $240 in 2024) before Part B starts paying, and then you typically pay 20 percent of the cost of services after that.

If you have higher income, you pay more through a surcharge called IRMAA (Income-Related Monthly Adjustment Amount). IRMAA is based on your income from two years ago. For example, if you are single and earned more than $97,000 in 2022, you paid an extra surcharge on top of the standard $165 in 2024. The surcharge can range from $70 to $560 per month depending on how much you earned. Medicare sends you a letter each year telling you if IRMAA applies to you.

Part D: Prescription Drug Coverage Premiums

Part D covers prescription medications through private insurance plans. The premium varies by plan and by location — there is no single Part D cost. Some plans cost $5 per month, others cost $100 or more. The plan you choose also affects your out-of-pocket costs when you fill a prescription: some plans have low premiums but high copays, others have higher premiums but lower copays.

You can change your Part D plan every year during the annual enrollment period (October 15 to December 7). If you do not sign up for Part D when you first become may be able to access and you go without coverage, you pay a late enrollment penalty — a permanent increase to your premium for as long as you have Part D. The penalty is roughly 1 percent of the national average Part D premium for each month you were not covered.

Use the Medicare Plan Finder on Medicare.gov to see the actual Part D premiums and copays for your medications in your area. Prices change every year and vary by zip code.

Medigap and Medicare Advantage: The Second Layer of Premiums

After you choose Part A and Part B, you have two main options for filling the gaps in coverage: Medigap (supplemental insurance) or Medicare Advantage (an alternative to Original Medicare).

Medigap is sold by private insurance companies and covers some of the costs that Original Medicare does not — like copays, coinsurance, and deductibles. Medigap premiums range from around $100 to $300+ per month depending on the plan letter (A through N), your age, your location, and the insurance company. Medigap does not cover prescription drugs, so you still need Part D.

Medicare Advantage (Part C) is an alternative way to get Part A and Part B coverage through a private insurance company. Many Medicare Advantage plans have $0 premiums, but you still pay the Part B premium to Medicare. Medicare Advantage plans often include prescription drug coverage (Part D) built in. However, they typically have networks (you must use certain doctors), higher copays per visit, and annual out-of-pocket limits. Some Medicare Advantage plans charge $50 to $200+ per month on top of Part B.

Income-Related Surcharges: When You Pay More

If your income is above a certain threshold, you pay IRMAA — an extra monthly charge added to your Part B and Part D premiums. IRMAA is calculated based on your Modified Adjusted Gross Income (MAGI) from two years before. For example, your 2024 IRMAA is based on your 2022 income.

The income thresholds and surcharge amounts change each year. In 2024, single filers with income over $97,000 and married filers with income over $194,000 paid an IRMAA surcharge. The surcharge can be $70, $175, $245, $315, or $560 per month depending on your income level. If your income drops significantly (due to retirement, divorce, or death of a spouse), you can request that Medicare recalculate your IRMAA.

How to Find Your Exact Monthly Costs

The easiest way to see what you will actually pay is to use the Medicare Plan Finder on Medicare.gov. You enter your zip code, the medications you take, and your preferred doctors, and the tool shows you the premium and out-of-pocket costs for every plan available to you. This is the most accurate way to compare costs before you choose.

You can also call Medicare directly at 1-800-MEDICARE (1-800-633-4227) to ask about costs for specific plans. Representatives can walk you through the options and answer questions about IRMAA, late enrollment penalties, and coverage details.

Frequently Asked Questions

Do I have to pay for Part A if I worked less than 10 years?

No, you do not have to buy Part A, but if you do not, you will pay out of pocket for hospital stays. If you worked between 30 and 39 quarters, you can buy Part A at a reduced rate. If you worked fewer than 30 quarters, the full premium applies. You can buy Part A when you turn 65 even if you do not buy Part B.

What happens if I delay signing up for Medicare?

If you delay Part B or Part D, you pay a permanent late enrollment penalty for as long as you have Medicare. The penalty is roughly 10 percent of the Part B premium for each 12-month period you were late, and roughly 1 percent of the national average Part D premium for each month you were not covered. The penalty does not go away, even if you sign up later.

Can I change my Medicare plan if my costs go up?

Yes. You can change Part D plans every year during open enrollment (October 15 to December 7). If you have Medicare Advantage, you can switch to Original Medicare or a different Advantage plan during the same window. If you have Original Medicare and Medigap, you can change Medigap plans, though insurers may deny coverage or charge more if you have pre-existing conditions.

Does Medicare cost more if I am still working?

No, your Part B and Part D premiums are the same whether you work or not. However, if you are still earning income, your IRMAA surcharge may be higher. Once you stop working, your income drops, and you can ask Medicare to recalculate your IRMAA for the following year.

Are there programs to help pay my Medicare premiums?

Yes. The may have access to Medicare Beneficiary (QMB) program, Specified Low-Income Medicare Beneficiary (SLMB) program, and may have access to Individual (QI) program help people with low income pay Part B, Part D, and other Medicare costs. Each state runs these programs differently. Contact your State Health Insurance information Program (SHIP) or call 1-800-MEDICARE to learn if you may be may be able to access.