Medicare premiums are deducted from your Social Security check, taken from your bank account, or paid by someone else on your behalf — depending on which part of Medicare you have and which payment method you choose.
Most people with Medicare Part B (doctor visits and outpatient care) and Part D (prescription drugs) pay monthly premiums. Part A (hospital care) is usually free if you or your spouse paid Medicare taxes for at least 10 years. Part B and D premiums change each year, and the amount you pay depends on your income from two years ago — a rule called Income-Related Monthly Adjustment Amounts (IRMAA).
If you get Social Security, your Part B premium is almost always taken directly from your monthly check before you see the money. If you don't get Social Security, Medicare sends you a bill. Part D premiums work the same way: deducted from Social Security if you get it, or billed separately if you don't. You can change your payment method at any time by contacting Medicare or your insurance plan.
Key Takeaways
- Part B and Part D premiums are deducted from your Social Security payment automatically, or billed to you monthly if you don't receive Social Security.
- Your premium amount depends on your income from two years prior, so a major life change (retirement, inheritance, or job loss) may affect what you pay next year.
- You can pay by automatic bank withdrawal, check, or online through Medicare.gov if you're not on Social Security.
- If you can't afford your premium, you may be able to get help through Medicaid or a Medicare Savings Program run by your state.
- Late enrollment penalties are added to your premium permanently if you don't sign up for Part B or Part D when first may be able to access.
How income affects what you pay
Medicare looks at your Modified Adjusted Gross Income (MAGI) from your tax return two years before the current year. If your income is above a certain threshold, you pay a higher premium — sometimes significantly higher. For example, if you turn 65 in 2024, Medicare uses your 2022 tax return to set your 2024 premiums.
This delay means a major income change — selling a house, receiving an inheritance, or retiring — won't affect your premium until two years later. However, if your income drops significantly (you retire, lose a job, or have a major loss), you can report a life-changing event to Medicare and request a recalculation. You'll need to provide documentation like a recent tax return, a letter from your employer, or proof of the event.
The income thresholds and premium amounts change every year. You can find the current year's amounts on Medicare.gov, or call 1-800-MEDICARE to ask what you'll pay based on your income.
Automatic deduction from Social Security
If you receive Social Security, your Part B premium is deducted automatically before your payment reaches your bank account. This is the default for most Medicare beneficiaries. Your Social Security statement will show the deduction as "Medicare Part B Premium."
The same applies to Part D premiums if you're enrolled in a prescription drug plan. Both deductions happen on the same day your Social Security payment is processed — usually the 3rd, 4th, or 5th of the month, depending on your birth date.
You cannot stop these deductions by opting out of Social Security. If you want to change your payment method or stop the automatic deduction, you must contact Medicare directly at 1-800-MEDICARE or log into your Medicare account at Medicare.gov.
Paying if you don't receive Social Security
If you're not on Social Security, Medicare sends you a bill each month. You can pay by mailing a check, setting up automatic bank withdrawal, or paying online through your Medicare account. The bill will show your Part B premium, Part D premium (if you have prescription drug coverage), and any other costs you owe.
Automatic bank withdrawal is the most reliable method because it removes the risk of missing a payment. To set this up, go to Medicare.gov, call 1-800-MEDICARE, or contact your insurance plan. You'll need to provide your bank account and routing number.
If you miss a payment, Medicare will send you a reminder. If you don't pay within 30 days, your coverage can be terminated. You can restart it, but there may be a late enrollment penalty added to your premium for the rest of your life.
Late enrollment penalties and when they apply
If you don't sign up for Part B when you first become may be able to access at 65, Medicare adds a penalty to your premium of 10% for each full 12-month period you were may be able to access but not enrolled. This penalty is permanent — it stays on your premium for as long as you have Part B.
The same rule applies to Part D. If you go 63 days or more without prescription drug coverage and later enroll, you pay a penalty calculated by the Centers for Medicare & Medicaid Services (CMS). The penalty amount changes yearly and is added to your premium permanently.
There are exceptions: if you had other creditable coverage (through an employer or union) during the time you weren't on Medicare, you won't owe a penalty. You'll need to provide proof of that coverage when you enroll. If you missed the deadline by a small amount due to a life event, you may be able to request a waiver, though this is rare.
Getting help paying your premium
If your income is low, your state's Medicare Savings Program may pay your Part B and Part D premiums for you. These programs are run by state Medicaid offices and have income limits that vary by state. Some states also cover your out-of-pocket costs like deductibles and copays.
To learn about you may have access to, contact your state Medicaid office or call 1-800-MEDICARE and ask about the Medicare Savings Program in your state. You'll need to provide proof of income, citizenship, and residency. The application process is handled by your state, not by Medicare.
If your income is very low, you may also be on Medicaid, which can cover your Medicare premiums as part of your Medicaid benefits. Medicaid may be able to access and income limits vary widely by state.
Changing your payment method or plan
You can change how you pay your Medicare premiums at any time. If you're currently having it deducted from Social Security and want to pay by bank withdrawal instead, call 1-800-MEDICARE or update your preferences on Medicare.gov. The change usually takes effect within one or two billing cycles.
If you're changing your prescription drug plan or switching to a different Medicare Advantage plan, your new plan will handle Part D premium collection. Make sure you understand how the new plan collects payment before you switch — some plans deduct from Social Security, while others bill you separately.
If you move to a different state, your Medicare premiums don't change, but your state's Medicare Savings Program rules may. Contact your new state's Medicaid office to see if you now may have access to for premium help.
Frequently Asked Questions
What if my Social Security payment is smaller than my Medicare premium?
Medicare will still deduct the full premium from your Social Security check, even if it leaves you with little or no payment that month. If this happens, contact 1-800-MEDICARE immediately — you may be able to switch to a different payment method or explore whether you may have access to for a Medicare Savings Program to cover your premiums.
Can I pay my Medicare premium in a lump sum instead of monthly?
No. Medicare requires monthly premium payments. You cannot pay a year's worth upfront or switch to quarterly or annual billing. Your only option is to arrange automatic monthly deduction or monthly billing.
What happens if I don't pay my Medicare premium?
If you miss a payment by more than 30 days, your coverage ends. You can restart it by paying the overdue amount, but you'll owe a late enrollment penalty that stays on your premium permanently. If you're having trouble paying, contact Medicare to discuss payment options or to see if you may have access to for help.
Does my Part A premium ever change?
Part A is free for most people. If you didn't pay Medicare taxes for 10 years, you may owe a monthly premium, which can change yearly. Call 1-800-MEDICARE to learn about you owe a Part A premium and what the current amount is.
Can someone else pay my Medicare premium for me?
Yes. A family member, friend, or organization can pay your premium on your behalf. They can set up automatic payments from their own bank account, mail a check, or pay online. The person paying doesn't have to be related to you or have power of attorney — they just need your Medicare number and billing information.