Yes, most people pay a monthly premium for Medicare Part B, but the amount depends on your income and when you first became may be able to access

Medicare Part B covers doctor visits, outpatient care, and medical equipment. Unlike Part A (hospital insurance), which is usually free if you or your spouse paid Medicare taxes for at least 10 years, Part B requires a monthly payment from nearly everyone who enrolls. For 2024, the standard premium is $164.90 per month, but you may pay more or less depending on your income from two years ago.

You do not have to enroll in Part B — it is optional. However, if you delay enrollment after you first become may be able to access, you will owe a permanent penalty on top of your regular premium for as long as you have Medicare. The penalty is 10 percent of the standard premium for each full year you could have enrolled but did not. That penalty stays with you even if your income later drops.

Key Takeaways

  • Most people pay a monthly Part B premium; the standard amount for 2024 is $164.90, but yours may be higher or lower based on your income from two years prior.
  • If you delay enrolling in Part B after you first become may be able to access and do not have other may have access to coverage, you will pay a permanent 10 percent penalty on your premium for each year you waited.
  • You can avoid the penalty only if you have employer coverage or other creditable coverage and enroll within eight months of losing that coverage.
  • Your Part B premium is deducted automatically from your Social Security check, or you receive a bill if you do not collect Social Security yet.
  • Income-related monthly adjustment amounts (IRMAA) can raise your premium significantly if your income exceeds certain thresholds, based on tax returns from two years ago.

When Part B Premium Payments Start

You become may be able to access for Medicare at age 65. If you are already receiving Social Security benefits, Medicare Part B enrollment happens automatically, and your premium is deducted from your monthly check starting the month after you turn 65. If you have not yet claimed Social Security, you will receive a bill for your Part B premium.

Your initial enrollment period lasts seven months: three months before the month you turn 65, the month you turn 65, and three months after. If you enroll during this window, your coverage and premium payments begin on the first day of the month you turn 65 (or the first of the following month if you enroll after that month starts).

If you miss this window and do not have other may have access to coverage, you enter a general enrollment period each year from January 1 to March 31. Coverage begins July 1 if you enroll during this period. However, you will owe the permanent penalty described above.

How Income Affects Your Part B Premium

Medicare uses your modified adjusted gross income (MAGI) from your tax return two years before the current year to calculate whether you pay extra. This is called an income-related monthly adjustment amount, or IRMAA. If your income exceeds certain thresholds, your Part B premium rises. For 2024, the thresholds begin at $97,000 for single filers and $194,000 for married couples filing jointly.

The higher your income above the threshold, the more you pay. Someone with income well above the threshold can pay $560 or more per month for Part B instead of the standard $164.90. This extra amount is separate from your regular premium and appears on the same bill or Social Security deduction.

If your income drops significantly — because you retired, lost a job, or had other major life changes — you can ask Medicare to recalculate your IRMAA using your current year's income instead of the two-year-old figure. You must file a form called the Life-Changing Event notice and provide proof of the change, such as a recent tax return, a letter from your employer, or divorce papers.

Situations Where You May Not Owe Part B Premiums

If you have employer-sponsored health insurance through your job or your spouse's job, you can delay enrolling in Part B without penalty. This is called having creditable coverage. You must enroll in Part B within eight months of losing that coverage — either when you or your spouse stops working or when the employer plan ends — to avoid the penalty.

Some people may have access to for Medicaid, which is a separate program run by your state. If you receive Medicaid, your state may pay your Part B premium for you. You still have to enroll in Part B, but you do not pay the premium yourself. Contact your state Medicaid office to find out whether you may have access to.

Veterans who receive VA health benefits do not have to enroll in Part B, though many do. If you are a veteran, check with the VA about whether Part B makes sense for your situation.

How to Pay Your Part B Premium

If you receive Social Security, your Part B premium is deducted automatically each month before you see your check. The amount appears on your Social Security statement. If you do not yet receive Social Security, Medicare sends you a bill each month or quarter, depending on how you set up payment.

You can change how you pay by contacting Social Security (if your premium is deducted from your check) or Medicare directly. You can set up automatic bank withdrawals, mail a check, or pay online through the Medicare website. If you fall behind on payments, Medicare may disenroll you from Part B, and you will face the penalty if you want to rejoin later.

Part B Costs Beyond the Premium

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

Many people buy a Medigap (supplemental insurance) or Medicare Advantage plan to cover some or all of these out-of-pocket costs. Medigap premiums are separate from Part B premiums and vary by plan and location. Medicare Advantage plans often have lower or no premiums but may have higher out-of-pocket costs when you use care.

What Happens If You Do Not Pay

If you do not pay your Part B premium, Medicare will send you notices and give you a grace period to catch up. If you do not pay within 90 days, Medicare can disenroll you from Part B. Once disenrolled, you cannot rejoin until the next general enrollment period (January 1 to March 31), and your coverage will not start until July 1 of that year. You will also owe the permanent penalty for the years you were not enrolled.

If you cannot afford your Part B premium, contact your state's Medicare Savings Program. These programs, run by each state, help people with limited income pay their Part B premiums, deductibles, and coinsurance. You must meet income and asset limits, which vary by state. Your local Area Agency on Aging or 211 can tell you whether you may have access to and how the process works.

Frequently Asked Questions

Can I drop Part B if I do not use the doctor?

You can choose not to enroll in Part B, but if you delay and later want to join, you will pay a permanent penalty. If you already have Part B and want to drop it, you can, but the same penalty applies if you rejoin later. Only drop Part B if you have other creditable coverage or are certain you will not need it.

What if I work past 65 and have employer insurance?

You can delay Part B without penalty as long as you have employer coverage through your job or your spouse's job. When you or your spouse stops working or the plan ends, you have eight months to enroll in Part B. After that window closes, the penalty applies.

Does my Part B premium change every year?

Yes. Medicare adjusts the standard premium each year, and your IRMAA can change if your income changes. You receive a notice each year showing your new premium. If your income dropped, you can request a recalculation using current-year income.

Can I get my Part B premium back if I overpaid?

If you overpaid due to an error, Medicare can issue a refund. Contact Medicare directly to report the overpayment. Refunds are not automatic, so you must request one.

What is the difference between Part B premium and IRMAA?

The Part B premium is the standard monthly cost everyone pays (or a reduced amount for low-income people). IRMAA is an extra charge added to your premium if your income is above a certain level. Both are deducted together from your Social Security check or included in your bill.