Updated September 2026 · Reviewed by the CoverageCo team
No. Most people pay no premium for Part A because of their work history, but nearly everyone pays a monthly Part B premium, plus deductibles and coinsurance when they use care. Routine dental, vision, hearing, and long-term custodial care aren't covered at all.
Key takeaways
- Part A is usually premium-free with enough work history — but still has deductibles.
- Part B has a monthly premium almost everyone pays, with a surcharge for higher incomes.
- Original Medicare alone has no annual out-of-pocket maximum.
- Help exists for limited incomes and is widely unclaimed.
Where the idea comes from
The confusion is understandable. Most people do get Part A without a premium, because they or a spouse paid Medicare taxes long enough while working. That genuinely feels free.
But premium-free isn't cost-free. Part A still carries a deductible each benefit period and coinsurance for longer stays. And Part A is only the hospital half of the program.
What you actually pay
Four categories, and only the first is ever zero:
| Cost | What it is |
|---|---|
| Part A premium | Usually $0 with enough work history; otherwise a monthly premium applies |
| Part B premium | Monthly, paid by nearly everyone, with a surcharge for higher incomes |
| Deductibles | Part A per benefit period; Part B annually |
| Coinsurance and copays | Your share each time you use care |
The uncapped exposure people miss
Original Medicare on its own has no annual limit on what you might pay. In a serious year, there's no ceiling at all.
That single fact is why most people add something — a Medigap policy, which covers much of that exposure for a predictable monthly premium, or a Medicare Advantage plan, which is required to have an annual out-of-pocket maximum.
Neither is free either. The real question isn't whether you'll pay for Medicare, it's which way of paying suits you.
If money is genuinely tight
Several programs help with Medicare costs, and they're substantially underused because people assume the limits are lower than they are.
Medicare Savings Programs, run by states, can help pay Part B premiums and sometimes other cost sharing. Extra Help — the Part D Low-Income Subsidy — can significantly reduce prescription costs.
Both are worth checking rather than assuming you won't qualify. Eligibility varies by state and changes over time.
Common questions
Do I have to pay for Part A?
Most people don't pay a Part A premium thanks to their own or a spouse's work history. Those without enough qualifying quarters may pay one. Either way, Part A has deductibles and coinsurance when used.
Is Part B mandatory?
Not strictly, but delaying it without creditable coverage from active employment can trigger a permanent late enrollment penalty and leave you without outpatient coverage in the meantime.
What does Medicare cost per month?
Most people pay the standard Part B premium set annually by CMS, plus any drug or supplement premiums they choose, plus an income-related surcharge for higher earners. Check current figures at Medicare.gov.
Is there help paying for Medicare?
Yes. Medicare Savings Programs can help with Part B premiums and cost sharing, and Extra Help reduces prescription drug costs. Both are widely underclaimed.