Medicare has four separate monthly costs, and which ones you pay depends on which parts you choose

Medicare Part A (hospital insurance) has no monthly premium for most people — you paid for it through payroll taxes while working. Part B (doctor visits and outpatient care) costs $164.90 per month in 2024, though the amount changes each year. Part D (prescription drugs) varies by plan, typically $5 to $100 per month. Part C (Medicare Advantage) replaces Parts A and B and usually costs $0 to $200 per month, but you still pay Part B taxes unless you're exempt.

Your actual bill depends on three things: which parts you enroll in, your income level, and whether you sign up on time. Higher earners pay more for Parts B and D through an income-related surcharge. Missing the enrollment important date can lock you into a permanent penalty on top of your premium.

Key Takeaways

  • Part A has no monthly premium for most people; Part B costs $164.90 per month in 2024 and increases annually.
  • Part D premiums vary by plan and pharmacy, ranging from roughly $5 to $100 monthly depending on coverage level.
  • If your income exceeds certain thresholds, you pay an additional surcharge on top of the standard Part B and Part D premiums.
  • Enrolling late in Part B or Part D triggers a permanent penalty added to your premium for as long as you have Medicare.
  • Medicare Advantage (Part C) often has low or zero monthly premiums but requires you to use in-network providers.

Part A: Hospital Insurance and Why Most People Pay Nothing

Part A covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health services. Most people age 65 and older pay no monthly premium because they or their spouse worked at least 10 years in a job where Medicare taxes were withheld from paychecks.

If you don't meet the 10-year work requirement, you can buy Part A coverage. The premium in 2024 is $505 per month if you have 30 to 39 quarters of work history, or $278 per month if you have 40 or more quarters. These amounts change annually. Even if you don't pay a premium, you still owe a deductible when you use hospital services — $1,632 per hospital stay in 2024.

Part B: Doctor Visits and Outpatient Services

Part B covers doctor office visits, lab tests, X-rays, ambulance services, and durable medical equipment like wheelchairs. The standard monthly premium is $164.90 in 2024. This amount increases each January based on the cost of living adjustment (COLA), so your premium will be higher in 2025.

You also owe a $240 annual deductible before Part B starts paying its share. After you meet the deductible, you typically pay 20 percent of the cost for most services, and Medicare pays 80 percent. Some preventive services like annual wellness visits and cancer screenings have no copay.

If you delay enrolling in Part B after you turn 65, you'll pay a permanent 10 percent penalty on your premium for each full year you waited. That penalty stays with you for life, so enrolling on time matters financially.

Part D: Prescription Drug Coverage and Plan Variation

Part D premiums depend entirely on which plan you choose — there is no single standard price. Plans range from about $5 to $100 per month, and the same pharmacy may be covered by one plan but not another. Your actual cost also depends on which drugs you take and whether they're on the plan's formulary (approved drug list).

You pay the premium, then a deductible (up to $545 in 2024), then copays or coinsurance for each prescription. Once your total out-of-pocket spending reaches $8,850 in 2024, catastrophic coverage kicks in and you pay only a small copay for the rest of the year.

Like Part B, missing the Part D enrollment important date triggers a permanent penalty. If you go 63 days or longer without Part D coverage, you pay an extra 1 percent of the national average premium for each month you were uninsured. That penalty is added to your premium permanently.

Part C: Medicare Advantage and Its Trade-offs

Medicare Advantage (Part C) is an alternative to Original Medicare (Parts A and B). Many plans charge $0 monthly premium, though some cost $50 to $200 per month. The trade-off is that you must use doctors and hospitals in the plan's network, and you typically need referrals to see specialists.

Part C plans include prescription drug coverage (Part D) built in, so you don't buy Part D separately. You still owe copays and coinsurance for services, and you still pay the Part B premium unless you're exempt. Out-of-pocket maximums are capped — in 2024, no more than $7,550 for in-network care — so your costs are predictable.

Advantage plans vary widely by region. Some areas have dozens of options; others have only one or two. You can switch plans once per year during the annual enrollment period (October 15 to December 7).

Income-Related Surcharges: When You Pay More

If your modified adjusted gross income (MAGI) exceeds certain thresholds, you pay an extra charge on top of your Part B and Part D premiums. The thresholds are $97,000 for single filers and $194,000 for married couples filing jointly in 2024. These thresholds do not change annually.

The surcharge is based on your income from two years prior. If you had high income in 2022, you'll pay more in 2024. The surcharge ranges from about $70 to $560 per month for Part B and $12 to $77 per month for Part D, depending on how much your income exceeds the threshold.

If your income drops due to retirement, job loss, or death of a spouse, you can request that Medicare recalculate your surcharge. You'll need to file Form SSA-44 with Social Security and provide proof of the income change.

Enrollment Timing and Permanent Penalties

You become may be able to access for Medicare at 65. The initial enrollment period runs for three months before the month you turn 65, the month itself, and three months after. If you enroll during this window, your coverage starts on the first day of your birth month (or the month after, depending on when you sign up).

If you miss this window and don't have other may have access to coverage, you pay a permanent penalty. Part B penalty is 10 percent per year of delay. Part D penalty is 1 percent per month of delay. These penalties stay on your premium for life, so a two-year delay costs you 20 percent extra on Part B forever.

The exception: if you have employer health insurance or are still working, you may have a special enrollment period that lets you enroll without penalty up to eight months after your coverage ends or you retire.

How to Find Your Actual Premium Amount

Your premium notice arrives in December for the coming year. It shows your Part B premium, any income-related surcharge, and whether you may have access to for a subsidy. If you disagree with the amount, you have 30 days to request a reconsideration.

For Part D, log into Medicare.gov or call 1-800-MEDICARE to compare plans in your area. Enter your zip code and the drugs you take. The tool shows the monthly premium, deductible, and copays for each plan side by side. Prices change annually, so compare plans every October during open enrollment even if you've been on the same plan for years.

If you can't afford your premiums, you may be may be able to access for the Part B Income-Related Monthly Adjustment Amount (IRMAA) reduction or the Low-Income Subsidy (LIS) program for Part D. Contact your local Social Security office or call 1-800-MEDICARE to ask about these programs.

Frequently Asked Questions

Do I have to pay Part A if I worked long enough?

No. If you or your spouse worked at least 10 years in a job where Medicare taxes were withheld, Part A is free. You still owe the hospital deductible when you use hospital services, but there is no monthly premium.

Can I change my Part D plan if the premium goes up?

Yes. During the annual enrollment period (October 15 to December 7), you can switch to a different Part D plan with a lower premium or better coverage for your drugs. The change takes effect January 1.

What happens if I can't pay my Medicare premium?

Contact Medicare at 1-800-MEDICARE or your local Social Security office. You may be may be able to access for the Low-Income Subsidy program, which covers Part D premiums and copays, or the Part B premium reduction program if your income is below 150 percent of the federal poverty level.

Do I pay Part B premium if I choose Medicare Advantage?

Yes. You still pay the Part B premium even if you enroll in a Medicare Advantage plan. The Advantage plan premium is separate and often $0, but the Part B premium is mandatory unless you're exempt.

Will my premium increase every year?

Part A and Part B premiums increase annually based on the cost of living adjustment (COLA). Part D premiums vary by plan and may increase, decrease, or stay the same. Medicare Advantage premiums also change yearly and vary by plan and region.