Medicare Part B requires a monthly premium, and most people pay it automatically from their Social Security check

Medicare Part B is not free. You pay a monthly premium, a yearly deductible, and a percentage of the cost when you use covered services. The premium amount depends on your income — higher earners pay more. For 2024, the standard premium is $164.90 per month, but yours could be lower or higher based on your income from two years ago.

Most people who get Social Security have the Part B premium taken directly from their monthly check. If you don't get Social Security, you pay Medicare directly by mail or online. The premium is separate from what you pay when you actually use a doctor or hospital.

You do not have to take Part B when you first become may be able to access at 65. But if you delay without a valid reason, you will pay a permanent penalty — 10 percent more for each year you waited. The exception is if you are still working and covered by your employer's health plan; in that case, you can delay without penalty.

Key Takeaways

  • The standard Part B premium for 2024 is $164.90 per month, but the amount you pay depends on your income from two years prior.
  • Your premium is usually deducted from your Social Security payment, or you pay Medicare directly if you do not receive Social Security.
  • You also pay a yearly deductible ($240 in 2024) and 20 percent of the cost of most covered services after the deductible is met.
  • If you delay Part B past age 65 without employer coverage or a may have access to reason, you will pay a 10 percent penalty for each year you waited, permanently.
  • Part B covers doctor visits, outpatient care, and some preventive services, but does not cover dental, vision, or hearing aids.

How the monthly premium is calculated based on your income

Medicare uses your income from two years before the current year to set your Part B premium. If you earned more in 2022, your 2024 premium will be higher. This is called Income-Related Monthly Adjustment Amount, or IRMAA.

For 2024, if you filed taxes individually and your income was $97,000 or less, you pay the standard premium. If your income was between $97,001 and $123,000, you pay more — the exact amount depends on which income bracket you fall into. The highest earners can pay up to $560.50 per month for Part B.

If your income drops significantly — because you retired, lost a job, or had a major life change — you can ask Medicare to recalculate your premium using your current year's income instead. You must contact Social Security or Medicare directly to request this change, and you will need to document the reason.

The deductible and what you pay when you use services

Beyond the monthly premium, you are responsible for a yearly deductible. For 2024, the Part B deductible is $240. This means you pay the first $240 of your covered services out of your own pocket each year. After you meet the deductible, Medicare pays 80 percent of the approved amount for most services, and you pay 20 percent.

This 20 percent cost-sharing applies to doctor visits, lab tests, imaging, and outpatient hospital services. Some preventive services — like annual wellness visits, cancer screenings, and vaccinations — are covered at no cost after you meet the deductible, or sometimes with no deductible at all.

If you see a doctor who does not accept Medicare assignment, you may pay more. These doctors can charge up to 15 percent above Medicare's approved amount. Before scheduling, ask whether the doctor accepts Medicare assignment to avoid surprise bills.

When you can delay Part B without paying a penalty

You do not have to enroll in Part B at 65 if you have health coverage through your current employer or your spouse's current employer. As long as the employer has 20 or more employees, you can wait to enroll in Part B without penalty. When you do enroll — whether that is at 67 or 70 — your premium will not be higher because you delayed.

If you lose your employer coverage, you have eight months to enroll in Part B without penalty. This is called your Special Enrollment Period. You must enroll within this window; if you miss it, the 10 percent annual penalty applies permanently.

If you delay Part B without a may have access to reason, the penalty is 10 percent of the standard premium for each full year you could have had it but did not. If you waited three years, you pay 30 percent more forever — even if your income drops later.

How to pay your Part B premium

If you receive Social Security, the easiest method is automatic deduction. Medicare deducts your premium from your monthly Social Security payment before you receive it. You do not have to do anything after you first enroll.

If you do not receive Social Security, you pay Medicare directly. You can set up automatic payments from your bank account, pay by check through the mail, or pay online at Medicare.gov. Call 1-800-MEDICARE if you need help setting up payment or if you want to change your payment method.

If you cannot afford the Part B premium, you may be able to get help through Medicaid or a Medicare Savings Program run by your state. These programs pay part or all of your premium if your income is low enough. Contact your state Medicaid office or call 211 to find out whether you may have access to.

What Part B covers and what it does not

Part B covers doctor visits, outpatient hospital services, lab work, imaging, mental health care, and some rehabilitation services. It also covers certain preventive services at no cost, including annual wellness visits, cancer screenings, and flu shots.

Part B does not cover dental care, vision exams, eyeglasses, hearing aids, or routine foot care. It does not cover prescription drugs — that is Part D. It does not cover long-term care in a nursing home or assisted living. If you need these services, you will need separate coverage or pay out of pocket.

Many people buy a Medigap policy (also called supplemental insurance) to cover the costs that Part B does not — the deductible, the 20 percent cost-sharing, and some services like dental and vision. Medigap premiums vary widely depending on the plan and your age, and you pay them in addition to your Part B premium.

Income changes and how to report them

If your income drops significantly in the current year, you do not have to wait for Medicare to recalculate your premium automatically. You can request a Life-Changing Event review by contacting Social Security or calling 1-800-MEDICARE. You will need to provide proof of the income change — a recent tax return, a letter from your employer, or documentation of job loss.

Common may have access to events include retirement, loss of employment, death of a spouse, divorce, or a significant drop in business income. Medicare will review your request and may lower your premium retroactively to the month the change occurred.

If you disagree with the income amount Medicare used to calculate your premium, you can request a reconsideration. You have 60 days from the date on your notice to file an appeal. Contact Social Security if your income is based on Social Security earnings, or Medicare if it is based on other income.

Frequently Asked Questions

What happens if I do not pay my Part B premium?

If your premium is not deducted from Social Security and you do not pay by the due date, Medicare will send you a bill. If you do not pay within three months, your Part B coverage can be terminated. You can restart it, but you may owe back premiums and face a penalty for late enrollment.

Can I get Part B for free if my income is very low?

Part B itself is not free, but your state's Medicare Savings Program may pay your premium and deductible if your income is below a certain level. Contact your state Medicaid office or call 211 to learn whether you may have access to. Income limits vary by state.

Does Part B premium increase every year?

Yes, the standard premium usually increases each year based on inflation and program costs. For 2024, it rose to $164.90 from $164.90 in 2023. The exact increase is announced in the fall for the following year. Your personal premium may also change if your income changes.

If I have Part B, do I still need Part D for prescriptions?

Yes. Part B does not cover prescription drugs. You need Part D coverage, which is a separate plan you purchase from a private insurance company. You can enroll in Part D when you first become may be able to access at 65, or during the annual enrollment period from October 15 to December 7.

What is the difference between Part B and Medigap?

Part B is your basic Medicare coverage — it covers doctor visits and outpatient services. Medigap is supplemental insurance that covers costs Part B does not, like the deductible and 20 percent cost-sharing. You pay both premiums if you have Medigap, but your out-of-pocket costs are usually lower.