Key takeaways:
Medicare is not completely free for older adults. You may have to pay for premiums, copays, deductibles, coinsurance, and other costs.
If you or your spouse paid taxes long enough while working, you typically qualify for premium-free Part A (hospital insurance).
Most people pay monthly premiums for Medicare Part B (medical insurance) and Part D (prescription medication coverage). But you can get help with these costs if you have limited income and resources.
If you have Medicare Advantage (Part C), you are still required to pay your Part B premium. You may have an additional premium for this private alternative to original Medicare (Parts A and B).
Turning 65 is a milestone, particularly when it comes to healthcare. Most people in the U.S. are eligible to enroll in Medicare and receive many benefits, such as hospitalization coverage, outpatient medical care, telehealth services, and nutrition therapy. But most people have some — or many — out-of-pocket costs, depending on your situation.
Is Medicare completely free for seniors?
No. Many people think Medicare is completely free, but this is not the case. Your expenses will vary based on your coverage. Under original Medicare (Part A and Part B), there is no limit to the out-of-pocket expenses you may have to pay.
If you buy a supplemental plan known as Medigap — which is available only with original Medicare — your policy can cover expenses such as deductibles and copays that Medicare doesn’t cover. Another option is to join a Medicare Advantage plan through a private insurance company. You’ll likely get additional benefits, such as vision, dental, and hearing, but you’ll have a more limited network of healthcare professionals and facilities available to you than with original Medicare.
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What do the different Medicare parts cover?
Medicare has four major parts: A, B, C, and D. Medicare Parts A and B — together or separately — are considered original Medicare. Part C, also known as Medicare Advantage, is a private alternative to original Medicare. It provides Part A and Part B benefits and often extras such as vision and dental care.
Each part of Medicare covers different services and supplies:
Medicare Part A: This hospital insurance covers inpatient care, including supplies and services, that are part of your treatment.
Medicare Part B: Benefits of this medical insurance include outpatient care, such as visits with healthcare professionals and outpatient therapy.
Medicare Part C: Also known as Medicare Advantage, this alternative to original Medicare is offered by private insurance companies. Medicare Advantage always combines Part A and Part B and usually includes prescription coverage known as Part D.
Medicare Part D: This prescription medication coverage helps pay for generic and brand medications at retail, mail-order, and specialty pharmacies.
Is Medicare Part A free for seniors?
Medicare Part A premiums are free for most people. But if you’re admitted to a hospital or a skilled nursing facility, you’ll have to pay a Part A deductible. And if your hospital stay is longer than 60 days, you’ll have to pay coinsurance each day.
According to the Centers for Medicare & Medicaid Services, about 99% of Medicare beneficiaries pay $0 for Part A premiums. This is known as premium-free Part A.
If you are an older adult, you will not have to pay a premium for Medicare Part A (based on age) if you are:
Age 65 or older
Eligible to receive monthly Railroad Retirement Board cash benefits or Social Security
To qualify for Social Security benefits, you generally must have 40 quarters (10 years) of required work credits of Social Security taxes paid based on your earnings — or credit you’re entitled to receive based on the earnings of a spouse, a parent, or a child. You can earn up to four credits per year if your income meets the minimum requirements.
Costs for Medicare Part A premiums if you don’t meet requirements
If you or your spouse did not work long to earn enough Social Security credits, you’ll have to pay for Part A. For 2026, you’ll pay $311 or $565 per month. You could pay even more if you are subject to the Part A late enrollment penalty.
Part A premiums without enough credits for premium-free coverage
If You Paid Medicare Taxes For: | Your Part A Premiums in 2026 Are: |
|---|---|
Less than 30 quarters | $565 per month |
30-39 quarters | $311 per month |
40 quarters (10 years) | $0 per month |
Is Medicare Part B free for seniors?
It depends. If you qualify for a Medicare Savings Program, you may receive help paying for all or some of Part B. This can include:
Premiums
Deductibles
Copays
Coinsurance
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Your eligibility for a Medicare Savings Program will typically depend on your income and resources, but the requirements can vary by state. These programs help you pay for your healthcare expenses if your income and resources are low enough. Some states don’t include certain income or resources in the calculation that determines your eligibility. So it’s important to contact your state’s benefits office to learn more about eligibility requirements.
If you don’t qualify for a Medicare Savings Program, you’ll pay the following for Part B:
Medicare Part B costs if you don’t meet requirements
Part B Costs | Amount You Pay in 2026 |
|---|---|
Standard premium | $202.90 per month; you can also pay more if you owe the Part B late enrollment penalty or if you are subject to the income-related monthly adjustment amount (IRMAA) for enrollees with higher incomes |
Deductible | $283 |
Coinsurance | 20% of the Medicare-approved amount after you meet the deductible |
Can seniors get Medicare Part C for free?
Yes. Some Medicare Advantage (Part C) plans are zero premium. This means your monthly plan premium is $0, but you are still responsible for paying your Part B premium (and your Part A premium if required). These plans usually include more benefits than original Medicare.
Even if your Medicare Advantage monthly premium is $0 beyond the Part B premium, you may still have to pay deductibles and copays. The good news is that there is an annual limit on how much you’ll have to pay out of pocket for Medicare Advantage. This is not the case with original Medicare.
The out-of-pocket maximum for Medicare Advantage plans in 2026 can’t exceed $9,250 for in-network covered services or $13,900 for in-network and out-of-network covered services combined.
Can seniors get Medicare Part D for free?
Yes. If your income and assets are under a certain limit, you may qualify for no premium or deductible for your prescription medication coverage through Extra Help. Some people can get Extra Help automatically; others have to apply. Extra Help also provides very low out-of-pocket costs per fill for brand-name and generic medications.
You will receive Extra Help automatically without having to apply if you:
Receive Supplemental Security Income (SSI) benefits
Have full Medicaid coverage
Get help from your state to pay for Part B premiums through a Medicare Savings Program
But if you don’t qualify for Extra Help, Part D costs can vary widely. The average projected premium is $34.50 for stand-alone Part D plans and $11.50 if prescription coverage is included in your Medicare Advantage plan. You can also have your premium increased by up to $91 per month in 2026 because of the IRMAA surcharge for enrollees with high incomes. You can also pay more if you owe the Part D late enrollment penalty.
How do Medicare premiums work?
Medicare premiums typically increase every year because of inflation and rising healthcare costs. If you have enough work credits, you won’t have to pay a premium for Part A. The amount you pay for Part B and Part D will depend on your income. What you pay for Medicare Advantage will depend on your costs for Part A, Part B, and Part D — as well as whether your plan charges an additional premium.
What out-of-pocket costs can you expect if you have Medicare?
Medicare covers the cost of many supplies and services for people with health conditions. But you still have to pay out-of-pocket costs, such as:
After you pay your Part B deductible, you will usually be responsible for 20% of the Medicare-approved amount for services and supplies. Medicare covers the rest. If you have a Medigap plan, that’s an additional premium. But you also have some of your out-of-pocket costs covered.
Can changing your Medicare plan help save money?
Maybe. Depending on your needs, changing your Medicare plan can save you money. Here are a few ways you may be able to reduce your costs:
Access to network discounts: Some Medicare Advantage plans have negotiated lower rates with healthcare professionals within their networks. You may realize these savings when you use in-network services. Also, your plan may offer additional benefits, such as vision and dental care and fitness programs that can help you save on healthcare expenses.
Better medication coverage: Switching to a different Medicare plan may allow you to find a Part D prescription medication program that covers your medications at a lower cost.
Reduced out-of-pocket costs: Medicare plans have varying deductibles, copays, and coinsurance for covered services. Select a plan with lower out-of-pocket costs for the services you use most often. Over time, this strategy may help curb costs. Also, be watchful on your invoices for billing errors. If Medicare denies a claim, ask your healthcare professional if it was properly coded or appeal the Medicare denial.
Frequently asked questions
If you don’t enroll in Medicare during specific windows to sign up for Part A, Part B, and Part D, you can face late enrollment penalties. These surcharges are added to your monthly premiums for a period of time if you’re late joining Part A. For most people, these are lifetime penalties added to Part B and Part D premiums.
Yes, you can have Medicare and job-based insurance. If you have creditable coverage through an employer, you won’t face Medicare late enrollment penalties. Having both kinds of insurance plans means that you have more comprehensive coverage. How they are combined determines whether Medicare is the primary or secondary payer.
Yes, you can drop your job-based plan and enroll in Medicare when you’re eligible. You might also want to do this if your employer has fewer than 20 employees to avoid one or more late enrollment penalties.
If you don’t enroll in Medicare during specific windows to sign up for Part A, Part B, and Part D, you can face late enrollment penalties. These surcharges are added to your monthly premiums for a period of time if you’re late joining Part A. For most people, these are lifetime penalties added to Part B and Part D premiums.
Yes, you can have Medicare and job-based insurance. If you have creditable coverage through an employer, you won’t face Medicare late enrollment penalties. Having both kinds of insurance plans means that you have more comprehensive coverage. How they are combined determines whether Medicare is the primary or secondary payer.
Yes, you can drop your job-based plan and enroll in Medicare when you’re eligible. You might also want to do this if your employer has fewer than 20 employees to avoid one or more late enrollment penalties.
The bottom line
Medicare is not entirely free. You may still have premiums to secure coverage. When you access care, you’re typically responsible for deductibles, copays, and other out-of-pocket costs depending on the part of Medicare covering your prescriptions, items, and services. If you have limited income and resources, you may qualify for help paying for your Medicare expenses.
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References
CMS.gov. (2025). Medicare Advantage and Medicare prescription drug programs expected to remain stable in 2026. Centers for Medicare & Medicaid Services.
CMS.gov. (2025). 2026 Medicare Parts A & B premiums and deductibles. Centers for Medicare & Medicaid Services.
CMS.gov. (2026). Original Medicare (Part A and B) eligibility and enrollment. Centers for Medicare & Medicaid Services.
KFF. (2025). There are a lot of Medicare Advantage plan options in my area. How do I decide which plan is best for me?
Medicare.gov. (n.d.). Avoid late enrollment penalties. Centers for Medicare & Medicaid Services.
Medicare.gov. (n.d.). Costs. Centers for Medicare & Medicaid Services.
Medicare.gov. (n.d.). Help with drug costs. Centers for Medicare & Medicaid Services.
Medicare.gov. (n.d.). How Medicare works with other insurance. Centers for Medicare & Medicaid Services.
Medicare.gov. (n.d.). How much does Medicare drug coverage cost? Centers for Medicare & Medicaid Services.
Medicare.gov. (n.d.). Medicare savings programs. Centers for Medicare & Medicaid Services.
Medicare.gov. (2026). Understanding Medicare Advantage plans. Centers for Medicare & Medicaid Services.
Social Security Administration. (n.d.). Social Security credits.
Social Security Administration. (n.d.). Supplemental Security Income (SSI).
