Medicare Part A, which covers hospital stays and inpatient care, is the part of Medicare that most people get without paying a monthly premium. About 99% of Medicare beneficiaries qualify for premium-free Part A because they or a spouse paid Medicare taxes for at least 10 years while working. Beyond Part A itself, Medicare also covers dozens of preventive services at no cost to you, from annual wellness visits to cancer screenings and vaccinations.
Why Part A Is Premium-Free for Most People
Every time you receive a paycheck, a portion goes toward Medicare taxes. Those contributions earn you work credits, and once you’ve accumulated 40 credits (roughly 10 years of work), you qualify for Part A with no monthly premium when you turn 65. You can also qualify based on your spouse’s work history, which matters if one partner spent years as a caregiver or worked in a role that didn’t pay into Medicare.
If you haven’t worked the full 10 years, Part A isn’t free. With 30 to 39 credits, the monthly premium is $311. With fewer than 30 credits, it jumps to $565 per month. These amounts adjust annually, so they tend to rise slightly each year.
What Part A Actually Covers
Part A pays for inpatient hospital stays, skilled nursing facility care, hospice, and some home health services. But “premium-free” doesn’t mean you’ll never pay anything out of pocket. Each time you’re admitted to the hospital, you owe a deductible of $1,676 in 2025. If your stay exceeds 60 days, daily coinsurance kicks in at $419 per day for days 61 through 90, and $838 per day after that using lifetime reserve days.
So while you won’t see a monthly bill for Part A, a hospital stay can still cost thousands of dollars. This is one reason many people add supplemental coverage, sometimes called Medigap, to help with those gaps.
Part B Is Not Free
Part B covers outpatient care: doctor visits, lab work, durable medical equipment, and outpatient procedures. Unlike Part A, Part B always has a monthly premium. Most people pay the standard amount, which is set by the government each year and deducted directly from Social Security checks. Higher earners pay more through income-related surcharges.
If you don’t sign up for Part B when you’re first eligible and don’t have qualifying coverage through an employer, you’ll face a late enrollment penalty of 10% for every full year you delayed. That penalty is added to your premium permanently, for as long as you have Part B.
Preventive Services With No Cost-Sharing
One of the most underused benefits in Medicare is its list of preventive services covered at zero cost to you, as long as your provider accepts Medicare’s standard payment terms. These include:
- Cancer screenings: mammograms, colonoscopies, lung cancer screenings, prostate cancer screenings, and cervical cancer screenings
- Cardiovascular screenings: cholesterol and blood sugar tests to assess heart disease risk
- Diabetes services: diabetes screenings, self-management training, and the Medicare Diabetes Prevention Program
- Vaccinations: flu shots, COVID-19 vaccines, pneumococcal shots, and hepatitis B shots
- Mental health: depression screenings and alcohol misuse counseling
- Annual visits: a one-time “Welcome to Medicare” visit when you first enroll, plus a yearly wellness visit every year after
The full list also includes glaucoma screenings, HIV screenings, hepatitis C screenings, bone density measurements, obesity counseling, and tobacco cessation programs. You pay nothing for these services, even though Part B itself requires a premium. Think of it this way: the premium buys you into Part B, but once you’re in, preventive care has no copays or deductibles attached.
$0-Premium Medicare Advantage Plans
You may have seen ads for Medicare Advantage plans with a $0 monthly premium. These are private insurance plans that replace Original Medicare, and some of them charge no additional premium on top of what you already pay for Part B. A few even help cover part of your Part B premium. But the Part B premium itself doesn’t go away. You’re still paying for Medicare; the Advantage plan simply doesn’t add an extra charge.
These $0-premium Advantage plans typically come with trade-offs like narrower provider networks or higher copays for certain services. The premium being zero doesn’t mean the plan is free to use.
Prescription Drug Coverage Isn’t Free Either
Part D, which covers prescription drugs, carries its own monthly premium that varies by plan. If you go 63 days or more without creditable drug coverage and later enroll, you’ll pay a penalty of 1% of the standard premium for every month you were uncovered. That adds up to 12% per year of delay, and like the Part B penalty, it stays with you for as long as you have drug coverage.
A program called Extra Help can significantly reduce or eliminate Part D costs for people with limited income. To qualify in 2024, your annual income generally needs to be below $22,590 as an individual or $30,660 as a married couple, with countable resources (savings, stocks, retirement accounts) below $17,220 individually or $34,360 for couples. Your home, one car, and personal belongings don’t count toward that resource limit.
Programs That Can Make Part B Free
If your income is low enough, Medicare Savings Programs run by your state can pay your Part B premium and potentially other Medicare costs. There are several tiers, each with different income limits for 2026:
- Qualified Medicare Beneficiary (QMB): covers Part B premiums, deductibles, and coinsurance for individuals earning up to $1,350 per month (or couples up to $1,824)
- Specified Low-Income Medicare Beneficiary (SLMB): covers the Part B premium for individuals earning up to $1,616 per month (or couples up to $2,184)
- Qualifying Individual (QI): covers the Part B premium for individuals earning up to $1,816 per month (or couples up to $2,455)
Resource limits for QMB, SLMB, and QI are $9,950 for individuals and $14,910 for couples. Many states use higher income or resource thresholds than the federal minimums, so it’s worth applying through your state Medicaid office even if you’re slightly above these numbers. Limits are also higher in Alaska and Hawaii.
Qualifying for QMB in particular is valuable because it eliminates nearly all out-of-pocket costs in Medicare, not just the monthly premium. For someone living on a fixed income, that can be the difference between affording care and skipping it.