Medicare costs vary by part and your income, but most people pay a monthly premium for Part B, a deductible when you use hospital care, and copays at the doctor

Medicare is not free. You pay three types of costs: a monthly premium (the amount you pay to have the coverage), a deductible (the amount you pay before Medicare starts to help), and copays or coinsurance (your share of the cost when you see a doctor or go to the hospital). The amount you pay depends on which parts of Medicare you have and how much you earn.

If you worked 10 years or more and paid Medicare taxes, you do not pay a monthly premium for Part A (hospital insurance). If you did not work that long, you can still buy Part A, but the premium ranges from roughly $275 to $550 per month depending on how many years you worked. Most people fall into the first group and pay nothing for Part A itself.

Part B (doctor and outpatient care) costs almost everyone a monthly premium. In 2024, the standard premium is $164.90 per month, but you may pay more if your income is above a certain level. The income thresholds change each year. If you are married and file taxes jointly, your combined income matters; if you file alone, your individual income matters.

When you use hospital care under Part A, you pay a deductible of $1,632 per hospital stay in 2024. After you meet that deductible, Medicare covers most of your hospital costs for the first 60 days. If you stay longer, you pay a daily copay. For doctor visits under Part B, you typically pay 20 percent of the cost after you meet an annual deductible of $240 in 2024.

Key Takeaways

  • Part A (hospital insurance) is free for most people who worked and paid Medicare taxes for 10 years or more; others pay roughly $275 to $550 per month.
  • Part B (doctor care) costs $164.90 per month in 2024 for most people, but higher earners pay more based on income thresholds that change yearly.
  • You also pay a deductible when you use hospital care ($1,632 per stay in 2024) and copays when you see a doctor (typically 20 percent of the cost after a $240 annual deductible).
  • Part D (prescription drugs) costs vary widely by plan, and Part C (Medicare Advantage) replaces Parts A and B with a different cost structure that often includes a monthly premium.
  • Your actual monthly cost depends on which parts you choose, your income level, and how much medical care you use.

How income affects what you pay

If your income is higher than a set threshold, you pay a surcharge on top of your Part B premium. This surcharge is called Income-Related Monthly Adjustment Amount, or IRMAA. The thresholds are based on your income from two years ago, so your 2024 payments reflect your 2022 tax return.

For 2024, if you are single and your income was more than $97,000 in 2022, you pay extra. If you are married filing jointly, the threshold is $194,000. The surcharge increases in steps as your income rises. Someone single earning $120,000 in 2022 would pay more than someone earning $98,000. The Social Security Administration sends you a notice each year showing what surcharge applies to you.

If your income drops — because you retire, lose a job, or have a major life change — you can ask Social Security to recalculate your IRMAA. You will need to report the change and provide proof, such as a recent tax return or a letter from your employer.

Part C and Part D costs

Part C (Medicare Advantage) is an alternative to Original Medicare (Parts A and B). Instead of paying Part B premiums to the federal government, you pay a premium to a private insurance company. That premium varies by plan and location, ranging from $0 to several hundred dollars per month. Many Part C plans also include prescription drug coverage, so you do not need to buy Part D separately.

Part C plans often have lower monthly premiums than Original Medicare plus a separate drug plan, but they usually have higher copays when you see a doctor and require you to use doctors in their network. Some plans cover dental, vision, or hearing aids, which Original Medicare does not.

Part D (prescription drug coverage) is available only if you have Original Medicare (Parts A and B). You buy Part D from a private insurance company, and the monthly premium ranges from roughly $5 to $100 or more, depending on the plan and the drugs you take. You also pay a deductible (usually $505 in 2024) and copays for each prescription. If you do not sign up for Part D when you first become may be able to access, you may pay a penalty for as long as you have Medicare.

When costs change each year

Medicare premiums, deductibles, and copays change on January 1 each year. The amounts are set by Congress and the Centers for Medicare and Medicaid Services (CMS) based on inflation and the cost of care. You will receive a notice in the mail in October or November showing your new costs for the coming year.

If you receive Social Security, your Part B premium is usually deducted automatically from your check. If you do not receive Social Security, you receive a bill from Medicare. If your premium increases and you think it is wrong, you have a short window — usually until the end of the year — to ask for a review.

Costs if you delay signing up

If you do not sign up for Part B or Part D when you first become may be able to access at age 65, you pay a penalty for each month you delay. The Part B penalty is 10 percent of the standard premium for each year you were may be able to access but did not enroll. The Part D penalty is 1 percent of the national average premium for each month you were may be able to access but did not enroll. These penalties are permanent — they stay with you for as long as you have Medicare.

There are exceptions: if you are still working and covered by your employer's health plan, you may not have to pay the penalty. If you think you fall into an exception, contact Medicare or Social Security to confirm before your coverage starts.

Costs under Medicaid and other programs

If your income is very low, you may be may be able to access for Medicaid, which is a separate program run by your state. Medicaid can help pay your Medicare premiums, deductibles, and copays. Each state has different income limits and rules. You explore through your state's Medicaid office, not through Medicare.

If you are a veteran, the Veterans Health Administration (VA) may cover some or all of your health care costs, and you may not need Medicare at all. If you are a federal employee or railroad retiree, you may have different coverage options. Contact your former employer's benefits office to understand what you are may have access to to.

Some people may have access to for Extra Help, a federal program that pays Part D premiums and copays for people with limited income and resources. You explore through Social Security. If you think you might may have access to, ask Social Security or your local Area Agency on Aging.

Questions to ask your doctor or Medicare

Before you turn 65 or when you first become may be able to access for Medicare, ask your current doctor whether they accept Medicare and what your copays will be. Ask whether you need a referral to see a specialist. If you are considering a Part C plan, ask your doctor whether they are in that plan's network.

Contact Medicare directly at 1-800-MEDICARE (1-800-633-4227) or visit Medicare.gov to compare plans in your area, see the exact costs, and understand what each plan covers. You can also ask a State Health Insurance information Program (SHIP) counselor — these are free advisors in every state who can answer questions about your costs and help you choose a plan.

Frequently Asked Questions

Do I have to pay for Medicare if I did not work long enough?

If you did not work 10 years or more and pay Medicare taxes, you can still get Medicare at 65, but you pay a monthly premium for Part A (hospital insurance). The premium is roughly $275 to $550 per month depending on how many years you worked. You still pay the standard Part B premium on top of that.

What happens if I cannot afford my Medicare premiums?

If your income is low, Medicaid may help pay your premiums and copays. You explore through your state's Medicaid office. If you do not may have access to for Medicaid, ask a SHIP counselor about other programs or whether you can get a lower-cost Part C plan in your area.

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

Yes. You have a window each year called Open Enrollment, from October 15 to December 7, when you can switch plans. If your income drops and your IRMAA surcharge increases, you can ask Social Security to recalculate it outside of Open Enrollment if you report a may have access to life change.

Do I pay the same copay every time I see my doctor?

Under Original Medicare (Parts A and B), you typically pay 20 percent of the cost after you meet your annual deductible, so the copay varies by service. Under Part C (Medicare Advantage), copays are usually fixed amounts set by your plan, so you pay the same amount each visit.

What if I work past 65 and have employer health insurance?

If your employer has 20 or more employees, you can delay signing up for Medicare without paying a penalty. When you do sign up, tell Medicare you were covered by employer insurance so the penalty does not explore. Get this in writing from your employer's benefits office.