Most people do have to pay a monthly premium for Part B, but some pay nothing

Medicare Part B covers doctor visits, outpatient care, and medical equipment. Most people enrolled in Medicare pay a monthly premium for it — the amount depends on your income and when you first became may be able to access. However, a small number of people pay zero because they were already covered by an employer plan when they turned 65, or because they meet specific criteria set by Medicare.

The standard Part B premium changes each year. In 2024, it ranges from $174.70 to $609 per month depending on your income level. If you have higher income, you pay more through a system called Income-Related Monthly Adjustment Amount (IRMAA). Most people pay the standard amount, which is deducted automatically from their Social Security check.

The key question is not whether Part B costs money — it does for nearly everyone — but whether you are required to enroll and pay, or whether you can delay without penalty.

Key Takeaways

  • Most Medicare beneficiaries pay a monthly Part B premium that is deducted from their Social Security check, and the amount increases if your income is above certain thresholds.
  • You are required to enroll in Part B when you turn 65 unless you or your spouse are still working and covered by an employer health plan.
  • If you delay Part B enrollment without may have access to coverage, you will pay a permanent 10 percent penalty on top of your premium for each year you were not enrolled.
  • Some people with very low income may pay reduced or no Part B premiums through programs like Medicaid or the Medicare Savings Program.
  • Your Part B premium amount is based on your income from two years prior, so changes in your earnings affect what you pay later.

When you must enroll in Part B and start paying

You become may be able to access for Medicare at 65. Part B enrollment is not automatic — you have to sign up. Your Initial Enrollment Period is the seven-month window that includes the month you turn 65, plus three months before and three months after. If you enroll during this window, your coverage starts the month you turn 65 (or the first day of the month after you sign up, depending on when you explore).

You are required to enroll in Part B during this period if you do not have coverage through a current employer plan. "Current employer plan" means you or your spouse are actively working and the employer offers health insurance. Retiree coverage does not count — if you are retired and covered through a former employer, you still must enroll in Part B at 65.

If you miss your Initial Enrollment Period and do not have may have access to coverage, you can still enroll later, but you will owe a late enrollment penalty. This penalty is 10 percent of the standard Part B premium for each full year you were not enrolled. The penalty is permanent — you pay it for the rest of your life on top of your regular premium.

How income affects what you pay

Your Part B premium is based on your Modified Adjusted Gross Income (MAGI) from two years before the year you are paying. For example, your 2024 premium is based on your 2022 income. Medicare uses income thresholds that change each year; if your income is above the threshold for your filing status, you pay more.

In 2024, the income thresholds are $97,000 for single filers and $194,000 for married couples filing jointly. If your income exceeds these amounts, you move into a higher premium bracket. The highest earners can pay up to $609 per month instead of the standard $174.70. This system is called IRMAA, and it applies to both Part B and Part D (prescription drug coverage).

If your income drops significantly — because you retire, lose a job, or have a major life change — you can request that Medicare recalculate your premium using your current year income instead of the two-year-old figure. You must file a form called the Medicare Income-Related Monthly Adjustment Amount Life-Changing Event within 60 days of the event. Common may have access to events include retirement, divorce, death of a spouse, or loss of income-producing property.

People who may pay reduced or no Part B premium

If your income is very low, you may not have to pay Part B premiums at all. The Medicare Savings Program (MSP) is a state-run program that pays Part B premiums, deductibles, and copayments for people who meet income and asset limits. Income limits vary by state but are generally around 135 to 200 percent of the federal poverty level. You explore through your state Medicaid office, not through Medicare directly.

Some people also may have access to for Medicaid in addition to Medicare. If you are enrolled in both programs (called "dual may be able to access"), Medicaid may cover your Part B premium. Medicaid may be able to access and income limits vary significantly by state, so you will need to contact your state Medicaid agency to learn what applies where you live.

A third option is the may have access to Individual (QI) program, which helps people with slightly higher income than the Medicare Savings Program. The QI program covers only Part B premiums, not deductibles or copayments. Like the MSP, it is administered by your state and has income limits that change yearly.

What happens if you do not pay your Part B premium

If you enroll in Part B but do not pay your premium, Medicare will send you a bill. If the bill goes unpaid for a certain period, Medicare can disenroll you from Part B. Once you are disenrolled, you cannot re-enroll until the next General Enrollment Period (January 1 through March 31 each year), and you will owe the late enrollment penalty when you do.

If you are having trouble paying your premium, contact Medicare at 1-800-MEDICARE before you fall behind. They can discuss your options, including whether you may have access to for a premium information program or whether a life-changing event allows you to recalculate your income.

Part B costs beyond the monthly premium

The monthly premium is only one cost. Part B also has an annual deductible (the amount you pay out of pocket before Medicare starts paying) and copayments or coinsurance (your share of the cost after the deductible is met). In 2024, the Part B deductible is $240 per year. After you meet the deductible, you typically pay 20 percent of the cost of covered services.

These costs are separate from your premium. Even if your premium is paid in full, you are responsible for the deductible and copayments when you use services. Some people purchase Medigap (supplemental insurance) to cover these out-of-pocket costs, but Medigap is optional and costs extra.

Questions to ask your doctor or Medicare

Before you turn 65, ask your employer or benefits administrator whether you will have retiree health coverage and whether it is considered "creditable coverage" by Medicare. This affects whether you must enroll in Part B at 65. If you are unsure, contact Medicare directly.

If your income changes significantly after you enroll, ask whether you can request an IRMAA recalculation. Have documentation of the life-changing event ready — a retirement letter, divorce decree, or notice of job loss.

If you cannot afford your Part B premium, ask whether you may have access to for the Medicare Savings Program, Medicaid, or the may have access to Individual program in your state. Your local Area Agency on Aging can help you find out.

Frequently Asked Questions

Can I delay Part B if I am still working at 65?

Yes, if you or your spouse have health coverage through a current employer. You can delay Part B without penalty as long as you enroll within eight months after your employment ends or your employer coverage stops. Once you stop working, you have a limited window to enroll without penalty, so mark your calendar.

What if I enrolled in Part B but did not realize I had to pay?

Contact Medicare when ready at 1-800-MEDICARE. If you have a valid reason for not paying (such as not understanding the requirement), Medicare may waive late fees. The sooner you contact them, the better your chances of resolving the issue without disenrollment.

Does my Part B premium go up every year?

The standard Part B premium amount changes each year based on program costs, but your individual premium may also change if your income changes. Medicare recalculates IRMAA brackets annually, so a raise or drop in income can affect what you pay.

If I have Medicaid, do I still have to pay Part B?

You still must enroll in Part B at 65, but Medicaid may pay your premium for you if you may have access to for the Medicare Savings Program or another state information program. Contact your state Medicaid office to learn what they cover.

What is the difference between Part B premium and Part B deductible?

The premium is what you pay monthly to have Part B coverage. The deductible is what you pay out of pocket for services before Medicare starts sharing costs. You pay both — the premium whether you use services or not, and the deductible only when you use covered care.