Medicare Part A and Part B have different costs — Part A is free for most people, Part B costs a monthly premium
Part A (hospital insurance) is free if you or your spouse paid Medicare taxes for at least 10 years while working. You pay nothing for inpatient hospital stays, skilled nursing facility care after a hospital stay, hospice care, and some home health services. Part A does have a deductible — you pay a set amount out of pocket before Part A coverage begins — but the monthly premium itself is zero.
Part B (medical insurance) costs a monthly premium that changes each year. Part B covers doctor visits, outpatient care, lab tests, and medical equipment. Most people pay the standard premium, though higher earners pay more. You also pay a deductible and a percentage of costs after that.
Part A is the piece that is truly free for most people. Part B requires a monthly payment, though the amount depends on your income and when you first became may be able to access for Medicare.
Key Takeaways
- Part A (hospital insurance) has no monthly premium if you worked and paid Medicare taxes for at least 10 years, though you do pay a deductible when you use it.
- Part B (doctor and outpatient care) requires a monthly premium that varies by year and by income level.
- Part D (prescription drugs) and Medigap or Medicare Advantage plans are not free and have their own premiums and costs.
- You can delay Part B without penalty if you have employer coverage, but delaying Part A has no benefit since it costs nothing.
What you pay with Part A even though the premium is free
Part A covers the service, but you still pay money when you use it. The main out-of-pocket cost is the deductible — a set dollar amount you pay before Part A starts paying. For hospital stays, this deductible resets each benefit period (usually each hospital stay or series of related stays). For skilled nursing facilities, you pay a daily coinsurance amount after the first 20 days.
Home health services and hospice have no deductible or coinsurance under Part A, so those are genuinely free if Part A covers them. But if you need a hospital bed or extended nursing care, you will pay money even though you have no monthly premium.
Part B premiums and how income affects what you pay
Part B premiums are set by Medicare each year and announced in the fall. The standard premium applies to people earning below a certain threshold. If your income is higher, you pay an Income-Related Monthly Adjustment Amount (IRMAA) on top of the standard premium — sometimes significantly more.
Income thresholds for IRMAA are based on your tax return from two years prior. A single person earning over roughly $91,000 per year (the exact figure changes annually) will pay more than the standard premium. Married couples filing jointly with income over roughly $182,000 face the same surcharge. The higher your income, the higher your Part B premium goes.
You also pay a deductible under Part B each year, and then you pay 20 percent of most services after that. So Part B is not free in any sense — it has a premium, a deductible, and ongoing cost-sharing.
Part D (prescription drugs) and supplemental plans are never free
Part D is prescription drug coverage, and it always costs a monthly premium. The premium varies widely depending on which plan you choose and which drugs you take. Part D also has a deductible, a coverage gap (sometimes called the "donut hole"), and coinsurance amounts.
Medigap (supplemental insurance) and Medicare Advantage (Part C) are also not free. Medigap plans have monthly premiums and help pay the deductibles and coinsurance that Original Medicare leaves you responsible for. Medicare Advantage plans often have lower or zero premiums but have networks, copays, and different coverage rules than Original Medicare.
If you want prescription drug coverage or want to reduce your out-of-pocket costs beyond what Part A covers for free, you will pay a premium for that coverage.
When you might not have to pay Part A premiums
Part A is free if you or your spouse paid Medicare taxes for at least 10 years. If you did not work that long or did not pay Medicare taxes, you can still get Part A but you will pay a monthly premium — either the full premium or a reduced premium depending on how many years you did work.
If you worked for a railroad, you may have paid Railroad Retirement Tax instead of Medicare tax. Those years count toward the 10-year threshold, so you may still may have access to for free Part A. If you are unsure whether you have enough work history, the Social Security Administration can tell you based on your earnings record.
Part A coverage that truly costs nothing
Hospice care under Part A has no deductible, no coinsurance, and no copays. If you are enrolled in Medicare hospice, Part A covers the full cost of hospice services related to your terminal diagnosis. You may pay a small copay for drugs and respite care, but the core hospice benefit is free.
Some home health services are also covered with no cost-sharing if Part A covers them. This includes skilled nursing visits, physical therapy, and occupational therapy ordered by a doctor as part of a home health plan. You pay nothing for these services as long as Part A determines they are medically necessary and you meet the may be able to access rules.
Preventive services under Part A — like a one-time welcome visit when you first turn 65 — are also free with no deductible or coinsurance.
How to know what you will actually pay
The easiest way to understand your costs is to look at your Medicare Summary Notice (MSN), which Medicare mails to you quarterly. It shows what Part A and Part B paid, what you paid, and what you still owe. If you have not received one, you can view it online through your Medicare account at Medicare.gov.
Your Part B premium appears on your Social Security statement each month, or on a separate bill if you do not receive Social Security. If you think your premium is wrong — for example, if your income has dropped — you can request a reconsideration of your IRMAA within 60 days of receiving the notice.
Frequently Asked Questions
Is Part A really free if I have to pay a deductible?
Yes. A free premium means you pay nothing each month just to have the coverage. The deductible is a separate cost you pay only when you use the service. Many people never meet the Part A deductible in a given year, so they pay nothing at all.
What happens if I did not work 10 years and cannot get free Part A?
You can still get Part A by paying a monthly premium. The premium depends on how many years you or your spouse worked and paid Medicare taxes. Social Security can calculate your premium based on your work history.
Can I get Part B without paying a premium?
No. Part B always requires a monthly premium. The amount varies by year and by your income, but there is no version of Part B with zero premium. If you have employer coverage when you turn 65, you can delay Part B without penalty, but you cannot avoid the premium entirely.
Do I have to pay for preventive services under Medicare?
No. Medicare covers certain preventive services with no deductible or coinsurance — things like cancer screenings, vaccines, and annual wellness visits. You pay nothing for these services, though your doctor's office may ask for a copay by mistake. If that happens, ask them to bill Medicare instead.
What is the difference between Part A deductible and Part B deductible?
Part A deductible applies to hospital and skilled nursing stays and resets each benefit period. Part B deductible is an annual amount that applies to most outpatient services. They are separate — meeting one does not count toward the other.