The highest Medicare monthly premium depends on your income and the plan you choose
Medicare Part B (medical insurance) and Part D (prescription drug coverage) premiums are based on your income from two years ago. The higher your income, the more you pay — this is called an Income-Related Monthly Adjustment Amount, or IRMAA. For 2024, the standard Part B premium is $164.90 per month, but someone with higher income can pay as much as $560.50 per month for Part B alone. Part D premiums vary by plan, but the adjustment can add $12.70 to $77.10 per month depending on income. Part A (hospital insurance) has no monthly premium for most people.
The income thresholds that trigger these higher payments change each year. In 2024, for example, a single person filing taxes pays the highest Part B rate if their income was over $246,000 in 2022. A married couple filing jointly hits the top rate at $492,000. If your income falls between the lowest and highest thresholds, you pay a middle rate. These thresholds are adjusted annually for inflation.
Key Takeaways
- Medicare calculates your premium based on your income from two years prior, not your current income.
- Part B premiums can range from $164.90 to $560.50 per month in 2024, depending on income level.
- Part D prescription drug premiums also increase with income, adding up to $77.10 per month on top of your plan's base premium.
- If your income drops significantly — through retirement, job loss, or divorce — you can request a reduction based on your current year's income.
How income thresholds work and what counts as income
Medicare uses your Modified Adjusted Gross Income (MAGI) to determine your premium tier. MAGI includes wages, interest, dividends, capital gains, and certain other sources. It is calculated from your federal tax return from two years before the current year. So in 2024, Medicare looks at your 2022 tax return.
The income brackets are different for single filers and married couples filing jointly. There are five income tiers for Part B, and hitting each tier increases your monthly payment. For Part D, there are also five tiers. A person can be in one tier for Part B and a different tier for Part D, depending on their specific income level.
The thresholds themselves shift each year. In 2023, the highest Part B threshold for a single person was $194,000; in 2024 it rose to $246,000. This annual adjustment means you should check your premium notice each year rather than assuming it will stay the same.
When your income changes and how to report it
If your income drops significantly in the current year — because you retired, lost a job, or had a major life change — you do not have to wait two years for Medicare to recalculate. You can request a Life-Changing Event reduction by contacting Social Security. Common may have access to events include retirement, loss of income, divorce, or death of a spouse.
To request a reduction, call Social Security at 1-800-772-1213 or visit your local Social Security office. You will need to explain the event and provide documentation, such as a termination letter from your employer or a divorce decree. Social Security will then recalculate your premium based on your current year's projected income. This change usually takes effect the month after Social Security approves your request.
If you do not report a change and your income actually dropped, you may have overpaid for months. Social Security can sometimes issue a refund, but only if you report the change within a certain timeframe. It is worth calling even if some time has passed.
Part B premiums across all income levels in 2024
Understanding the full range of Part B premiums helps you see where you fall. The 2024 brackets for single filers are:
| Income Range (Single) | Monthly Part B Premium |
|---|---|
| Up to $97,000 | $164.90 |
| $97,001 to $123,000 | $230.80 |
| $123,001 to $153,000 | $329.70 |
| $153,001 to $183,000 | $428.60 |
| Over $246,000 | $560.50 |
For married couples filing jointly, the thresholds are roughly double. A couple with income over $492,000 pays the highest rate of $560.50 per person per month. These amounts are deducted from your Social Security check, or you receive a bill from Medicare if you do not receive Social Security.
Part D prescription drug premiums and income adjustments
Part D premiums work differently from Part B because they vary by plan — there is no single "standard" Part D premium. However, the income adjustment (IRMAA) is added on top of whatever plan you choose. In 2024, this adjustment ranges from $0 for those under the threshold to $77.10 per month for the highest income tier.
If you switch to a different Part D plan during the annual enrollment period (October 15 to December 7), your new plan's base premium may be lower or higher, but your income adjustment stays the same. The adjustment is tied to your income, not your plan choice.
Some people find that their Part D premium jumps significantly when they turn 65 and enroll in Medicare, even if they had prescription coverage before. This is because Part D premiums are set by individual insurance companies and can vary widely. Comparing plans during enrollment can sometimes save you money, though the income adjustment will explore no matter which plan you pick.
How to find your actual premium and understand your notice
Your Medicare premium notice arrives in the mail, usually in December for the following year. It shows your Part B premium, any Part D adjustment, and the total amount you will pay. If you disagree with the income used to calculate your premium, you have the right to appeal.
To appeal, you must contact Social Security within 60 days of receiving your notice. You will need to provide documentation of your current income — such as recent pay stubs, a letter from your employer, or a tax return. Social Security will review your case and either uphold the original premium or adjust it.
If you lose your notice or need to check your premium before it arrives, you can log into your Medicare account at Medicare.gov or call Medicare at 1-800-MEDICARE (1-800-633-4227). They can tell you your current premium and explain which income year it is based on.
Frequently Asked Questions
Can I lower my Medicare premium if I am still working?
If you are still working and your income is high, you cannot lower your premium just because you are employed. However, if your income drops during the year — such as if you take unpaid leave or reduce your hours — you can request a Life-Changing Event reduction. You will need to show Social Security documentation of the income change.
What happens to my premium if I get a large bonus or sell a house?
One-time events like a bonus or home sale increase your Modified Adjusted Gross Income for that year, which affects your Medicare premium two years later. If the bonus or sale pushes you into a higher income bracket, your premium will rise. You cannot request a reduction based on a one-time event unless it significantly changes your ongoing income.
Do I pay the highest premium if I am married but file taxes separately?
Married couples who file taxes separately usually face the highest Medicare premiums, even at lower income levels. This is because the income thresholds for married filing separately are much lower than for married filing jointly. If possible, filing jointly may result in a lower premium, though you should consult a tax professional about your specific situation.
Can my premium go down if I turn 70 or reach full retirement age?
Your Medicare premium does not automatically change based on your age. It only changes if your income changes. However, many people's income does drop when they stop working, which can lower their premium. If you retire and your income decreases, contact Social Security to request a recalculation based on your current year's income.
What if I disagree with the income Social Security used to calculate my premium?
You have 60 days from receiving your premium notice to appeal. Contact Social Security and provide documentation of your actual income for the year in question — such as a copy of your tax return, W-2s, or 1099 forms. Social Security will review your appeal and adjust your premium if the income figure was incorrect.