Medicare Part A and Part B have different costs, and what you pay depends on your work history and income
Medicare Part A (hospital insurance) is free for most people 65 and older who worked and paid Medicare taxes for at least 10 years. If you did not work that long, you may pay a monthly premium — either about $278 or $505 per month in 2024, depending on how many years you worked.
Medicare Part B (medical insurance) costs a monthly premium that changes each year. The standard premium is $164.90 per month in 2024, but you may pay more if your income is higher. Most people have Part B premiums taken directly from their Social Security check.
Both parts also have deductibles and copayments — amounts you pay when you actually use care. These are separate from the monthly premium and can add up quickly if you need frequent medical care.
Key Takeaways
- Most people pay nothing for Part A if they worked and paid Medicare taxes for at least 10 years; others pay $278 or $505 per month depending on work history.
- Part B costs $164.90 per month in 2024 for most people, but higher earners pay more based on income thresholds set two years prior.
- You also pay a $1,632 deductible for Part A hospital stays and a $240 annual deductible for Part B doctor visits in 2024.
- Part A copayments for hospital stays range from $408 to $816 per day depending on how long you stay; Part B requires 20% copayment for most services after the deductible.
- Income-related premiums for Part B and Part D are based on your tax return from two years before, so changes in income take time to show up in your bill.
Part A costs: who pays nothing and who pays a premium
If you or your spouse worked at least 10 years in a job where you paid Medicare taxes, you pay no monthly premium for Part A. This covers hospital stays, skilled nursing facility care, hospice, and some home health services. You are automatically enrolled in Part A when you turn 65 if you are already receiving Social Security.
If you worked fewer than 10 years, you can still buy Part A. The premium is $278 per month if you worked 30 to 39 years, or $505 per month if you worked fewer than 30 years. Some people who are not yet 65 but have been on disability for two years, or who have end-stage renal disease, also may have access to for Part A.
Even if Part A is free, you still pay out-of-pocket costs when you use it. In 2024, you pay a $1,632 deductible for each hospital stay. After that, you pay copayments: $408 per day for days 1 through 60, $816 per day for days 61 through 90, and $816 per day for each "lifetime reserve day" (you have 60 of these over your lifetime). Skilled nursing facility care costs $204 per day for days 1 through 20, then $408 per day for days 21 through 100.
Part B costs: the monthly premium and income-related increases
Part B costs $164.90 per month in 2024 for most people. However, if your income is above certain thresholds, you pay a higher premium called an Income-Related Monthly Adjustment Amount (IRMAA). The income thresholds are based on your tax return from two years before you enroll, so changes in your income do not show up in your bill right away.
For 2024, if you filed taxes as a single person and your modified adjusted gross income was above $97,000, you pay more for Part B. The amounts range from $230.80 to $560.50 per month depending on how much your income exceeds the threshold. If you filed as married filing jointly, the threshold is $194,000. These thresholds change each year.
Part B also has a $240 annual deductible in 2024. After you meet the deductible, you typically pay 20% of the cost for doctor visits, outpatient services, and medical equipment. Some services like preventive care (annual wellness visits, cancer screenings, vaccines) have no copayment after the deductible is met.
Deductibles and copayments add up quickly
The monthly premium is only part of what you pay. The deductibles and copayments can be substantial, especially if you have a hospital stay or need ongoing medical care. A single night in the hospital triggers the $1,632 Part A deductible, and a week-long stay could cost you $408 per day for seven days plus the deductible.
For Part B, the $240 deductible applies once per calendar year. After that, you pay 20% of the Medicare-approved amount for most services. If you see a specialist, have lab work done, or need imaging like an X-ray or MRI, those 20% copayments add up. A doctor visit might cost you $30 to $50 out of pocket; an MRI could be $100 to $300 depending on the facility.
Many people buy Medigap (supplemental insurance) or enroll in Medicare Advantage (Part C) to reduce these out-of-pocket costs. Medigap premiums vary widely by plan and location, typically ranging from $100 to $300 per month. Medicare Advantage plans often have lower or no premiums but may have higher copayments and network restrictions.
How to find out what you will actually pay
Your actual costs depend on several things: whether you have Part A for free or pay a premium, your income level (which affects Part B premiums), which services you use, and whether you have supplemental coverage. The easiest way to see your specific costs is to log into your Medicare account at Medicare.gov or call 1-800-MEDICARE to speak with someone who can review your situation.
When you first turn 65, you receive a notice showing your Part A and Part B premiums. If your income changes significantly — through retirement, a large withdrawal, or the sale of a home — your Part B premium may increase the following year. You can appeal an income-related premium increase if your income dropped due to retirement, death of a spouse, or loss of income-producing property.
If you cannot afford your premiums, some state programs help pay Part A and Part B costs for people with limited income and resources. Your local Area Agency on Aging or a Medicare counselor can tell you whether you may have access to.
Part B premiums by income level in 2024
| Modified Adjusted Gross Income (Single) | Modified Adjusted Gross Income (Married Filing Jointly) | Part B Premium per Month |
|---|---|---|
| $97,000 or less | $194,000 or less | $164.90 |
| $97,001–$121,000 | $194,001–$242,000 | $230.80 |
| $121,001–$145,000 | $242,001–$290,000 | $329.70 |
| $145,001–$169,000 | $290,001–$338,000 | $428.60 |
| $169,001 or more | $338,001 or more | $560.50 |
Questions to ask your doctor or Medicare counselor
Before you have a procedure or start ongoing treatment, ask your doctor or their billing office what your out-of-pocket cost will be. Medicare-approved amounts vary by location and service, so knowing the 20% copayment ahead of time helps you budget. Ask whether the service is covered by Part B or whether it requires Part A (like an overnight hospital stay).
If you are considering Medigap or Medicare Advantage, ask your current doctors whether they accept those plans. Some doctors do not accept Medicare Advantage plans, and you want to know before you enroll. A Medicare counselor can walk you through the trade-offs between plans and help you understand what you will pay out of pocket for your specific health needs.
If your income changes significantly, contact Social Security or Medicare to report it. Your Part B premium for the following year may decrease, and you may become may be able to access for programs that help pay your premiums.
Frequently Asked Questions
Do I have to pay for Part A if I did not work long enough?
No, you can choose not to buy Part A if you do not want it. However, if you delay buying it after you turn 65, you may face a permanent premium increase of 10% for each year you were may be able to access but did not enroll. If you are still working and have employer coverage, you may be able to delay without penalty.
Why is my Part B premium higher than my neighbor's?
Your Part B premium is higher if your income is above the threshold for your filing status. The income used is from your tax return two years before, so a large income that year (like from selling a home or taking a retirement account withdrawal) can increase your premium. You can appeal if your income dropped since that tax year.
What happens if I cannot pay my Part B premium?
Contact Medicare or your local Social Services office to ask about programs that help pay premiums for people with limited income. Some states have Medicaid programs that cover Part B premiums. If you stop paying, Medicare may disenroll you, and you will face a penalty if you want to re-enroll later.
Does Medicare cover everything after I pay the deductible?
No. After you pay the deductible, you pay 20% of the Medicare-approved cost for most Part B services. Some services like preventive care are covered at 100% with no copayment. Part A has different copayments depending on the length of your hospital stay or skilled nursing facility stay.
Can I reduce my out-of-pocket costs?
Yes. Medigap plans cover some or all of your deductibles and copayments, though you pay a separate premium. Medicare Advantage plans often have lower premiums but may have higher copayments and require you to use in-network doctors. Compare plans each year during open enrollment to see which saves you the most money.