Medicare has different costs depending on which parts you choose

Medicare costs vary based on which parts you enroll in and your income level. Part A (hospital insurance) is free for most people at 65 if they or their spouse paid Medicare taxes while working. Part B (medical insurance) costs a monthly premium that changes each year — in 2024 it was $164.90 per month for most people, but this amount increases annually. Part D (prescription drug coverage) premiums depend on which plan you choose and range widely. Part C (Medicare Advantage) replaces Parts A and B and typically costs less in monthly premiums, though you may pay more when you use care.

Beyond the monthly premium, you also pay when you actually use Medicare services. These costs include deductibles (the amount you pay before Medicare starts paying), copayments (a fixed amount per visit), and coinsurance (a percentage of the cost). The exact amounts depend on which parts you have and which plan you choose.

Key Takeaways

  • Part A is free for most people; Part B premiums are around $164.90 monthly in 2024 but increase each year.
  • Part D prescription drug premiums vary by plan and region, typically ranging from $7 to $100+ per month.
  • Part C (Medicare Advantage) often has lower or zero monthly premiums but may charge more per doctor visit or service.
  • You pay deductibles, copayments, and coinsurance on top of premiums whenever you use covered services.
  • If your income is higher, you may pay an additional surcharge called IRMAA on top of your Part B and Part D premiums.

Part A costs: Hospital insurance

Most people do not pay a monthly premium for Part A if they or their spouse worked and paid Medicare taxes for at least 10 years. If you do not meet this requirement, you can still enroll in Part A by paying a monthly premium, which varies based on how many quarters of Medicare tax you paid — typically between $278 and $556 per month in 2024.

Even with free Part A, you pay when you use hospital services. In 2024, the Part A deductible was $1,632 per hospital stay. If you stay in the hospital longer than 60 days, you pay a daily coinsurance amount ($408 per day in 2024 for days 61–90). Skilled nursing facility care, home health care, and hospice have their own cost structures under Part A.

Part B costs: Doctor visits and outpatient care

Part B premiums are deducted from your Social Security check each month. The standard premium was $164.90 in 2024, but Medicare adjusts this amount every January based on inflation and program costs. If you enroll late (after your initial enrollment period), you may pay a permanent 10% penalty on top of the standard premium for each 12-month period you delayed.

You also pay a Part B deductible once per calendar year — $240 in 2024 — before Medicare starts sharing costs with you. After you meet the deductible, you typically pay 20% of the approved amount for doctor visits, outpatient services, and medical equipment. Some preventive services like annual wellness visits and cancer screenings are covered at no cost after you meet the deductible.

Part D costs: Prescription drugs

Part D premiums depend entirely on which plan you choose and where you live. Plans are offered by private insurance companies approved by Medicare, and each plan has its own monthly premium, deductible, and list of covered drugs. Premiums can range from around $7 to $100 or more per month, and the average national premium changes each year.

When you fill a prescription, you pay a copayment or coinsurance based on which tier the drug is on — generic drugs cost less than brand-name drugs. You also pay a deductible before coverage begins, which varies by plan but was capped at $505 in 2024. If your annual drug costs reach a certain threshold (called the coverage gap or "donut hole"), you pay a higher percentage until your out-of-pocket costs hit a yearly limit.

Part C costs: Medicare Advantage plans

Medicare Advantage plans are an alternative to Original Medicare (Parts A and B). Many plans have zero monthly premiums, though some charge $50 to $200 or more per month. The trade-off is that you typically pay more when you use services — copayments for doctor visits, specialist visits, and emergency room care are often higher than in Original Medicare.

Medicare Advantage plans include Part D drug coverage in most cases, so you do not pay a separate prescription drug premium. However, you must use doctors and hospitals in the plan's network, except in emergencies. Plans vary widely in their cost structure, so comparing the monthly premium alone does not tell you the full picture — you need to look at copayments, deductibles, and which doctors and pharmacies are included.

Income-related surcharges (IRMAA)

If your income is above a certain level, you pay an additional monthly surcharge called the Income-Related Monthly Adjustment Amount (IRMAA) on top of your Part B and Part D premiums. Medicare uses your tax return from two years prior to calculate this, so your 2024 income affects your 2026 premiums. The income thresholds and surcharge amounts change each year.

In 2024, for example, single filers with income over $97,000 began paying IRMAA. The surcharge increases in steps as your income rises, and it can add $70 to $560+ per month to your Part B premium alone, depending on your income level. If your income drops significantly due to retirement or a life event, you can request that Medicare recalculate your IRMAA.

Costs you should plan for beyond premiums

Your total Medicare costs include far more than the monthly premium. You need to budget for deductibles, copayments, and coinsurance each year. For Original Medicare, you also pay 20% coinsurance for most services after meeting your deductible, which can add up quickly if you have ongoing health needs or a major health event.

Costs not covered by any part of Medicare include dental care, vision care (except for one eye exam every two years), hearing aids, and most long-term care. Many people purchase a Medigap policy (supplemental insurance) to cover some of these gaps, which adds another monthly premium ranging from $100 to $300+ depending on the plan and your age. Others choose Medicare Advantage plans that sometimes include dental and vision benefits, though with limits.

Frequently Asked Questions

Why does my Part B premium differ from what I read online?

Part B premiums change every January and vary based on your income level. If you have higher income, you pay IRMAA surcharges on top of the standard premium. Additionally, if you delayed enrolling in Part B, you pay a permanent 10% penalty. Your specific premium appears on your Social Security statement or Medicare bill.

Do I have to pay for Part A if I never worked?

If you did not pay Medicare taxes for at least 10 years, you can still enroll in Part A by paying a monthly premium. The amount depends on how many quarters of Medicare tax you or your spouse paid — typically between $278 and $556 per month. You can find your specific premium by contacting Social Security or Medicare.

What happens if I cannot afford my Medicare premiums?

If your income is low, you may may have access to for programs that help pay Medicare premiums and cost-sharing. These include the may have access to Medicare Beneficiary (QMB) program and the Specified Low-Income Medicare Beneficiary (SLMB) program, which are run by your state. Contact your state Medicaid office or call 1-800-MEDICARE to learn what programs may be available based on your income.

Can I change my Medicare plan if my costs are too high?

Yes, you can switch plans during the Annual Enrollment Period (October 15 to December 7 each year). If you experience a major life event like losing employer coverage, moving to a new state, or a significant drop in income, you may may have access to for a Special Enrollment Period that allows you to change plans outside the standard window.

Are there any Medicare costs that are completely free?

Yes. Part A is free for most people. Preventive services like annual wellness visits, cancer screenings, and certain vaccines are covered at no cost under both Part A and Part B after you meet your deductible. The exact preventive services covered are listed on Medicare.gov.