Medicare provides valuable health insurance for individuals 65 or older and certain people with disabilities who are under age 65. But it also comes with complex rules and sometimes significant out-of-pocket costs. Here are the Medicare Out-of-Pocket costs you should expect to pay:
Premiums
Most beneficiaries pay the standard Medicare Part B premium of $185 per month in 2025. However, some Medicare beneficiaries will pay different amounts. Medicare Part B payments are prevented by law from reducing Social Security payments, so some Social Security beneficiaries pay lower premiums because their Social Security payments have not increased enough to cover the current standard Medicare premiums. High-income retirees reporting more than $160,000 ($212,000 for joint filers) pay higher Part B premiums, ranging from $259.00 to $628.90 monthly, depending on the level of reported income. The higher costs are due to the Income-related Monthly Adjustment Amount (IRMAA).
Most Medicare beneficiaries don’t pay a premium for Medicare Part A hospital insurance. Most Medicare beneficiaries have their premiums deducted from their Social Security check. The premium cost for Medicare Part D prescription drug coverage varies depending on the plan you select. The Income-related Monthly Adjustment Amount (IRMAA) scale also applies to Part D premiums.
Deductible and coinsurance
Medicare Part B has a $257 deductible in 2025. After that, Medicare beneficiaries typically need to pay 20 percent of the cost of most doctor’s services. That can quickly add up if a lot of health services are needed over time. There is no annual limit on how much you might be required to pay out of pocket. This is why securing a Medicare Supplement is so important.
There are some services Medicare beneficiaries are eligible for that are not subject to cost-sharing requirements, such as a wellness visit once every 12 months and a variety of preventative care services, including flu shots and cardiovascular disease screenings. Some preventive screening tests like colonoscopies and mammograms are free under Part B, but only if certain conditions are met. However, if a problem is discovered during a preventive visit, it could lead to other medical services that do have an additional cost.
Hospital stays
If you are hospitalized, Medicare Part A has a $1,676 deductible. If you end up spending more than 60 days in the hospital, it will cost you $419 per day for days 61 through 90 and $838 for up to 60 lifetime reserve days after that. Everyone with Part A must pay each time they are admitted to the hospital. For people who need hospital services frequently, out-of-pocket costs could be considerable. Once your 60 lifetime reserve days are used up, you will become responsible for your own hospital expenses. Again, Medicare Supplements can cover these expenses.
Medicare Supplemental Insurance
Many Medicare beneficiaries buy supplemental insurance policies to cover much if not all the cost-sharing requirements of traditional Medicare as well as some additional services. A Medicare Supplement policy can help to make your health care costs in retirement much more predictable. Many plans will cover some of Medicare Part B’s out-of-pocket costs and longer hospital stays than traditional Medicare. The out-of-pocket costs can be substantial or virtually zero, depending on what type of a supplemental plan you choose. As the most comprehensive, Medicare Supplement Plan G will cover all copays and deductibles that you have, except the annual Part B deductible, $257 in 2025.
Prescription drug coverage Most beneficiaries can choose among multiple plans for their stand-alone Medicare Part D prescription drug coverage, and each offers different prices and coverage. The Texas average basic premium is $66.72 per month in 2025, with an average deductible charge of $482. Premiums are higher for people who go 63 or more days without prescription drug coverage after becoming eligible for Medicare and for high-income Medicare beneficiaries. To get the best value for your money, you will need to continue to compare plans each year because the prices and covered medications change annually. I can help with this.
Farnum Health Insurance 