Part B premiums depend on your income, not just your age

Most people on Medicare Part B pay a monthly premium that changes each year. For 2025, the standard premium is $185 per month if your income is below a certain threshold. But if you earn more than that threshold, you pay a higher amount — sometimes significantly higher. The exact premium you owe depends on your modified adjusted gross income (MAGI) from two years ago, which Medicare uses to sort people into income brackets.

You do not choose your bracket. Medicare calculates it automatically using your tax return. If your income was higher two years ago, you will pay more now. If your income drops — because you retired, took a pay cut, or had a major life change — you can ask Medicare to recalculate based on your current income, but you have to request it.

Key Takeaways

  • The standard Part B premium for 2025 is $185 per month, but you pay more if your income exceeds $103,000 as a single filer or $206,000 as a married couple filing jointly.
  • Medicare uses your income from two years prior to set your premium, so changes in your earnings take time to show up in what you owe.
  • You can request a recalculation if your income dropped due to retirement, job loss, or other life events, but you must contact Social Security or Medicare to do so.
  • Part B premiums are deducted from your Social Security check each month unless you chose to pay Medicare directly.
  • Your premium covers doctor visits, outpatient care, and some preventive services, but you still owe a deductible and copayments for most care.

The income brackets that determine your 2025 premium

Medicare divides Part B enrollees into five income tiers. The standard premium of $185 applies to single filers earning up to $103,000 per year, or married couples filing jointly earning up to $206,000. Above those thresholds, your premium jumps in steps.

A single filer earning $103,001 to $129,000 pays $259 per month. The next bracket, $129,001 to $161,000, costs $370 per month. From $161,001 to $193,000, you pay $481 per month. And if you earn more than $193,000 as a single filer, your premium is $592 per month. Married couples have higher income thresholds but follow the same structure — the highest bracket starts at $386,000 in combined income.

These brackets and amounts change each year. The 2024 standard premium was $164.90, so you can see how the cost rises annually. Your Social Security Administration notice, sent in December, will tell you which bracket you fall into and what you will pay starting in January.

When your income changes and how to report it

If your income drops significantly — because you retired, left a job, or had a major loss — you do not have to wait two years for Medicare to catch up. You can request a recalculation by contacting Social Security or calling Medicare directly at 1-800-MEDICARE (1-800-633-4227).

You will need to explain what changed and provide proof: a recent tax return, a letter from your employer showing you left, a divorce decree, or documentation of the event that lowered your income. Social Security will review your request and send you a new notice if your premium changes. This process usually takes a few weeks.

If you do not report a change, you will keep paying the higher premium until the two-year lag catches up. Many people do not realize they can request this, so if you had a major life event in the past two years, it is worth a call.

How your premium is paid and what happens if you cannot afford it

Your Part B premium is normally deducted directly from your Social Security check each month. If you do not receive Social Security, Medicare sends you a bill. You can choose to pay Medicare directly instead of having it taken from Social Security, but you have to request this arrangement.

If you cannot afford your premium, you may be able to get help through Medicaid or a Medicare Savings Program (MSP). These programs, run by your state, can pay your Part B premium for you if your income is low enough. The income limits vary by state, but they are generally higher than Medicaid's own limits. You explore through your state's Medicaid office, not through Medicare.

Some people also may have access to for the Part B premium subsidy if they have very low income and limited savings. This is different from an MSP and is handled directly by Social Security.

What Part B actually covers and what you still owe

Your Part B premium pays for the insurance itself, but it does not cover all your costs. You still owe a yearly deductible — $240 for 2025 — before Medicare starts paying its share. After you meet the deductible, Medicare typically covers 80 percent of approved services, and you pay the remaining 20 percent.

Part B covers doctor office visits, outpatient hospital services, lab tests, X-rays, and some preventive care like cancer screenings and vaccines. It does not cover routine dental, vision, or hearing care. If you want coverage for those services, you need a separate plan or to pay out of pocket.

Many people on Medicare Part B also buy a Medigap (supplemental insurance) plan to cover the deductible and the 20 percent copayment. Medigap premiums vary widely depending on which plan you choose and your age, but they are separate from your Part B premium.

Part B premiums for people on a fixed income

If you are on Social Security and your income has not changed in years, your Part B premium will still increase each year. Social Security has a "hold harmless" rule that protects your overall benefit — if your Part B premium goes up, your Social Security payment cannot decrease. But this means the increase comes out of any cost-of-living adjustment (COLA) you would have received.

For example, if Social Security gives you a 2 percent COLA but Part B premiums rise 3 percent, you see no increase in your check because the extra Part B cost eats the COLA. This affects millions of people on fixed incomes, and it is one reason many seniors struggle with rising healthcare costs even when their benefits officially increase.

Frequently Asked Questions

Can I delay enrolling in Part B to avoid paying premiums?

You can delay Part B if you are still working and covered by your employer's health plan, but if you wait past your enrollment window, you will owe a permanent penalty on top of your regular premium. The penalty is 10 percent for each year you were may be able to access but did not enroll. It is usually better to enroll on time unless your employer coverage is still active.

What if I move to a different state — does my premium change?

Your Part B premium does not change when you move. It is set by Medicare nationally, not by state. However, if you move to a state with a different Medicaid program and you were receiving help with premiums, your coverage may change. Contact your new state's Medicaid office to see if you still may have access to for information.

Do I have to pay Part B premiums if I am still working?

Yes, you pay Part B premiums even if you are still employed and have employer coverage. However, you may be able to delay enrolling in Part B without penalty if your employer plan is considered creditable coverage. You should contact your employer's benefits office and Medicare to confirm your situation before declining Part B.

How do I know if my income bracket changed for next year?

Social Security sends a notice in December telling you what your Part B premium will be for the coming year and which income bracket you are in. If you do not receive a notice, call Social Security at 1-800-772-1213 or Medicare at 1-800-633-4227. You can also check your Medicare.gov account online if you have one set up.

What if I disagree with the income Medicare used to calculate my premium?

You can appeal if you believe Medicare used the wrong income figure. You have 60 days from the date on your notice to request a reconsideration. You will need to provide documentation of your actual income, such as a recent tax return or a letter from your employer. Contact Social Security or Medicare to start the appeal process.