Yes, most people pay a monthly premium for Medicare Part B
Medicare Part B is not free. You pay a monthly premium — the amount you owe each month to keep your coverage active. In 2024, the standard premium is $164.90 per month, though the exact amount changes each year and varies based on your income.
Part B covers doctor visits, outpatient care, lab tests, and medical equipment. If you do not pay the premium, you lose this coverage. You also typically pay a yearly deductible (the amount you must pay out of pocket before Part B starts to help) and coinsurance (a percentage of the cost you share with Medicare after the deductible is met).
Some people with very low income and limited resources may have their Part B premium paid by their state through a program called Medicaid. If you think this might explore to you, your local Medicaid office can tell you whether you may have access to.
Key Takeaways
- You must pay a monthly premium to have Medicare Part B coverage; the standard amount in 2024 is $164.90, but it changes yearly and by income level.
- Higher-income beneficiaries pay a larger premium through an income-related adjustment; you will receive a notice if this applies to you.
- Your premium is usually taken automatically from your Social Security check each month.
- If you delay signing up for Part B when you first become may be able to access, you may face a permanent penalty on your premium.
- Some people with low income may have Medicaid pay their Part B premium on their behalf.
How much you pay depends on your income
The standard monthly premium covers most people, but if your income is above a certain threshold, you pay more. This is called an Income-Related Monthly Adjustment Amount (IRMAA). The income level that triggers this adjustment changes each year.
Medicare uses your tax return from two years ago to calculate whether you owe the adjustment. For example, in 2024, Medicare looks at your 2022 income. If your income was higher in 2022 than it is now, you can ask Medicare to recalculate based on your current situation — but you must report the change yourself. Medicare will not automatically lower your premium if your income drops.
You will receive a notice in the mail if an income adjustment applies to you. The notice explains the amount and tells you how to appeal if you believe the calculation is wrong.
When your premium is automatically deducted
If you receive Social Security, your Part B premium is taken directly from your monthly check. You do not have to pay it separately or write a check. The amount appears on your Social Security statement each month.
If you do not receive Social Security, Medicare sends you a bill each month. You can pay by mail, phone, or online through the Medicare website. If you miss a payment, Medicare will send you a reminder, and if you do not pay within three months, your coverage can be terminated.
What happens if you do not sign up when you first become may be able to access
Most people become may be able to access for Medicare at age 65. If you do not sign up for Part B during your Initial Enrollment Period (the seven-month window that includes the month you turn 65 and the three months before and after), you may face a permanent penalty.
The penalty is 10 percent of the standard premium for each full year you could have had Part B but did not sign up. If you waited three years, for example, you would pay 30 percent more than the standard premium for the rest of your life. This penalty does not go away even if you sign up later.
There are exceptions: if you were covered by an employer health plan while you were still working, or if you have certain other coverage, you may not owe a penalty. But you must be able to prove this coverage was in place. If you are unsure whether an exception applies to you, contact Medicare directly before your Initial Enrollment Period ends.
Other costs beyond the monthly premium
The monthly premium is only one cost. You also pay a yearly deductible — in 2024, this is $240 — before Medicare Part B starts to pay its share. After you meet the deductible, you typically pay 20 percent of the cost of covered services, and Medicare pays 80 percent.
Some services, like preventive care (annual wellness visits, cancer screenings, vaccines), have no deductible and no coinsurance. You pay nothing for these. Other services, like mental health visits, may have different cost-sharing rules.
If you have a Medigap policy (supplemental insurance) or a Medicare Advantage plan (Part C), those plans may cover some or all of your Part B costs. But you still must pay the Part B premium itself — Medigap and Medicare Advantage do not replace it.
How to find out your exact premium amount
Your premium notice arrives in the mail each December for the coming year. It shows your standard premium, any income-related adjustment, and the total you will pay each month.
You can also log into your Medicare account at Medicare.gov to see your premium information anytime. If you do not have an online account, you can create one using your Social Security number and email address.
If you receive a notice and the amount seems wrong, you have the right to appeal. The notice includes instructions on how to request a review. You typically have 60 days from the date on the notice to file an appeal.
Medicaid may cover your Part B premium if your income is very low
If your income is below a certain level and your resources (savings, property, and other assets) are limited, your state Medicaid program may pay your Part B premium for you. This is called a Medicare Savings Program. The income and resource limits vary by state.
To find out whether you may have access to, contact your state Medicaid office or call 1-800-MEDICARE. They can tell you the income limit in your state and what documents you need to provide. If you may have access to, Medicaid pays Medicare directly, and you do not have to pay the premium yourself.
Frequently Asked Questions
What if I cannot afford the Part B premium?
Contact your state Medicaid office to see whether you may have access to for a Medicare Savings Program, which pays your premium if your income is low enough. You can also ask Medicare about payment plans or hardship waivers if you are having temporary difficulty. Call 1-800-MEDICARE to discuss your situation.
Can I drop Part B to save money?
You can drop Part B, but if you sign up again later, you will likely owe a permanent penalty on your premium. The only time you can drop Part B without penalty is if you have other health coverage through an employer or union that is still active.
Does the Part B premium increase every year?
Yes, the standard premium typically increases each year based on inflation and changes in Medicare costs. The new amount takes effect each January. You will receive a notice in December showing your premium for the coming year.
If I work past age 65, do I still have to pay for Part B?
If you are still covered by your employer health plan, you can delay signing up for Part B without penalty. But you must sign up within eight months after your employment or coverage ends, or you will owe a penalty. Check with your employer's benefits office about your coverage dates.
What is the difference between the Part B premium and the Part B deductible?
The premium is what you pay each month to have Part B coverage. The deductible is what you pay out of pocket for covered services before Medicare starts to help. You pay both — the premium whether you use services or not, and the deductible only when you receive care.