Most people pay a monthly premium for Part B, but the amount depends on your income

Part B is not free. You pay a monthly premium, and the amount you owe in 2024 depends on how much income you reported to the IRS two years earlier. If your income was below a certain threshold, your premium is lower. If it was higher, you pay more — sometimes significantly more. The standard premium is one amount, but Income-Related Monthly Adjustment Amount (IRMAA) can raise it.

You also pay a yearly deductible before Part B starts covering anything, and then you pay coinsurance — usually 20 percent of the cost — for most services after that. Some people may have access to for help paying these costs through Medicaid or other programs, but Part B itself is not free for anyone.

Key Takeaways

  • Part B premiums are deducted automatically from your Social Security check each month, or you receive a bill if you do not get Social Security.
  • Your premium amount is based on your income from two years ago, so a big income change now will not affect what you pay until two years later.
  • You can request a reduction in your IRMAA if your income dropped significantly due to retirement, job loss, or death of a spouse.
  • If you delay signing up for Part B when you first become may be able to access, you will owe a permanent penalty on top of your regular premium.
  • Some people with low income and assets may may have access to for Medicaid to help pay Part B premiums and other out-of-pocket costs.

How the standard Part B premium works

The standard Part B premium is set each year by Medicare and announced in the fall. The amount changes year to year based on program costs. In recent years it has ranged from around $160 to $175 per month, but you should check the current year's amount on Medicare.gov or your Social Security statement.

If you are already receiving Social Security when you turn 65, Medicare deducts your Part B premium directly from your monthly check. You do not have to do anything — it happens automatically. If you are not yet receiving Social Security, you will get a bill from Medicare each month, usually by mail or through your online Medicare account.

You can choose to pay by check, automatic bank withdrawal, or credit card, depending on how you set it up. If you miss a payment, Medicare will send you a notice and may suspend your coverage until you pay what you owe.

Income-Related Monthly Adjustment Amount (IRMAA) and higher premiums

If your income is above a certain level, you pay more than the standard premium. This extra amount is called IRMAA. Medicare looks at your tax return from two years ago to decide. For example, in 2024, Medicare uses your 2022 income.

The income thresholds change each year. If you are single and your 2022 income was above roughly $97,000, you likely paid an IRMAA surcharge in 2024. If you are married filing jointly, the threshold is roughly $194,000. The higher your income above the threshold, the higher your surcharge — it can add $70 to $350 or more per month to your Part B premium.

This can feel unfair if your income has dropped since then — for instance, if you retired or lost a job. You can request that Medicare recalculate your IRMAA based on your current income, but you have to file a form and provide proof of the change. This is called an appeal or Life-Changing Event request.

The deductible and coinsurance you pay on top of the premium

Paying the premium does not mean Part B covers everything. You also owe a yearly deductible — the amount you have to pay out of your own pocket before Part B starts paying anything. In 2024, the Part B deductible is $240, but this amount changes each year.

Once you have paid the deductible, Part B covers 80 percent of the cost of most services, and you pay the remaining 20 percent. This is called coinsurance. For example, if you see a doctor and the visit costs $100, and you have already met your deductible, you pay $20 and Part B pays $80.

Some services have different rules. Preventive care — like annual wellness visits and certain screenings — is covered at 100 percent with no coinsurance. But most doctor visits, lab tests, and imaging follow the 20 percent coinsurance rule. Hospital stays are covered under Part A, not Part B, and have their own deductible and cost-sharing rules.

What happens if you do not sign up for Part B when you first become may be able to access

When you turn 65, you have a window to sign up for Part B without penalty. This window is called your Initial Enrollment Period, and it runs for seven months — three months before the month you turn 65, the month you turn 65, and three months after.

If you miss this window and do not have other health coverage (like employer coverage or TRICARE), you will owe a late enrollment penalty. This penalty is a permanent increase to your Part B premium — 10 percent more for each full year you were may be able to access but did not sign up. If you were may be able to access for three years and did not sign up, your premium will be 30 percent higher for as long as you have Part B. This penalty does not go away.

There are some exceptions. If you were covered by an employer health plan or your spouse's employer plan when you turned 65, you may not owe a penalty, but you have to sign up within eight months of losing that coverage. If you are not sure whether you have an exception, contact Social Security or Medicare before your enrollment window closes.

Help paying Part B premiums and out-of-pocket costs

If your income is low and your assets are limited, you may may have access to for Medicaid or a Medicare Savings Program to help pay your Part B premium, deductible, and coinsurance. These programs are run by your state, not by Medicare, so the rules and income limits vary.

The most common program is the may have access to Medicare Beneficiary (QMB) program, which pays your Part B premium, deductible, and coinsurance if you meet the income and asset limits. Another is the Specified Low-Income Medicare Beneficiary (SLMB) program, which pays only the premium. Some states also offer Medicaid itself, which covers Part B costs and more.

To learn about you may have access to, contact your state Medicaid office or call 211 for a referral. You will need to provide proof of income and assets. The process usually takes a few weeks, and once you are approved, the program pays the premium directly to Medicare on your behalf.

Requesting an IRMAA reduction if your income changed

If your income dropped significantly since the year Medicare is using to calculate your IRMAA, you can request a reduction. Common reasons include retirement, job loss, death of a spouse, or a major drop in investment income.

You file a form called the Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event (form SSA-44). You will need to provide proof of the income change — a recent tax return, a letter from your employer, a death certificate, or divorce papers, depending on what happened.

Mail the form to Social Security or submit it online through your Medicare account. Social Security will review it and send you a notice of the decision. If approved, your new IRMAA takes effect the month after Social Security processes the request. If denied, you can appeal.

Frequently Asked Questions

Can I drop Part B to save money?

You can drop Part B if you have other health coverage, like an employer plan or TRICARE. But if you drop it without other coverage and then want to sign up again later, you will owe the late enrollment penalty for the rest of your life. Only drop Part B if you are certain you have coverage that will continue.

Does my Part B premium go up every year?

The standard premium usually increases each year, but the amount varies. Some years it stays nearly the same; other years it jumps. Your IRMAA can also change if your income changes. Check your Social Security statement or Medicare.gov each fall to see what you will pay the following year.

What if I cannot afford my Part B premium?

Contact your state Medicaid office or call 211 to learn about Medicare Savings Programs and Medicaid. If your income is low enough, these programs will pay your premium for you. You can also ask Social Security about a payment plan if you have fallen behind on bills.

Does Part B cover prescription drugs?

No. Part B covers doctor visits, lab tests, imaging, and some equipment, but not prescription drugs. You need Part D coverage for that, which is a separate plan you purchase from a private insurance company. Part D also has a monthly premium and a yearly deductible.

If I am still working at 65, do I have to sign up for Part B?

Not if your employer has 20 or more employees and you are covered by their health plan. You can delay Part B without penalty as long as you are actively employed and covered. But once you leave that job, you have eight months to sign up or you will owe a late penalty.