Medicare is not entirely free at age 65, but one major piece of it can be. Most people pay $0 for Part A (hospital insurance) if they or a spouse paid Medicare taxes for at least 10 years. Every other part of Medicare, including doctor visits, prescriptions, and supplemental coverage, carries monthly premiums, deductibles, and copays that add up throughout the year.
What Makes Part A Free (or Not)
Part A covers hospital stays, skilled nursing facilities, and hospice care. You qualify for premium-free Part A if you’ve earned at least 40 Social Security work credits, which translates to roughly 10 years of employment where Medicare taxes were withheld from your paycheck. In 2026, you earn one credit for every $1,890 in covered earnings, with a maximum of four credits per year. A spouse’s work history counts too, so if your partner has 40 credits, you’re covered even if you never worked yourself.
If you haven’t reached 40 credits, Part A isn’t free. You’ll pay a monthly premium that depends on how many credits you do have. And even with premium-free Part A, you still face a hospital deductible of $1,676 per benefit period in 2025. That means each time you’re admitted to the hospital (after a gap of at least 60 days from a previous stay), you owe that amount before Part A kicks in.
Part B Costs Everyone Pays
Part B covers doctor visits, outpatient care, lab work, and preventive services. Unlike Part A, there’s no way to get Part B for free. Every enrollee pays a standard monthly premium. For 2025, most people pay the standard amount, which is deducted directly from Social Security checks for those already receiving benefits.
On top of the monthly premium, Part B has an annual deductible of $257 in 2025. After you meet that deductible, you typically pay 20% of the Medicare-approved amount for most services, with no out-of-pocket cap. That 20% coinsurance is uncapped in Original Medicare, which is one reason many people add supplemental insurance.
Higher Premiums for Higher Earners
If your modified adjusted gross income exceeds certain thresholds (based on your tax return from two years prior), you’ll pay more for Part B and Part D through what’s called an Income-Related Monthly Adjustment Amount, or IRMAA. These surcharges are added on top of the standard premium and can more than double your monthly cost depending on your income bracket.
Prescription Drug Coverage Isn’t Included
Original Medicare doesn’t cover most prescription drugs. For that, you need Part D, which is a separate plan you purchase from a private insurer. The national base premium for Part D is $36.78 per month in 2025, though actual plan premiums vary widely depending on the insurer and the drugs covered. Some plans offer $0 premiums after subsidies and demonstrations that reduce the base premium, but you’ll still face copays and a coverage structure that changes depending on your total drug spending.
Skipping Part D when you’re first eligible is risky. If you go 63 days or more without creditable drug coverage and enroll later, you’ll pay a permanent penalty of 1% of the base premium for every month you delayed. That penalty is added to your premium for as long as you have Part D coverage.
What Original Medicare Doesn’t Cover
Even with Parts A, B, and D combined, several common healthcare needs fall outside Medicare’s scope. Original Medicare does not cover routine dental care (cleanings, fillings, extractions, dentures), eye exams for prescription glasses, hearing aids and the exams to fit them, long-term care, cosmetic surgery, massage therapy, or routine physical exams beyond the one-time “Welcome to Medicare” visit and annual wellness visits.
These gaps are significant for people 65 and older, since dental work, hearing aids, and vision correction are among the most common healthcare expenses in that age group. You’ll either pay out of pocket for these services or pick up a Medicare Advantage plan that bundles some of them in.
Medicare Advantage: A Different Cost Structure
Medicare Advantage (Part C) plans are offered by private insurers as an alternative to Original Medicare. Many advertise $0 monthly premiums and include extras like dental, vision, and hearing coverage. However, you still must pay your Part B premium to enroll in a Medicare Advantage plan. The $0 premium refers only to the additional plan cost on top of Part B.
These plans use networks, referrals, and prior authorizations, so the tradeoff for lower upfront costs is less flexibility in choosing providers. They do include an annual out-of-pocket maximum, which Original Medicare lacks, giving you a ceiling on your total spending in a given year.
Late Enrollment Penalties
Timing matters with Medicare. If you don’t sign up during your initial enrollment period (the seven-month window around your 65th birthday) and you don’t have qualifying coverage through an employer, you’ll face penalties that permanently increase your premiums.
For Part A (if you have to buy it), your premium goes up 10%, and you pay that higher rate for twice the number of years you were late. For Part B, the penalty is 10% for each full 12-month period you could have had coverage but didn’t. That Part B penalty lasts for as long as you have Medicare, which for most people means the rest of their life. The Part D penalty, as noted above, works similarly but is calculated monthly at 1% of the base premium.
Help for Lower-Income Enrollees
If your income and savings are limited, Medicare Savings Programs can cover some or all of your Medicare costs. The Qualified Medicare Beneficiary (QMB) program pays your Part A and Part B premiums, deductibles, coinsurance, and copays. For 2026, you qualify as an individual with monthly income below $1,350 and resources under $9,950. For married couples, those limits are $1,824 and $14,910 respectively.
The Specified Low-Income Medicare Beneficiary (SLMB) program covers just the Part B premium for individuals earning up to $1,616 per month or couples earning up to $2,184. Limits are somewhat higher in Alaska and Hawaii, and some states use more generous thresholds than the federal minimums.
What You’ll Actually Spend
To put it all together: a typical 65-year-old with 40 work credits pays $0 for Part A premiums but faces a $1,676 hospital deductible per admission. They pay a monthly Part B premium plus a $257 annual deductible and 20% coinsurance on most outpatient services. If they add Part D, that’s another monthly premium plus drug copays. Dental, vision, and hearing come out of pocket unless they choose a Medicare Advantage plan that includes them.
Medicare at 65 is subsidized, not free. The hospital coverage piece costs nothing upfront for most people, but the full picture involves several hundred dollars per month in premiums and potentially thousands more in deductibles and cost-sharing throughout the year.