If you have Medicare, here’s what you’ll pay for health care in 2025

Richard Eisenberg

Many of the 61 million Americans with Medicare are wondering whether their out-of-pocket health costs will be higher in 2025 than in 2024 and, if so, by how much.<div class="paywall-selector"></div><div class="paywall">



The answer, like so much about Medicare, is “it’s going to depend on people’s individual circumstances,” says Gretchen Jacobson, vice president of Medicare at The Commonwealth Fund, a health care research and policy foundation.



But one thing is for certain: Out-of-pocket health costs for Medicare beneficiaries can be significant, likely to often run into the thousands—perhaps tens of thousands—in 2025.



The combination of just Medicare premiums and co-pays “eat up about one-third of Social Security income and one-fifth of total income” for middle-income retirees, according to a<a href="https://crr.bc.edu/do-older-adults-understand-healthcare-risks-and-do-advisors-help/"> new report</a> from the Center for Retirement Research at Boston College.



The Commonwealth Fund found that one-third of Medicare beneficiaries struggle to afford co-pays, deductibles (the amount owed each year before insurance kicks in) and costs for medical services that aren’t covered. About one in five delay or skip needed health care because of the cost.



The most significant Medicare change for 2025 will be the new $2,000 cap for prescription drugs. It’s expected to<a href="https://aspe.hhs.gov/sites/default/files/documents/ee9b0f2bf15e69d7e3c7ca7618eaa2af/projecting-impact-part-d.pdf"> lower out-of-pocket medication costs</a> for 11 million Medicare beneficiaries, saving them roughly $600 apiece, on average.



“I ordered my first prescription of Humira yesterday. I’m done paying for it for the year because of the $2,000 cap. I’m saving thousands of dollars,” says Philip Moeller, author of Get What’s Yours for Medicare.



But the cap won’t mean a thing for people on Medicare whose prescriptions cost under $2,000 total this year. And even those with pricey pills may be surprised to find which types of drug costs aren’t included in the $2,000 cap, as explained below.



President Donald Trump rescinded the Biden administration’s project that would have set a $2 price for a monthly supply of generic drugs for Medicare beneficiaries with chronic conditions.



One quirk in Medicare costs for 2025 that may surprise you: The monthly premium for <a href="https://fortune.com/well/article/medicare-part-b-price-increase/">Part B</a> (doctor’s bills, primarily) has risen by 6%, even though inflation overall only went up by 2.9% in 2024. <a href="https://fortune.com/well/article/medicare-part-b-premium-cost-coverage/" data-type="link" data-id="https://fortune.com/well/article/medicare-part-b-premium-cost-coverage/">Part B premiums</a> have grown 20% faster than inflation in the last 10 years, according to the Center for Retirement Research.



“Part B premiums are related to health care costs, not inflation, and health care costs are going up by a larger amount than the rate of inflation,” says Moeller.



The Part B premium for most Medicare beneficiaries is $185 a month in 2025 compared with $174.70 in 2024. That adds up to a stiff $2,220 for the year.



Keep in mind that costs depend on whether you have Traditional Medicare (<a href="https://fortune.com/well/article/what-is-medicare-part-a/" data-type="link" data-id="https://fortune.com/well/article/what-is-medicare-part-a/">Part A</a> for hospital bills and Part B) plus a <a href="https://fortune.com/well/2024/11/11/medigap-coverage-health-conditions-2025-rule/">Medigap</a> supplemental policy if you buy one or you go with a private insurer’s Medicare Advantage plan (Part C, which has Open Enrollment through March 31).



Traditional Medicare does not cover most vision, hearing, or dental costs but many Medicare Advantage plans cover some of them.



Part D prescription drug plans are sold as standalone policies to people with Traditional Medicare and as part of Medicare Advantage plans.



Here’s a rundown of the out-of-pocket costs for people with Medicare in 2025:



<h2 class="wp-block-heading">Part A</h2>



Premium: Roughly 99% of Medicare beneficiaries have no Part A premium. For the other 1% who didn’t work enough hours to avoid owing the premium, their monthly amount is either $285 or $518—$3,420 or $6,216 for the year.



Deductible and coinsurance: If you’re admitted to a hospital in 2025, the deductible is $1,676 for costs incurred during the first 60 days of care. For days 61 through 90, there’s a $419 daily coinsurance charge and then $838 a day for “lifetime reserve days.” For care in a skilled nursing facility, the daily coinsurance cost during days 21 through 100 is $209.50. Those amounts are up about 3% from 2024.



<h2 class="wp-block-heading">Part B</h2>



Premium: The $185 standard monthly premium works out to $2,405 for the year and most Part B premiums are deducted automatically from Social Security benefit payments. Nearly a third of Medicare Advantage plans offer a reduction in the Part B premium in 2025, according to the KFF health policy research, polling and news outlet.



But there’s a higher Part B premium—sometimes much higher—for the roughly 8% of Medicare beneficiaries whose 2023 income exceeded $106,000 (single people) or $212,000 (couples filing joint tax returns).



That’s due to what’s known as the IRMAA surcharge (Income-Related Monthly Adjustment Amount), which works on a sliding scale with monthly premiums of $259 to $628.90 for 2023 incomes of $500,000 or more for singles and $750,000 or more for couples. Over the year, that translates to Part B premium of $3,108 to $7,546.80.



Deductible and coinsurance: The annual deductible is $257. You pay 20% of Part B medical costs such as doctor’s visits, lab tests, X-rays, ambulances, outpatient mental health services and medical equipment like wheelchairs.



<h2 class="wp-block-heading">Part C</h2>



Premium: Most people with Part C Medicare Advantage plans have $0 premiums. The average premium, including for those with $0 premiums, is $17 a month or $204 for the year.



Deductible and coinsurance: The deductible amount varies by Medicare Advantage plan, but the maximum in 2025 is $590, as in 2024.



Out-of-pocket spending limit: Medicare Advantage plans set their own out-of-pocket spending limits, but the maximum is $9,350 for in-network care and $14,000 for in- and out-of-network combined. The plans usually have fixed copays for doctors’ visits.



<h2 class="wp-block-heading">Part D</h2>



Here’s where things get complicated.



That’s due to the new $2,000 prescription drug cap, which price tiers your medications are on and the cost differences between standalone Part D plans and Part D offerings rolled into Medicare Advantage plans.



“When you choose a Medicare Advantage plan, you get the drug coverage that your plan has,” says Jacobson.



Part D premiums are not part of the $2,000 cap calculation. The cap only applies to prescriptions covered by your plan. The GoodRx Research team found the average Part D plan covered just 54% of prescribed drugs in 2024.



“Many people may be surprised to find out that the covered medications they took in 2024 will not be covered in 2025,” says Cindy George, senior personal finance editor at GoodRx.



The cap also doesn’t apply to prescriptions administered in doctors’ offices, since they’re covered by Part B.



Something that may surprise Medicare beneficiaries: Prescriptions bought with discount cards like GoodRx and SingleCare also aren’t included in the $2,000 Part D cap.



That means people with expensive medications will need to pencil out whether to use discount cards in 2025 or skip them so they can hit the $2,000 cap, making additional covered prescriptions free after that.



“The current situation forces people to make these tough calls,” says David Lipschutz, co-director of the Center for Medicare Advocacy. “I think it’s really a matter of trying to game out how much your drug will cost you over the course of a calendar year when you might hit that cap.”



“You can get help making these decisions from your<a href="https://www.shiphelp.org/"> State Health Insurance Assistance Program</a>,” says George.&nbsp;



This year is the start of the voluntary<a href="https://fortune.com/well/2024/10/14/medicare-prescription-payment-plan-pros-cons/"> Medicare Prescription Payment Plan</a>, which lets you smooth those costs out throughout the year.



Premium: KFF estimates the average monthly premium for standalone Part D plans (ones typically bought by people with Traditional Medicare) is $45, up slightly from 2024. For Medicare Advantage Part D plans, the average monthly premium will be just $7.



The Part D IRMAA premium surcharge for beneficiaries whose 2023 incomes exceeded $106,000 ($212,000 for couples) ranges from $13.70 a month to $85.80 a month.



Deductible and coinsurance: Most standalone plans have deductibles—$486 in 2025, on average, according to KFF. Some 60% of Medicare Advantage Part D plans will charge deductibles in 2025, up dramatically from 21% in 2024, according to KFF; average amount: $225.) The average deductible charged by Medicare Advantage plans has quadrupled since last year—from $59 to $225.



KFF expects 28% of Medicare Advantage Part D plans to charge coinsurance for their preferred brands of prescriptions and 57% will for non-preferred brands. In 2024, only 2% and 11% did, respectively.



<h2 class="wp-block-heading">Medigap</h2>



Medigap policies have a range of coverage (standardized by the government) and a concurrent range of costs. There are 10 types in most states, with letters A-D, F, G and K-N.



Premium: Insurers base premiums on a variety of factors, including age, health, location and gender.



“Medigap is one area of Medicare where you really can shop around based on premium,” says Lipschutz.



The<a href="https://medicaresupp.org/"> American Association for Medicare Supplement Insurance</a> says a 65-year-old nonsmoking woman in New York City might pay between $306 and $606 a month for a comprehensive Part G plan in 2025, which works out to $3,672 to $7,212 for the year. A similar woman in Dallas might pay $104 to $223 a month (roughly $1,200 to $2,700 for the year).



“Medigap is not inexpensive, but it helps to provide more financial security and financial predictability,” says Jacobson. “Instead of paying coinsurance for every single service you receive through the year, you’re paying one monthly premium.”



Deductible, coinsurance and out-of-pocket limits: Plan C pays for the Part B deductible and Plan G can be sold with a high-deductible version ($2,870 deductible in 2025, up slightly from 2024).



Plans K and L have coinsurance for Part B costs (50% for K; 75% for L) and out-of-pocket limits: $7,220 for K and $3,610 for L in 2025.



More on Medicare:



<ul>
<li><a href="https://fortune.com/well/article/medicare-changes-2025/">3 big changes coming to Medicare in 2025</a>. Here’s what they&#8217;ll mean for you</li>



<li>What Medicare beneficiaries need to know <a href="https://fortune.com/well/article/medicare-generic-medications/">about generic medications</a></li>



<li>Medicare has a new pilot program to help people with dementia. <a href="https://fortune.com/well/article/medicare-dementia-guide-program-caregivers/">Here&#8217;s how it works</a></li>



<li>If you are denied coverage by Medicare, you have the right to appeal the decision. <a href="https://fortune.com/well/article/medicare-claim-denial-appeal/">Here&#8217;s how</a></li>
</ul></div>

The most significant Medicare change for 2025 will be the new $2,000 cap for prescription drugs.

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