Most people pay $0 per month for Medicare Part A and $185 per month for Medicare Part B in 2025. That Part B premium rises to $202.90 in 2026. But these baseline numbers only tell part of the story. Your actual costs depend on your work history, your income, and how much care you use throughout the year.
Part A Premiums: Free for Most People
Medicare Part A covers hospital stays, skilled nursing care, hospice, and some home health services. If you or your spouse paid Medicare taxes for at least 10 years (40 quarters), you pay nothing for Part A. This applies to the vast majority of enrollees.
If you don’t meet that threshold, you’ll pay a monthly premium. People with 30 to 39 quarters of work history pay a reduced premium, while those with fewer than 30 quarters pay the full amount, which can run over $500 per month. These situations are uncommon, but they catch some people off guard, particularly those who spent much of their career self-employed without paying into the system or who immigrated to the U.S. later in life.
Part A Out-of-Pocket Costs
Even with premium-free Part A, you’re responsible for deductibles and coinsurance when you actually use hospital services. Part A works on a “benefit period” system rather than a calendar year. Each benefit period begins when you’re admitted to a hospital and ends once you’ve been out for 60 consecutive days.
For each benefit period, you pay a deductible of $1,676 in 2025 before Part A kicks in. That means if you’re hospitalized twice in the same year with fewer than 60 days between stays, you pay the deductible once. If you’re hospitalized twice with a gap of more than 60 days, you pay it twice.
After the deductible, hospital days 1 through 60 are fully covered. Days 61 through 90 carry a daily coinsurance cost. Beyond 90 days, you dip into a limited pool of “lifetime reserve days” with even higher daily charges. For skilled nursing facility stays, the first 20 days are covered in full after a qualifying hospital stay, but days 21 through 100 cost $217 per day in 2025. After day 100, Medicare stops covering skilled nursing entirely.
Hospice care under Part A has minimal costs. You pay a copayment of up to $5 for each outpatient prescription related to pain and symptom management, but the vast majority of hospice services are covered with no out-of-pocket expense.
Part B Monthly Premiums
Part B covers doctor visits, outpatient care, lab tests, preventive screenings, durable medical equipment, and mental health services. The standard monthly premium is $185 in 2025 and increases to $202.90 in 2026. This premium is typically deducted directly from your Social Security check.
Higher earners pay more through a system called IRMAA (Income-Related Monthly Adjustment Amount). Medicare uses your tax return from two years prior to set your premium. For 2026, single filers with modified adjusted gross income above $109,000 (or married couples filing jointly above $218,000) pay surcharges that push the Part B premium as high as $689.90 per month at the top bracket. If you’re married filing separately and earned more than $109,000, premiums jump sharply to $649.20 or more, making this filing status particularly expensive for Medicare purposes.
These income-based surcharges reset every year based on your most recent tax data. If your income drops due to retirement, selling a business, or other life changes, you can appeal to Social Security for a reduction.
Part B Deductible and Coinsurance
Before Part B starts paying for services, you need to meet an annual deductible of $257 in 2025, rising to $283 in 2026. Once you’ve hit that threshold, you typically pay 20% of the Medicare-approved amount for most services. There is no cap on that 20%, which is one reason many people carry supplemental (Medigap) insurance or enroll in a Medicare Advantage plan.
Preventive services like annual wellness visits, flu shots, and certain cancer screenings are covered at 100% with no deductible or coinsurance. This only applies when the service is coded as preventive. If your doctor discovers a problem during a screening and begins diagnostic work during the same visit, you may owe cost-sharing for the diagnostic portion.
Total Annual Cost Estimate
For a typical beneficiary with premium-free Part A and standard Part B, the baseline annual cost in 2025 looks like this:
- Part A premium: $0
- Part B premium: $2,220 per year ($185 x 12)
- Part B deductible: $257
- Part B coinsurance: 20% of covered services after the deductible
That puts your minimum annual spend at roughly $2,477 before any hospital stays, skilled nursing care, or significant outpatient treatment. A single hospitalization adds the $1,676 Part A deductible on top of that. For 2026, the Part B premium alone rises to $2,434.80 annually, and the deductible increases to $283.
Late Enrollment Penalties
If you don’t sign up for Medicare when you’re first eligible and you don’t have qualifying coverage through an employer, you’ll face permanent premium increases. For Part A (if you have to buy it), the penalty is a 10% increase applied for twice the number of years you delayed. For Part B, the penalty is 10% added to your premium for every full 12-month period you could have enrolled but didn’t.
These penalties are not temporary. A two-year delay in signing up for Part B means a 20% surcharge on your monthly premium for as long as you have Medicare. On a 2026 standard premium of $202.90, that works out to an extra $40.58 every month, indefinitely. The enrollment window matters: your initial enrollment period spans seven months, starting three months before the month you turn 65 and ending three months after. Missing it without qualifying employer coverage triggers penalties that compound over time.
What Medicare Does Not Cover
Parts A and B together leave several significant gaps. Prescription drugs require a separate Part D plan, which carries its own premium, deductible, and copayments. Dental care, vision exams, hearing aids, and most long-term custodial care are not covered. Routine foot care, cosmetic procedures, and care received outside the United States are also excluded.
These gaps explain why roughly 90% of Medicare beneficiaries carry some form of additional coverage, whether through a Medigap policy, a Medicare Advantage plan, Medicaid, or employer-sponsored retiree benefits. Factoring in the cost of supplemental coverage gives a more realistic picture of what you’ll actually spend on healthcare in retirement.