Part B costs you a monthly premium, an annual deductible, and a percentage of most doctor and outpatient services
Medicare Part B covers doctor visits, outpatient care, lab tests, and medical equipment. You pay for it in three ways: a monthly premium taken from your Social Security check, an annual deductible you meet before coverage kicks in, and coinsurance (usually 20%) on most services after that.
The exact amounts change each year. For 2024, the standard monthly premium is $164.90, the annual deductible is $240, and you typically pay 20% of the cost for doctor visits and outpatient services once you've met your deductible. If your income is higher, you pay more — Medicare adds an extra charge called an Income-Related Monthly Adjustment Amount (IRMAA).
Most people are automatically enrolled in Part B when they turn 65, and the premium comes straight out of their Social Security payment. If you delayed enrolling and sign up later, you may owe a permanent penalty on top of your regular premium.
Key Takeaways
- The 2024 Part B premium is $164.90 per month for most people, taken automatically from your Social Security check.
- You pay a $240 annual deductible before Part B coverage begins, then 20% coinsurance on most services.
- If your income exceeds certain thresholds, you pay a higher premium through IRMAA surcharges that can range from $65 to $560 extra per month.
- Delaying Part B enrollment after age 65 results in a permanent 10% penalty for each year you waited, added to your premium for life.
The monthly premium and how it's deducted
Your Part B premium is deducted from your Social Security benefit each month. If you're not yet receiving Social Security, Medicare bills you directly. The standard premium for 2024 is $164.90, but the amount you pay depends on your income from two years prior.
If you earned more than $97,000 as a single filer (or $194,000 married filing jointly) in 2022, Medicare adds an IRMAA surcharge to your premium. This surcharge increases in steps based on your income level. For example, a single person with income between $97,001 and $123,000 pays an extra $65 per month; someone with income over $500,000 pays an extra $560 per month. These income thresholds and surcharge amounts are set by Medicare and change yearly.
You receive a notice each fall showing your premium for the following year. If you believe the income figure Medicare used is wrong — perhaps you had a major life change like retirement or a spouse's death — you can request a recalculation.
The annual deductible and coinsurance
Before Part B starts paying for services, you must pay a $240 annual deductible (for 2024). This resets every January 1st. Once you've paid $240 out of pocket for covered services, your coinsurance kicks in.
Coinsurance means you pay a percentage of the cost, and Part B pays the rest. For most doctor visits and outpatient services, you pay 20% after meeting your deductible. For example, if you have a lab test that costs $100, you pay $20 and Part B pays $80. Some preventive services — like annual wellness visits, cancer screenings, and vaccinations — have no coinsurance; Part B covers them fully once you've met your deductible.
Part B does not cover everything. Routine dental, vision, and hearing care are not included. If you need these services, you can purchase a separate dental, vision, or hearing plan, or pay out of pocket.
Income-Related Monthly Adjustment Amount (IRMAA)
IRMAA is an extra charge added to your Part B premium if your income is above a certain level. Medicare uses your Modified Adjusted Gross Income (MAGI) from your tax return from two years before. For 2024 premiums, Medicare looked at your 2022 income.
The income thresholds and surcharge amounts are:
| Income (Single Filer) | Income (Married Filing Jointly) | Extra Monthly Charge |
|---|---|---|
| $97,000 or less | $194,000 or less | $0 (standard premium only) |
| $97,001–$123,000 | $194,001–$246,000 | $65 |
| $123,001–$153,000 | $246,001–$306,000 | $164.90 |
| $153,001–$183,000 | $306,001–$366,000 | $264.70 |
| Over $183,000 | Over $366,000 | $560 |
If your income drops — for example, you retire or your spouse passes away — you can request that Medicare recalculate your IRMAA using your current year's income instead. You'll need to file a form and provide documentation of the life event.
What happens if you delay enrollment
Most people are automatically enrolled in Part B at 65. If you delay enrollment and sign up later, you pay a permanent penalty. The penalty is 10% of the standard premium for each full year you delayed. If you waited three years, you'd pay an extra 30% on top of your regular premium — for life.
There are exceptions. If you were covered by a group health plan through your job or your spouse's job when you turned 65, you can enroll in Part B without penalty during an eight-month window after that coverage ends. You must have been actively working or be a spouse of someone actively working. If you miss this window, the penalty applies.
If you think you have a valid reason for late enrollment, contact Social Security or Medicare to discuss your situation. Some people have had penalties waived, but this is rare and requires documentation.
How Part B works with other coverage
If you have a Medigap policy (supplemental insurance), it covers some or all of the costs that Part B doesn't — like the deductible and coinsurance. This can significantly reduce your out-of-pocket costs, though Medigap premiums vary by plan and location.
If you have a Medicare Advantage plan (Part C), you don't pay Part B coinsurance the same way. Instead, you pay copays or coinsurance set by your Advantage plan, which may be lower or higher than the standard 20%. You still pay the Part B premium, but your out-of-pocket costs depend on your specific plan.
If you have coverage through your employer or a union, that coverage may coordinate with Part B. Always tell your employer's benefits office that you're on Medicare so they can explain how the two work together.
When costs increase and how to plan
Part B premiums and deductibles increase most years. The increases are tied to the cost of living adjustment (COLA) that Social Security receives. In years when Social Security doesn't increase, Part B premiums typically don't increase either — this is called "hold harmless" protection.
You'll receive a notice each October or November showing your premium for the following year. Review it carefully. If the amount seems wrong, you have a window to appeal or request a recalculation. If your income has changed significantly, request an IRMAA recalculation right away rather than waiting until the next year.
To manage costs, ask your doctor about generic medications, preventive services you're may have access to to at no cost, and whether any tests or procedures are truly necessary. Some community health centers offer sliding-scale fees for services Part B doesn't cover.
Frequently Asked Questions
Can I refuse Part B when I turn 65?
Yes, you can decline Part B at 65 if you have coverage through an active employer or union. You must have written confirmation from your employer that you're covered. If you decline without this coverage, you'll owe a permanent penalty when you enroll later. Contact Medicare before declining to make sure you won't be penalized.
What if I can't afford the Part B premium?
If your income is low, you may be able to get help through Medicaid or the Medicare Savings Program (MSP), which pays some or all of your Part B premium. Contact your state Medicaid office or local Area Agency on Aging to learn whether you meet the income limits. These programs vary by state.
Does Part B cover prescription drugs?
No. Prescription drug coverage is Part D, a separate plan you purchase from a private insurance company. You can enroll in Part D when you turn 65 or during the annual open enrollment period. If you delay enrolling without creditable coverage, you'll owe a penalty.
Why does my Part B premium change every year?
Premiums are set based on the projected cost of Part B services for the coming year. If healthcare costs rise, premiums typically rise. Your personal premium may also change if your income changes, triggering a different IRMAA surcharge.
Can I get a refund if I overpaid my Part B premium?
If you've overpaid — for example, because your income dropped and you requested an IRMAA recalculation — Medicare will refund the difference. The refund is usually applied to future premiums rather than sent as a check, but you can request a direct refund by contacting Social Security.