What you pay for Medicare and when the bill arrives
Medicare has four parts, and each one charges a monthly premium — except Part A, which is free for most people who paid Medicare taxes while working. Part B (doctor visits and outpatient care) costs a standard amount each month, though your actual bill depends on your income. Part D (prescription drugs) and Part C (Medicare Advantage, an alternative to Original Medicare) vary by plan and insurer.
Your premium bill arrives in different ways depending on which part you're paying for. Part B and Part D premiums are usually deducted automatically from your Social Security check. If you don't get Social Security, Medicare sends you a bill by mail. Part C premiums go to your insurance company, not to Medicare.
The amount you pay changes each year. Medicare announces new premiums in the fall, and they take effect on January 1. If your income rose in the past two years, you may pay a higher premium — this is called Income-Related Monthly Adjustment Amount, or IRMAA.
Key Takeaways
- Part A is free for most people; Part B, Part C, and Part D all charge monthly premiums that vary by income and plan choice.
- Part B and Part D premiums are usually taken directly from your Social Security payment each month.
- If your income is above a certain threshold, you pay an extra amount called IRMAA on top of your regular Part B and Part D premiums.
- You can change your Part C or Part D plan during the annual enrollment period (October 15 to December 7) to find a lower premium if your current plan's cost rises.
- If you miss a payment, Medicare gives you a grace period, but your coverage can be suspended if the bill stays unpaid.
Part B premiums and how income affects what you pay
Part B covers doctor visits, lab tests, imaging, and outpatient surgery. The standard Part B premium is set by Medicare each year. In 2024, the standard premium is $164.90 per month, but this amount changes annually. If you enroll in Part B after you first become may be able to access for Medicare, you may pay a permanent penalty — an extra 10 percent for each year you delayed.
If your modified adjusted gross income (MAGI) from two years ago was above a certain level, you pay IRMAA on top of the standard premium. For 2024, if your MAGI was above $97,000 (single) or $194,000 (married filing jointly), you owe extra. The higher your income, the more you pay — the highest earners pay up to $560.50 per month for Part B alone. Medicare uses your tax return from two years prior, so your 2024 bill is based on your 2022 income.
You can request that Medicare recalculate your IRMAA if your income dropped significantly — for example, due to retirement, job loss, or death of a spouse. You must file a form called the Medicare Income-Related Monthly Adjustment Amount — Life-Changing Event (form SSA-44) with Social Security within 60 days of the event.
Part D prescription drug premiums and coverage gaps
Part D is optional coverage for prescription medications. You choose a plan from private insurers, and each plan sets its own premium. Premiums range widely — some plans cost $5 per month, others $100 or more. The premium you pay depends entirely on which plan you pick, not on your income (though IRMAA still applies on top).
Part D has a coverage gap, sometimes called the "donut hole." Once you and your plan have spent $5,030 on covered drugs in 2024, you enter the gap and pay a higher share of drug costs until you reach $7,550 in out-of-pocket spending. After that, catastrophic coverage kicks in and you pay only a small copay. The exact dollar amounts change each year.
If you don't enroll in Part D when you first become may be able to access for Medicare, you pay a permanent penalty of about 1 percent of the national average Part D premium for each month you went without coverage. This penalty is added to your premium for as long as you have Part D.
Part C (Medicare Advantage) premiums and plan changes
Part C, also called Medicare Advantage, is an alternative to Original Medicare (Parts A and B). Private insurers offer Part C plans, and each plan sets its own premium. Some plans charge zero premium — you pay only the Part B premium to Medicare, and the insurer covers the rest. Other plans charge $50, $100, or more per month on top of Part B.
Part C plans often include prescription drug coverage (Part D) bundled in, so you don't buy Part D separately. However, you still pay IRMAA if your income is high enough. Part C plans also typically have lower out-of-pocket maximums than Original Medicare, but they restrict which doctors and hospitals you can use.
You can switch Part C plans or drop Part C and go back to Original Medicare during the annual enrollment period (October 15 to December 7). Changes take effect on January 1. If you drop Part C and don't enroll in Part D at the same time, you'll owe the Part D late penalty.
How to pay your premium and what happens if you miss a payment
For Part B and Part D, the easiest method is automatic deduction from your Social Security check. If you don't receive Social Security, you can set up automatic bank withdrawal through Medicare, or you can pay by check or money order by mail. Medicare sends bills to the address on file with Social Security.
If you pay by check, mail it to the address shown on your bill. Do not send payment to a Medicare office — bills direct you to a lockbox address. Payments take 7 to 10 business days to process after Medicare receives them.
If you miss a payment, Medicare gives you a grace period. For Part B, you have three months to pay before your coverage is suspended. For Part D, the grace period is also three months. During the grace period, your coverage stays active, but you should pay as soon as possible. If you don't pay within the grace period, your coverage ends. You can restart it, but you'll owe all back premiums plus a late penalty.
If you're having trouble paying, contact Medicare at 1-800-MEDICARE (1-800-633-4227) to discuss payment plans or other options. Some people may be able to get help paying premiums through Medicaid or other state programs.
Income-Related Monthly Adjustment Amount (IRMAA) explained
IRMAA is an extra charge added to your Part B and Part D premiums if your income is above a threshold. Medicare calculates IRMAA based on your modified adjusted gross income (MAGI) from your tax return filed two years before the year you're paying for. For example, your 2024 IRMAA is based on your 2022 tax return.
MAGI includes wages, self-employment income, interest, dividends, and certain other sources. It does not include Social Security benefits (unless you file a joint return and your spouse has substantial income). The income thresholds change each year. For 2024, the thresholds are $97,000 (single) and $194,000 (married filing jointly). If your MAGI is above these amounts, you pay extra.
The extra amount increases in brackets. For Part B in 2024, if your MAGI is $97,001 to $121,500 (single), you pay an extra $65.90 per month. If it's $121,501 to $146,000, you pay an extra $164.70. The highest bracket — MAGI above $500,000 (single) — adds $395.60 to your Part B premium. Part D has similar brackets.
If your income dropped due to retirement, job loss, or a major life event, you can ask Medicare to recalculate your IRMAA using your current year's income instead. You must file form SSA-44 within 60 days of the event. Social Security reviews the request and may lower your premium retroactively.
Enrollment periods and when premiums start
Your premium start date depends on when you enroll in each part of Medicare. If you enroll in Part B during your Initial Enrollment Period (the seven-month window centered on your 65th birthday), coverage and premiums begin the first day of the month you turn 65 or the month after you enroll, whichever is later. If you delay enrollment past this window, your coverage start date is delayed, and you pay a permanent penalty.
For Part D, you have the same Initial Enrollment Period. If you enroll late, your coverage doesn't begin until the first day of the month after Medicare gets your enrollment, and you pay a permanent penalty for each month you were without coverage.
For Part C, you can enroll during your Initial Enrollment Period or during the annual enrollment period (October 15 to December 7 each year). Changes made during the annual period take effect on January 1.
Frequently Asked Questions
Can I change my Part D plan if my premium went up?
Yes. During the annual enrollment period (October 15 to December 7), you can switch to a different Part D plan with a lower premium. The change takes effect on January 1. You can also switch if you have a may have access to life event, such as loss of other drug coverage or a move to a new state.
What if I'm still working and have health insurance through my employer?
You may be able to delay Part B and Part D without penalty if your employer coverage is considered creditable. You must enroll in Part B and Part D within eight months of losing the employer coverage, or you'll owe a late penalty. Ask your employer's benefits department whether your plan qualifies.
Do I have to pay Part A premium?
Most people don't — Part A is free if you or your spouse paid Medicare taxes for at least 10 years while working. If you don't meet this requirement, you can buy Part A coverage, and the premium is based on how many quarters of Medicare tax you paid. In 2024, the Part A premium ranges from $278 to $556 per month.
What happens if I don't pay my premium for several months?
After the three-month grace period, your coverage ends. You can restart it by paying all back premiums, but you'll also owe a late penalty. If you restart Part B or Part D after a gap, the penalty is permanent and stays on your premium for as long as you have that coverage.
How do I know if IRMAA applies to me?
Medicare sends a letter called the Medicare Income-Related Monthly Adjustment Amount Notice if you owe IRMAA. The letter shows your MAGI, the income threshold, and the extra amount you'll pay. If you disagree with the income figure, you can request a recalculation by filing form SSA-44 if you had a may have access to life event.