Medicare premiums are the monthly fees you pay to have Medicare coverage

A premium is the amount you pay each month to keep your Medicare active. Most people pay premiums for Part B (doctor visits and outpatient care) and Part D (prescription drugs). Some people also pay a premium for Part A (hospital care), though most do not. If you choose a Medicare Advantage plan instead of Original Medicare, you pay that plan's premium instead of the Part B premium.

The amount you pay depends on which parts of Medicare you have, when you first signed up, and how much income you reported on your tax return from two years ago. The Social Security Administration adjusts premiums every year, so what you pay in 2024 will likely differ from what you pay in 2025.

Your premium is usually taken directly from your Social Security check each month. If you do not receive Social Security, Medicare sends you a bill. Some people pay more than the standard amount because of their income level — this is called an Income-Related Monthly Adjustment Amount, or IRMAA.

Key Takeaways

  • Part B premiums are deducted from your Social Security payment each month, and the amount changes yearly based on what Medicare costs to run.
  • If your income was above a certain threshold two years ago, you will pay a higher premium through an IRMAA surcharge added to your Part B and Part D costs.
  • Part A has no premium for most people, but those who did not work long enough in jobs covered by Medicare may pay a monthly fee.
  • Medicare Advantage plans have their own premiums, which vary by plan and location, and are often lower than Original Medicare Part B premiums.
  • You can see what you will pay by logging into your Medicare account at Medicare.gov or calling 1-800-MEDICARE to speak with someone.

Part B premiums and how they are set

Part B covers doctor visits, lab work, imaging, and outpatient hospital services. The standard Part B premium for 2024 is $164.90 per month, but this amount changes each year. The Centers for Medicare & Medicaid Services (CMS) sets the premium based on the cost of running the program divided by the number of people enrolled.

If you signed up for Part B when you first became may be able to access at 65, you pay the standard premium. If you delayed signing up and did not have other health coverage, you may pay a late enrollment penalty — a permanent increase of 10 percent for each year you were may be able to access but did not enroll. This penalty stays with you for life, so it matters whether you sign up on time.

Your Part B premium is usually taken from your Social Security check automatically. If you do not receive Social Security, Medicare sends you a bill each month. You can also choose to pay quarterly or annually if you prefer.

Part D premiums for prescription drug coverage

Part D covers prescription medications at pharmacies. Unlike Part B, there is no single standard Part D premium — each insurance company that offers Part D sets its own price. Plans in your area might range from $5 to $100 per month or more, depending on which drugs they cover and which pharmacies they use.

You choose a Part D plan during the annual enrollment period (October 15 to December 7 each year). If you do not sign up when you first become may be able to access and you do not have other drug coverage, you pay a late enrollment penalty when you finally join. The penalty is 1 percent of the national average Part D premium for each month you were may be able to access but not enrolled — and like the Part B penalty, it is permanent.

Your Part D premium is also usually deducted from your Social Security check. If you switch plans during open enrollment, your new premium takes effect on January 1.

Part A premiums and who pays them

Part A covers hospital stays, skilled nursing facility care, hospice, and home health services. Most people do not pay a Part A premium because they or their spouse worked for at least 10 years in jobs covered by Medicare (almost all jobs in the United States).

If you did not work long enough to may have access to for premium-free Part A, you can still enroll and pay a monthly premium. For 2024, the Part A premium ranges from $278 to $556 per month depending on how many quarters of work history you have. A quarter is roughly three months of covered work.

If you have premium-free Part A, you do not see a deduction on your Social Security check for it. If you pay a Part A premium, it is usually deducted automatically like Part B and Part D.

Income-related surcharges (IRMAA) and when you pay more

If your income was above a certain level two years ago, you pay more than the standard premium. This extra amount is called an Income-Related Monthly Adjustment Amount. For 2024, if your modified adjusted gross income was above $97,000 (single) or $194,000 (married filing jointly), you owe an IRMAA.

The surcharge applies to both Part B and Part D. The higher your income, the higher the surcharge. Someone with a single income of $500,000 might pay $560 per month for Part B alone, compared to the standard $164.90. The surcharge is recalculated each year based on your most recent tax return.

If your income drops because you retire, sell a home, or have another major life change, you can ask Medicare to recalculate your IRMAA. You will need to file a form called the Medicare Income-Related Monthly Adjustment Amount — Life-Changing Event (form SSA-44). Social Security processes this request, not Medicare directly.

Medicare Advantage plan premiums

If you choose a Medicare Advantage plan (Part C) instead of Original Medicare, you do not pay the Part B premium to Medicare. Instead, you pay the plan's own premium, which varies by insurer and location. Some plans have a $0 premium, while others charge $50 to $200 or more per month.

Even if your Medicare Advantage plan has a $0 premium, you still pay the Part B premium to Medicare unless you are in a plan that covers Part B. You also still need Part D coverage for prescriptions unless your Advantage plan includes drug coverage — most do, but not all.

Medicare Advantage premiums can change year to year. Plans are required to notify you by September 30 each year if your premium is changing for the next year. If your plan's premium increases, you have the right to switch to a different plan during open enrollment.

When and how premiums are deducted

If you receive Social Security, your Medicare premiums are deducted from your check automatically each month. The deduction appears as a line item on your Social Security statement. You can see the breakdown of what you are paying for Part A, Part B, and Part D.

If you do not receive Social Security, Medicare sends you a bill each month. You can pay by mail, phone, or online through your Medicare account. If you miss a payment, Medicare will send you a notice and may suspend your coverage if the bill goes unpaid for long enough.

You can change how you pay by contacting Social Security (if you receive benefits) or Medicare directly at 1-800-MEDICARE. You can also log into your account at Medicare.gov to see your current premiums and payment method.

Questions to ask your doctor or Medicare

Before you enroll in Medicare or during open enrollment, ask your doctor which plans in your area cover the services and medications you use most. Ask whether your current medications are on the plan's formulary (the list of covered drugs) and what your out-of-pocket cost will be.

Call 1-800-MEDICARE or visit Medicare.gov to compare plans side by side. You can enter your zip code and current medications, and the tool will show you the total estimated cost for each plan — premium plus out-of-pocket costs — so you can see which is cheapest for your situation.

If you think your IRMAA is wrong, ask Social Security to review it. Bring your most recent tax return and any documents showing a major life change (retirement letter, home sale closing statement, divorce decree). Social Security can recalculate your adjustment if your circumstances have changed.

Frequently Asked Questions

Why did my Medicare premium go up this year?

Medicare adjusts premiums annually based on the cost of running the program. Part B premiums rose significantly in recent years because of higher costs for doctor services and hospital care. If your income increased, you may also owe an IRMAA surcharge. You can see the breakdown of your premium on your Social Security statement or Medicare bill.

Can I get help paying my Medicare premiums?

Yes. The Medicaid program in your state may cover your Part B and Part D premiums if your income is low enough. Contact your state Medicaid office or call 1-800-MEDICARE to find out whether you may have access to. Some nonprofits also offer premium information, though availability varies by location.

What happens if I do not pay my premium?

If your premium is deducted from Social Security, it is paid automatically. If you receive a bill and do not pay, Medicare will send you a notice. If you do not pay within a certain period, your coverage can be suspended. Contact Medicare when ready if you are having trouble paying so you can discuss payment options.

Do I have to pay a premium for Part A?

Most people do not — Part A is premium-free if you or your spouse worked at least 10 years in Medicare-covered jobs. If you did not work long enough, you can enroll and pay a monthly premium ranging from $278 to $556 depending on your work history. You can ask Social Security to check your work record.

Can I change my Medicare plan if my premium is too high?

Yes, during the annual open enrollment period from October 15 to December 7, you can switch to a different plan. You can also switch if you have a major life change like moving, losing other health coverage, or a significant drop in income. Contact Medicare to report the change and see which plans are available to you.