Who pays Medicare Part B premium for seniors?

There is no hard income cutoff to qualify for Medicare Part B, but earning more than $109,000 as an individual or $218,000 as a joint filer in 2026 triggers higher monthly premiums.

How Income Affects Part B Costs

• Standard Premium: If your modified adjusted gross income (MAGI) is at or below $109,000 for single filers or $218,000 for joint filers, you pay the standard 2026 monthly Part B premium of $202.90.
• IRMAA Surcharges: Earners above those thresholds pay an Income-Related Monthly Adjustment Amount (IRMAA), which adds an extra charge ranging from $81.20 to $487.00 per month on top of the standard premium.
• Tax Year Used: Your 2026 costs are based on the tax return you filed two years prior (your 2024 tax return).

2026 Part B Income Brackets & Premiums

• $109,000 or less (Individual) / $218,000 or less (Joint): Standard premium of $202.90
• $109,001 – $137,000 (Individual) / $218,001 – $274,000 (Joint): Total monthly premium of $284.10
• $137,001 – $171,000 (Individual) / $274,001 – $342,000 (Joint): Total monthly premium of $405.80
• $171,001 – $205,000 (Individual) / $342,001 – $410,000 (Joint): Total monthly premium of $527.50
• $205,001 – $499,999 (Individual) / $410,001 – $749,999 (Joint): Total monthly premium of $649.20
• $500,000+ (Individual) / $750,000+ (Joint): Total monthly premium of $689.90

You can avoid paying or reduce your Medicare Part B premium by qualifying for state assistance, dropping coverage, or using specific plan benefits as detailed by CBS News.

Ways to Avoid or Reduce Part B Costs

• Medicare Savings Programs (MSPs): Low-income beneficiaries can qualify for state programs that pay for Part B premiums, deductibles, and coinsurance.
• Medicare Advantage "Giveback" Plans: Some private Medicare Advantage plans offer a Part B premium reduction that pays part or all of your monthly premium.
• Drop Part B Coverage: You can terminate Medicare Part B by contacting the Social Security Administration in writing or by phone, though dropping coverage may result in a permanent late-enrollment penalty if you rejoin later.
• Appeal Income Surcharges (IRMAA): If your premium is high due to past high income and you experienced a qualifying life event (like retirement or reduced work hours), you can file Form SSA-44 to lower your rate.
• Delay Enrollment (If Still Working): If you or your spouse are actively working past 65 with qualifying employer group health coverage (20+ employees), you can delay Part B without penalty.

Medicare Part A (Hospital Insurance) is free of a monthly premium for most seniors who worked and paid Medicare taxes for at least 10 years (40 quarters).

Medicare is not entirely free, and no single part covers everything without other potential out-of-pocket costs. Here is how the costs break down by part:

Premium-Free vs. Paid Parts of Medicare

• Medicare Part A (Hospital Insurance): $0 monthly premium for about 99% of seniors who have enough work history. However, it still has a deductible ($1,736 per benefit period in 2026) and coinsurance for long hospital or skilled nursing stays. If you lack the required work credits, you can buy Part A for a monthly fee.
• Medicare Part B (Medical Insurance): Not free. Most people pay a standard monthly premium ($202.90 in 2026), plus an annual deductible and 20% coinsurance for most doctor services.
• Medicare Part C (Medicare Advantage): Sometimes $0 plan premium. These are private plans, and some feature a $0 additional monthly charge, but you must still pay your standard Part B premium.
• Medicare Part D (Prescription Drug Coverage): Not automatically free, though private plan prices vary.

How to Get Help With Costs

• Medicare Savings Programs (MSPs): If you have a low income, your state may pay for your Part B premiums, deductibles, and co-pays.
• Extra Help Program: Low-income seniors can get assistance with prescription drug costs through the federal Extra Help program, which lowers or eliminates Part D premiums and deductibles.

Neither option is universally "better"; Original Medicare (Parts A and B) and Medicare Advantage (Part C) serve different needs depending on your budget, health, and preference for doctors. You can review your official choices on the Medicare Coverage Options Page.

Original Medicare (Parts A & B)

• How it works: Run directly by the federal government. Covers hospital care (Part A) and doctor visits (Part B).
• Doctor choice: Go to any doctor or hospital in the U.S. that accepts Medicare without needing referrals.
• Costs: No yearly limit on out-of-pocket costs unless you buy a separate Medigap (supplement) policy. You also need separate Part D for prescription drugs.
• Best for: People who travel often within the U.S., want absolute freedom in choosing specialists, or prefer predictable coinsurance paired with a Medigap plan.

Medicare Advantage (Part C)

• How it works: Offered by private insurance companies approved by Medicare. Combines Part A, Part B, and usually Part D (prescription drugs) into one plan.
• Extra benefits: Often includes routine dental, vision, hearing, and gym memberships.
• Costs: Features a mandatory yearly out-of-pocket maximum limit, but you must use specific provider networks (HMO or PPO) and may need prior approval for treatments.
• Best for: People who want lower upfront or bundled monthly costs, desire extra perks like dental/vision, and stay within a local hospital or doctor network.

You are likely paying close to $700 a month because of an income-based surcharge called IRMAA (Income-Related Monthly Adjustment Amount) added to your Social Security Administration Benefits Planner.

Why the Cost is High

• The IRMAA Surcharge: While the standard Medicare Part B monthly premium is $202.90, higher earners must pay an extra surcharge. If your total monthly cost reaches nearly $700, your past income has pushed you into a higher IRMAA bracket.
• Look-Back Period: Medicare determines IRMAA using your Modified Adjusted Gross Income (MAGI) from two years prior. A high-income tax return from two years ago dictates your current monthly bill.
• Combined Parts: This total often includes surcharges for both Part B (outpatient care) and Part D (prescription drug coverage).
• Automatic Deduction: This amount is typically taken directly out of your monthly Social Security check or billed quarterly if you are not yet collecting benefits.

What You Can Do

• Check for Life-Changing Events: If you experienced a major income drop due to a life-changing event (such as marriage, divorce, or work reduction), you can appeal to have your surcharge lowered.
• Review Details: You can check specific rules and thresholds directly through AARP's Medicare Guide or contact Social Security.