Medicare does not have income limits for enrollment

Unlike some government programs, Medicare does not turn people away based on how much money they earn. You can be a millionaire or have no income at all — either way, if you meet the age or disability requirements, you can enroll in Medicare Part A and Part B. Income does not determine whether you get Medicare.

However, income does affect two important things: how much you pay for your premiums and whether you may have access to for programs that help cover those costs. This distinction matters because your income level can mean the difference between paying standard premiums and paying significantly more — or between paying full price and getting help from a state or federal program.

Key Takeaways

  • Medicare enrollment is not restricted by income; anyone who meets age or disability requirements can enroll regardless of earnings.
  • Your income determines your premium amount for Part B and Part D, with higher earners paying surcharges called Income-Related Monthly Adjustment Amounts (IRMAA).
  • Programs like the Low-Income Subsidy and Extra Help use income thresholds to determine whether you pay reduced premiums for prescription drug coverage.
  • Income limits for information programs vary by state and change yearly, so checking your specific situation each year is necessary.
  • Social Security, pensions, interest, and rental income all count toward the income calculations that determine your Medicare costs.

How income affects your Part B and Part D premiums

If your income exceeds certain thresholds, Medicare charges you a higher monthly premium for Part B (medical insurance) and Part D (prescription drug coverage). These extra charges are called Income-Related Monthly Adjustment Amounts, or IRMAA. The thresholds change each year and depend on your income from two years prior — so in 2024, Medicare looks at your 2022 income.

The income brackets are different for single filers and married couples filing jointly. For example, in 2024, a single person with income above $97,000 begins paying IRMAA surcharges on Part B, while a married couple filing jointly starts paying surcharges at $194,000. These amounts increase each year. The surcharge itself can range from about $70 to over $300 per month for Part B alone, depending on how far above the threshold your income falls.

Part D premiums follow a similar structure but with different income thresholds. If you have higher income, you will pay more for your prescription drug plan. The exact amount depends on which plan you choose, but the income-based surcharge applies on top of your plan's base premium.

Low-Income Subsidy and Extra Help programs

If your income is low, you may may have access to for the Low-Income Subsidy (LIS) program, also called "Extra Help." This program helps pay your Part D premiums, deductibles, and copayments for prescription drugs. To may have access to, your income must fall below 150% of the federal poverty line, though some states use slightly higher thresholds.

The federal poverty line changes each year. For 2024, 150% of the poverty line for a single person is approximately $1,968 per month, though this varies by state and household size. If you receive Supplemental Security Income (SSI) or Medicaid, you automatically may have access to for Extra Help without needing to check income limits separately.

To find out whether you may have access to, you can contact Social Security at 1-800-772-1213 or visit your local Social Security office. You can also explore through the Medicare website or ask your state Medicaid office, since they administer the program in many states. Processing typically takes several weeks, so explore early in the year is wise if you think you might may have access to.

Medicaid and Medicare Savings Programs

Medicaid is a separate program from Medicare, and it has its own income limits that vary significantly by state. Some states are more generous than others. If you have very low income, you may may have access to for both Medicare and Medicaid at the same time — a situation called "dual may be able to access." Medicaid can help pay your Medicare premiums and cost-sharing.

Medicare Savings Programs (MSP) help pay your Part A and Part B premiums, deductibles, and copayments if your income is low but slightly higher than Medicaid limits. Income thresholds for MSP are typically around 120% to 135% of the federal poverty line, depending on which program tier you enter. Like Medicaid, MSP income limits vary by state.

To learn your state's specific Medicaid and MSP income limits, contact your state Medicaid office or call 1-800-MEDICARE. Each state sets its own thresholds, so what qualifies in one state may not in another. Your state office can tell you exactly where you stand and what programs might help with your costs.

What counts as income for Medicare purposes

Medicare counts most forms of income when calculating your IRMAA surcharges and determining whether you may have access to for information programs. This includes wages from employment, self-employment income, Social Security benefits, pensions, interest and dividends, rental income, and distributions from retirement accounts like IRAs and 401(k)s.

For IRMAA calculations specifically, Medicare uses your Modified Adjusted Gross Income (MAGI), which is your adjusted gross income plus certain tax-exempt income. For information programs like Extra Help and MSP, the rules can differ slightly — some programs count only earned income and Social Security, while others include investment income. The specific definition depends on which program you are checking.

One important note: if you had a major life change — such as retirement, loss of a spouse, or a significant drop in income — you may be able to request an adjustment to your IRMAA calculation. Medicare will use your current year's income instead of the two-year-old figure if your circumstances have changed substantially. You have to request this adjustment; it does not happen automatically.

Income thresholds change every year

All Medicare income thresholds — for IRMAA surcharges, Extra Help, MSP, and Medicaid — adjust annually. The federal poverty line increases most years, which means income limits for information programs go up. IRMAA brackets also increase, though not always by the same percentage as inflation.

Because thresholds change, you should review your situation every year during Medicare's Open Enrollment Period, which runs from October 15 to December 7. If your income dropped during the year, you might now may have access to for a program you did not may have access to for before. If your income rose, you might owe IRMAA surcharges you did not owe last year. Checking annually takes about 15 minutes and can save you hundreds of dollars.

You can find current year thresholds on Medicare.gov, or call 1-800-MEDICARE to speak with someone who can explain your specific situation. Your state Medicaid office also publishes current income limits for Medicaid and MSP programs.

What to do if your income changes mid-year

If your income drops significantly during the year — for example, you retire or lose a job — you do not have to wait until next year to adjust your Medicare costs. You can request an IRMAA reduction by contacting Social Security and explaining your change in circumstances. Social Security will use your current year's projected income instead of the two-year-old figure.

Similarly, if you become newly may be able to access for an information program because your income fell, you can explore at any time. Extra Help and MSP do not have enrollment periods; you can explore whenever you become may be able to access. The sooner you explore after a drop in income, the sooner the program can start helping with your costs.

Keep documentation of your income change — a termination letter from your employer, a notice that your pension or Social Security changed, or a tax return showing lower income. Social Security will ask for proof when you request an adjustment.

Frequently Asked Questions

Does having a high income mean I cannot get Medicare?

No. Income does not prevent you from enrolling in Medicare if you are 65 or older or meet other may be able to access requirements. High income only affects how much you pay for premiums through IRMAA surcharges, not whether you can enroll.

What if I am married and my spouse has much higher income than I do?

For IRMAA purposes, Medicare uses combined household income for married couples filing jointly. Your spouse's income counts even if you file taxes separately. For some information programs like Extra Help, the rules differ — contact Social Security to learn how your specific situation is treated.

Can I reduce my IRMAA by moving money into a different type of account?

No. IRMAA is based on your Modified Adjusted Gross Income, which is calculated from your tax return. Moving money between accounts does not change your MAGI. However, if your income genuinely dropped due to a life event, you can request an adjustment by contacting Social Security.

How do I know if I may have access to for Extra Help or a Medicare Savings Program?

Contact Social Security at 1-800-772-1213, visit your local Social Security office, or call your state Medicaid office. They can tell you the current income limits for your state and whether your income falls within the range for any program.

If I do not may have access to now, can I check again next year?

Yes. Income limits increase each year, and your own income may change. It is worth checking annually during Open Enrollment or whenever your income changes, even if you did not may have access to before.