Medicare Part A and Part B have different costs, and Part A is free for most people
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 hospital stays, skilled nursing care after a hospital stay, hospice, and some home health services. There is no monthly premium.
Part B (medical insurance) costs a monthly premium — the standard amount in 2024 is $164.90, though it varies by income. Part B covers doctor visits, outpatient care, lab tests, and medical equipment. You also pay a yearly deductible (currently $240) before Part B starts to pay, plus 20% of the cost of most services after that.
Part A does have costs beyond the premium: if you stay in the hospital, you pay a deductible for each hospital stay (currently $1,696), and you pay daily copayments if your stay goes beyond 60 days. Skilled nursing care also has copayments after the first 20 days.
Key Takeaways
- Part A hospital insurance is free with no monthly premium if you worked and paid Medicare taxes for at least 10 years, but you pay a deductible and copayments when you use hospital or skilled nursing services.
- Part B medical insurance costs a monthly premium (standard $164.90 in 2024) plus a yearly deductible and 20% of most service costs after that.
- Part D (prescription drug coverage) requires a monthly premium that varies by plan, and you pay out-of-pocket costs for medications depending on your plan and which drugs you take.
- Preventive services like screenings, vaccines, and wellness visits are covered at no cost under Part B once you have met your deductible.
- Medigap and Medicare Advantage plans have their own premiums and cost structures separate from Original Medicare.
What preventive care costs nothing under Part B
Once you are enrolled in Part B, certain preventive services are covered with no copayment or coinsurance — you pay nothing out of pocket. These include annual wellness visits, cancer screenings (mammograms, colonoscopies, Pap tests), bone density tests, cardiovascular screenings, diabetes screenings, and flu, pneumonia, and shingles vaccines.
The catch is that you must have already met your Part B deductible ($240 in 2024) for most of these services to be free. A few preventive services — like flu shots and some vaccines — are covered even before you meet the deductible. The best approach is to ask your doctor or the facility ahead of time whether a specific screening or vaccine will be free under your plan.
Part D prescription drug coverage and its costs
Part D is optional prescription drug coverage. It is not free — you pay a monthly premium that varies by plan and insurance company, typically ranging from $7 to $100 per month depending on the plan you choose. You also pay out-of-pocket costs for medications: a copayment or coinsurance for each prescription, which depends on which tier the drug is on and which plan you have.
Part D has a coverage gap (sometimes called the "donut hole") where you pay a larger share of drug costs once you and your plan have spent a certain amount. In 2024, once combined spending reaches $5,850, you enter the gap and pay 25% of brand-name drug costs and 25% of generic drug costs until your out-of-pocket spending reaches $8,550. After that, you pay only 5% of costs for the rest of the year.
If you do not enroll in Part D when you first become may be able to access, you may pay a penalty if you join later — a permanent increase to your monthly premium. The penalty is about 1% of the national average Part D premium for each month you were not covered.
Medigap and Medicare Advantage have separate premiums
Medigap (supplemental insurance) is sold by private insurers and covers some of the costs that Original Medicare does not — like copayments, coinsurance, and deductibles. Medigap plans have their own monthly premiums, which vary widely by plan type, your age, your location, and the insurance company. There is no standard Medigap premium; you shop for plans and prices directly.
Medicare Advantage (Part C) is an alternative to Original Medicare, offered by private insurers. It usually has a lower or zero monthly premium than Original Medicare plus Medigap, but it comes with copayments and coinsurance for services, and it limits you to a network of doctors and hospitals. Some Medicare Advantage plans include Part D drug coverage built in; others do not.
If you choose Medicare Advantage, you are still required to pay your Part B premium to Medicare. The Advantage plan premium is separate and is what the insurance company charges.
Income-related premiums for higher earners
If your income is above a certain threshold, you pay a higher Part B and Part D premium. This is called the Income-Related Monthly Adjustment Amount (IRMAA). In 2024, if your modified adjusted gross income is above $97,000 (single) or $194,000 (married filing jointly), you pay more.
The higher amount depends on how much your income exceeds the threshold. IRMAA can add $70 to $560 per month to your Part B premium and $12 to $77 per month to your Part D premium, depending on your income level. Medicare uses your tax return from two years prior to calculate this, so changes in your income take time to show up in your premiums.
If you have a major life event — retirement, loss of income, divorce — you can request that Medicare recalculate your IRMAA using your current year income instead of the two-year-old return.
State and federal programs that help pay Medicare costs
If your income is low, you may be able to get help paying Part A and Part B premiums through Medicaid (a joint federal and state program). Each state runs its own Medicaid program with different income limits and rules. Some states cover Part B premiums only; others cover premiums, deductibles, and copayments.
The Medicare Savings Program is a Medicaid program specifically for people with limited income and resources. It pays some or all of your Part A and Part B premiums, deductibles, and copayments. Income limits vary by state, but generally you must have income below 135% to 200% of the federal poverty level. You explore through your state Medicaid office.
The Low-Income Subsidy (LIS) program, also called "Extra Help," helps pay Part D premiums and out-of-pocket drug costs if your income and resources are below certain limits. You can explore through Social Security or at ssa.gov.
Frequently Asked Questions
If I worked less than 10 years, do I have to pay for Part A?
Yes. If you or your spouse did not pay Medicare taxes for at least 10 years, you must pay a monthly premium for Part A — currently up to $278 per month in 2024, depending on how many years of work credits you have. You can still enroll in Part A at 65, but the premium applies for as long as you have it.
Are dental, vision, and hearing covered under any free part of Medicare?
Original Medicare Part A and Part B do not cover routine dental, vision, or hearing care. Some Medicare Advantage plans include dental or vision benefits, but they are not free — they come with the plan's premium and copayments. You can also buy standalone dental, vision, or hearing plans separately.
Do I have to pay for my annual wellness visit?
No, the annual wellness visit is free under Part B once you are enrolled, even before you meet your deductible. However, if your doctor finds a problem during that visit and you need additional tests or treatment, those services may have a cost depending on whether they are preventive or diagnostic.
What happens if I cannot afford my Part B premium?
Contact your state Medicaid office to see if you may have access to for the Medicare Savings Program, which can pay your Part B premium for you. You can also ask Social Security about payment plans or hardship exemptions if you are having temporary financial difficulty.
Can my Part B premium change from year to year?
Yes. The standard Part B premium changes each year — it was $164.90 in 2024. If your income is above the IRMAA threshold, your premium may be higher and can change if your income changes. Medicare sends you a notice each fall showing your premium for the next year.