Most people qualify for premium-free Medicare Part A. However, there are exceptions that can require a person to pay an additional premium.
There may also be options to pay zero-premium amounts for other parts of Medicare, including Part B, Part C, Part D, and Medigap.
This article looks at how a person may get Part A at no cost, or why they might have to pay a premium. It also discusses options to help pay premiums for other parts of Medicare coverage.
Glossary of Medicare terms
- Out-of-pocket cost: This is the amount a person must pay for care when Medicare does not pay the total amount or offer coverage. Costs can include deductibles, coinsurance, copayments, and premiums.
- Premium: This is the amount of money someone pays each month for Medicare coverage.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before Medicare starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, coinsurance is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Original Medicare includes Part A, hospital insurance, and Part B, medical insurance. Most people do not pay the premium for Medicare Part A. However, there are exceptions when a person may have to pay the Part A premium.
Qualifying conditions for free Medicare Part A
For a person to qualify for premium-free Medicare Part A, they must meet certain conditions. They must:
- be 65 years or older
- be eligible for monthly Social Security or Railroad Retirement Board (RRB) cash benefits
- have end-stage renal disease
If a person receives Social Security or RRB benefits at least 4 months before their 65th birthday, they will automatically receive Medicare Part A. If they do not receive either of these benefits they may still be eligible for Medicare Part A but must file an application.
A person must earn enough quarters of coverage (QCs) in their working life to be eligible for Social Security Benefits. QCs are ‘earned’ through payroll taxes. Employers deduct payroll taxes from each paycheck under the Federal Insurance Contributions Act (FICA).
If a person or their spouse has worked for 10 years or more they will generally have paid the full FICA tax by payroll deduction and meet the conditions for premium-free Medicare Part A.
If a person is under 65, they may still qualify for premium-free Part A if they meet the following conditions:
- they are eligible for Social Security benefits due to disability
- has end stage renal disease
- has amyotrophic lateral sclerosis (ALS)
If a person is not eligible for premium-free Part A, they can buy it. In 2025, the monthly premiums range from $285 to $518. The cost depends on how much taxes a person paid during a certain amount of calendar quarters.
There are several programs that may help a person get reduced or premium-free Medicare parts B, C, and D.
For example, a person with certain income and asset conditions may be able to get some parts of Medicare premium-free through the Medicare savings programs (MSPs), which are run by state governments.
Other programs include Extra Help and Medigap. However, as of 2020, enrollees can no longer sign up for Medigap plans to pay for the Medicare Part B deductible.
Medicare Part B
Medicare Part B covers doctor services, outpatient hospital services, durable medical equipment, some home health services, and some other medical services not covered by Medicare Part A.
Medicare savings programs
MSPs may pay premiums, copays, coinsurance, and deductibles for individuals with certain income and assets. There are four types of MSPs:
- Qualified Medicare Beneficiary (QMB) program
- Specified Low-Income Medicare Beneficiary (SLMB) program
- Qualified Individual (QI) program
- Qualified Disabled and Working Individual (QDWI) program
The monthly premium a person pays is based on their income level. The Part B premium may be deducted from a monthly benefit check if they receive any of the following:
- Social Security benefits
- railroad retirement board benefits
- office of personnel management payments
Supplement Insurance
A Medicare Access and CHIP Reauthorization Act of 2015 made it unlawful for supplement plans to pay Part B deductibles. So, new Medicare enrollees no longer have access to some supplement insurance plans, also known as Medigap, that may pay Part B deductibles.
Medicare Part C
Medicare Part C, also known as Medicare Advantage, are private insurance plans from companies approved by Medicare. They offer the same coverage as original Medicare, and may have additional benefits.
A person must be enrolled in Medicare parts A and B to enroll in a Medicare Advantage plan.
Zero-premium Medicare Advantage plans have no monthly premium, although a person may still need to pay for the Part B premium.
However, zero-premium plans may have higher deductibles, copays, or additional out-of-pocket costs compared to an Advantage plan with a monthly premium.
Medicare Part D
Medicare Part D is prescription drug coverage. A person can enroll in the plan, or it may be included as part of an Advantage plan.
Part D premiums vary, generally according to a person’s income. If a person qualifies for certain MSPs, they may get help with their Medicare prescription drug costs.
The Extra Help program may also help a person with premiums and other costs such as deductibles and coinsurance.
Medigap is health insurance sold by private insurance companies. It aims to supplement original Medicare coverage by paying costs that original Medicare does not cover.
A Medigap policy may pay a person’s healthcare costs, such as coinsurance, deductibles, and copays. However, Medigap is not free, and a person may have to pay a monthly premium. A person can get more details about specific policies online.
Most people receive Medicare Part A at no cost, but some people may need to pay a monthly premium. A person who is not eligible for premium-free Part A can buy coverage.
Medicare offers several programs to help a person with costs, such as Medigap and Extra Help.
