Medicare Part A and Part B premiums, deductibles, and copays
Medicare Part A (hospital insurance) is free for most people at 65 if they or their spouse paid Medicare taxes for at least 10 years. Medicare Part B (medical insurance) costs a monthly premium that changes each year — in 2024 it is $164.90 per month for most people, though higher earners pay more. Both parts have annual deductibles and per-visit costs you pay when you use them.
The amount you pay depends on three things: whether you worked long enough to may have access to for free Part A, your income level, and how much medical care you actually use. This section breaks down what each part costs and who pays what.
Key Takeaways
- Most people pay nothing for Medicare Part A if they worked and paid Medicare taxes for at least 10 years, but Part B costs a monthly premium that varies by income.
- Part A has a $1,632 annual deductible per hospital stay in 2024, while Part B has a $240 annual deductible and then 20% copay for most services.
- If your income is above $97,000 as a single person or $194,000 as a married couple, you pay a higher Part B premium called an Income-Related Monthly Adjustment Amount (IRMAA).
- You must enroll in Part B during your initial enrollment window or face a permanent penalty on your premium, even if you delay coverage.
- Part A and Part B do not cover everything — dental, vision, hearing aids, and long-term care are not included.
Part A costs: hospital stays and skilled nursing
Part A is free for most people at 65. You do not pay a monthly premium if you or your spouse worked and paid Medicare taxes for at least 10 years. If you did not work that long, you can buy Part A for $278 per month in 2024, though some people with lower incomes may pay less.
When you use Part A, you pay a deductible — a set amount you must pay before Medicare starts to help. In 2024, the Part A deductible is $1,632 per hospital stay. If you are admitted to the hospital again more than 60 days after leaving, you pay a new deductible. For skilled nursing care (like rehabilitation after surgery), you pay nothing for the first 20 days, then $204 per day for days 21 through 100 in 2024.
Hospice care under Part A is covered with no deductible, though you may pay small copays for drugs and respite care. Home health services are also covered with no deductible if a doctor orders them and you meet medical need requirements.
Part B costs: doctor visits and outpatient care
Part B costs $164.90 per month in 2024 for most people. This is the standard premium, deducted automatically from your Social Security check or paid by bill. The premium increases slightly most years to keep pace with healthcare costs.
After you pay the Part B deductible ($240 in 2024), Medicare covers 80% of the cost for most services — doctor visits, lab tests, X-rays, and outpatient procedures. You pay the remaining 20%, called a coinsurance. There is no yearly cap on how much you pay out of pocket for Part B services, which is why many people buy supplemental insurance (called Medigap) to cover the 20% gap.
Some Part B services have a fixed copay instead of 20% coinsurance. For example, mental health visits cost $50 per session after the deductible. Preventive services like annual wellness visits, cancer screenings, and vaccines are covered at no cost after the deductible is met.
Higher premiums if your income is above the threshold
If your income is higher than a set amount, you pay extra on top of the standard Part B premium. This extra charge is called an Income-Related Monthly Adjustment Amount (IRMAA). In 2024, if you are single and your income is above $97,000, or married filing jointly and above $194,000, you pay more.
The IRMAA is based on your tax return from two years before. So in 2024, Medicare looks at your 2022 tax return. If your income was high in 2022 but dropped in 2023 or 2024 — because you retired, sold a house, or had other major changes — you can request a review and potentially lower your premium.
IRMAA also applies to Part D (prescription drug coverage) and to Medicare Advantage plans. The higher your income above the threshold, the more you pay. At the highest income level, the Part B premium can be $560 or more per month.
When you enroll and what happens if you miss the important date
You have a seven-month window to enroll in Part B without penalty — three months before you turn 65, the month you turn 65, and three months after. If you miss this window and do not have other health coverage, you pay a permanent 10% penalty on your Part B premium for as long as you have Medicare.
The penalty is added to your premium every month, even if you later enroll. For example, if you miss the important date by two years and then enroll, you pay 20% extra on your premium forever. There is no way to remove this penalty once it is applied.
The only exception is if you had employer health insurance when you turned 65. If you were still working and covered by your employer's plan, you can enroll in Part B later without penalty, as long as you enroll within eight months of losing that coverage.
What Part A and Part B do not cover
Original Medicare (Part A and Part B together) does not cover dental work, vision care, hearing aids, or long-term custodial care in a nursing home or at home. It also does not cover routine foot care, most acupuncture, or cosmetic surgery. Prescription drugs are covered only if you are in the hospital or skilled nursing facility; otherwise you need Part D coverage.
Many people buy a Medigap policy (supplemental insurance) to cover the 20% coinsurance and deductibles that Part B leaves unpaid. Others choose Medicare Advantage (Part C), which is an alternative to Original Medicare and often includes dental and vision benefits, though usually with limits.
How to estimate your total out-of-pocket costs
Your total cost depends on how much care you use. If you rarely see a doctor, you may pay only the monthly Part B premium and the annual deductible. If you have chronic conditions and see specialists regularly, you will pay the 20% coinsurance on top of the premium and deductible.
A rough example: if you pay $164.90 per month for Part B ($1,978.80 per year), meet the $240 deductible, and then have $2,000 in covered services, you pay 20% of that $2,000 ($400) plus the premium and deductible — a total of about $2,619 out of pocket. If you have a hospital stay, add the $1,632 Part A deductible on top.
Many people find that buying a Medigap plan (which costs $100 to $300+ per month depending on the plan) is worth it because it caps their out-of-pocket costs and covers the deductibles and coinsurance that Original Medicare leaves unpaid.
Frequently Asked Questions
Do I have to pay for Part A if I worked long enough?
No. If you or your spouse paid Medicare taxes for at least 10 years, Part A is free at 65. You do not pay a monthly premium. You only pay when you use it — the deductible for a hospital stay or the copay for skilled nursing care.
What happens if I do not enroll in Part B when I turn 65?
If you miss the seven-month enrollment window and do not have other health coverage, you pay a permanent 10% penalty on your Part B premium for life. The penalty is added to your premium every month you have Medicare, with no way to remove it later.
Why do some people pay more for Part B?
If your income is above $97,000 (single) or $194,000 (married), you pay an extra charge called IRMAA on top of the standard premium. The higher your income, the more you pay. This is based on your tax return from two years before.
Does Medicare Part A or B cover dental or vision care?
No. Original Medicare does not cover dental, vision, hearing aids, or long-term custodial care. Many people buy a Medigap plan or choose Medicare Advantage to add these benefits, though coverage and costs vary by plan.
Can I see any doctor with Part B?
Yes, Part B lets you see any doctor who accepts Medicare. You pay 20% coinsurance after the annual deductible. If you choose Medicare Advantage instead, you may have a network of doctors and need referrals for specialists.