How Medicare Part B premiums work

Medicare Part B covers doctor visits, outpatient care, and medical equipment. Most people pay a monthly premium for Part B, and the amount depends on your income. The standard premium in 2024 is $164.90 per month, but if you earn more than a certain amount, you pay a higher premium called an Income-Related Monthly Adjustment Amount (IRMAA).

Your income from two years ago determines your IRMAA bracket. For example, if you turn 65 in 2024, Medicare looks at your 2022 tax return to set your premium. If your income was under $97,000 (single) or $194,000 (married filing jointly), you pay the standard premium. Above those thresholds, your premium rises in steps — sometimes significantly.

You have several ways to pay: automatic deduction from your Social Security check, a monthly bill from Medicare, or a payment arrangement with your bank. Most people choose the Social Security deduction because it happens automatically and you do not have to remember to send a check.

Key Takeaways

  • Part B premiums are deducted from your Social Security payment automatically unless you choose a different payment method.
  • Your income from two years before you turn 65 (or two years before you start Part B) determines whether you pay the standard premium or a higher IRMAA amount.
  • You can request a reduction in your IRMAA if your income dropped due to retirement, job loss, or death of a spouse — Medicare calls this a Life-Changing Event.
  • If you delay starting Part B and do not have other health coverage, you may owe a permanent penalty when you finally enroll.

When you start paying Part B premiums

You become responsible for Part B premiums the month your coverage begins. For most people, that is the month you turn 65, as long as you enroll during your Initial Enrollment Period — the seven-month window that starts three months before your 65th birthday and ends three months after.

If you are still working and have health insurance through your employer, you can delay Part B without penalty. You have eight months after your employment ends (or your employer coverage stops, whichever comes first) to enroll without owing a late penalty. This is called the Special Enrollment Period.

If you miss your enrollment window and do not have a may have access to reason, Medicare adds a 10 percent penalty to your Part B premium for each full year you were may be able to access but not enrolled. That penalty stays with you for life, so the cost of waiting can be steep.

Income-Related Monthly Adjustment Amounts (IRMAA)

If your income exceeds the threshold, you pay more than the standard premium. In 2024, the brackets start at $97,000 (single) and go up to $500,000 (single). The highest earners pay $560.50 per month instead of $164.90. These amounts change each year.

IRMAA also affects your Part D (prescription drug) and Part C (Medicare Advantage) premiums if you have them. The higher your income bracket, the more you pay across all three. Medicare sends you a notice each year in December showing your IRMAA amount for the coming year.

If you disagree with the income amount Medicare used, you can request a review. You have 60 days from the date on your notice to ask Medicare to reconsider. You will need to provide documents like your tax return, a letter from your employer, or proof of a major life change.

Requesting an IRMAA reduction after a life change

If your income dropped significantly since the tax year Medicare used to calculate your IRMAA, you can request a reduction. Life-Changing Events that may have access to include retirement, job loss, death of a spouse, divorce, or a substantial decrease in income or assets.

You must file a form called the Medicare Income-Related Monthly Adjustment Amount — Life-Changing Event (form CMS-L564) with Medicare. You can mail it, fax it, or submit it online through your Medicare account at Medicare.gov. You will need to include proof of the event — a termination letter from your employer, a death certificate, divorce papers, or a recent tax return showing lower income.

Medicare typically processes these requests within 30 days. If approved, your new IRMAA takes effect the month after Medicare receives your request. If you are already paying the higher amount, Medicare may refund the difference.

Payment methods and how to set them up

The easiest way to pay is to have your Part B premium deducted directly from your Social Security check. This happens automatically if you enroll in Part B while you are already receiving Social Security. If you are not yet receiving Social Security, you can set up automatic deduction from your bank account instead.

To arrange automatic bank withdrawal, call Medicare at 1-800-MEDICARE (1-800-633-4227) or log into your account at Medicare.gov. You will need your bank routing number and account number. Once set up, the payment comes out on the same day each month.

If you prefer to pay by mail, Medicare sends you a bill each month. You can also pay online through Medicare.gov without setting up automatic deduction. Some people choose this method if their income varies and they want to review the amount before paying.

What happens if you cannot afford your Part B premium

If your income is very low, you may be able to get help paying your Part B premium through a program called Medicaid or a Medicare Savings Program. These programs are run by your state, not by Medicare directly, and may be able to access varies widely by state.

To find out whether your state has a Medicare Savings Program, contact your state Medicaid office or call 1-800-MEDICARE. You can also visit the Centers for Medicare & Medicaid Services (CMS) website, which lists contact information for each state's program. You will need to provide proof of income and assets.

Some states also offer may have access to Individual (QI) programs that help pay Part B premiums for people whose income is slightly above the Medicaid limit. The income thresholds and benefits differ by state, so it is worth checking even if you were turned down for Medicaid.

Part B premium changes and annual notices

Medicare announces the standard Part B premium each year in the fall, usually in October or November. The amount can go up or down depending on program costs. Your IRMAA brackets also change annually based on inflation adjustments.

You will receive a notice in December showing your Part B premium for the coming year. If your premium is going up, the notice explains why. If you disagree with the amount or think your income has changed, you have 60 days from the date on the notice to request a review or report a life-changing event.

If your income dropped in the current year due to retirement or job loss, do not wait for next year's notice. File a Life-Changing Event form as soon as the change happens. The sooner you report it, the sooner your premium can be adjusted.

Frequently Asked Questions

Can I delay Part B if I am still working?

Yes. If you have health insurance through your employer, you can delay Part B without penalty. You have eight months after you leave your job or lose your employer coverage to enroll. After that window closes, you will owe a 10 percent penalty for each year you were may be able to access but not enrolled.

What if my Social Security check is not enough to cover my Part B premium?

Medicare will not deduct more than your entire Social Security payment. If your premium is higher than your check, Medicare will bill you separately for the difference. You can also contact your state Medicaid office to see whether you may have access to for a Medicare Savings Program to help cover the cost.

How do I know if my IRMAA is correct?

Medicare uses your tax return from two years before you turn 65 (or two years before you start Part B). If your income has changed since then, you can request a review by filing form CMS-L564 and providing proof of the change. You have 60 days from the date on your IRMAA notice to request a review.

What if I move to a different state?

Your Part B premium stays the same — it does not change based on which state you live in. However, if you move, you may become may be able to access for different state programs like Medicaid or a Medicare Savings Program. Contact your new state's Medicaid office to find out what help is available.

Can I change my payment method after I start Part B?

Yes. You can switch from Social Security deduction to bank withdrawal, or vice versa, at any time. Call 1-800-MEDICARE or log into Medicare.gov to make the change. The new method usually takes effect within one or two billing cycles.