How Medicare Premiums Come Out of Your Social Security Check

Medicare premiums are deducted directly from your Social Security payment each month

When you turn 65 and enroll in Medicare, your Part B premium (medical insurance) and Part D premium (prescription drug coverage) are automatically taken from your Social Security check. You do not receive a separate bill — the deduction happens before you see the money. This means your actual Social Security deposit is smaller than the benefit amount Medicare calculated for you.

The amount deducted changes each year. Part B premiums increase annually, and Part D premiums vary by plan. If you have higher income, you may also pay an additional surcharge called Income-Related Monthly Adjustment Amount (IRMAA), which also comes out of Social Security. The total can be substantial enough to affect your monthly budget, so understanding how much will be deducted before you turn 65 helps you plan.

Key Takeaways

• Medicare Part B and Part D premiums are deducted from your Social Security payment automatically, reducing the amount you receive each month.
• Part B premiums increase every January, and the 2024 standard premium is $164.90 per month, though yours may be higher if you have above-median income.
• If you delay Social Security past 65, you can still enroll in Medicare at 65 without waiting, and premiums will be deducted from your first Social Security check when you eventually claim.
• You can choose to pay Medicare premiums separately instead of having them deducted from Social Security, though most people let the automatic deduction happen.
• If your Social Security benefit is very small, Medicare premiums might exceed your monthly payment, and you would owe the difference to Medicare directly.

Standard Part B premiums and how they change

The standard Part B premium is set by Medicare each year and announced in the fall for the following January. The amount has risen nearly every year for the past two decades. In recent years, premiums have jumped significantly — for example, the 2023 premium was $164.90, and it remained at that level for 2024. However, the exact amount you pay depends on your income from two years prior, which is why the premium varies from person to person.

If your modified adjusted gross income (MAGI) from two years ago was below a certain threshold, you pay the standard premium. If it was above that threshold, you pay a higher amount. For 2024, those thresholds start at $97,000 for single filers and $194,000 for married couples filing jointly. Above those amounts, your premium increases in brackets, potentially reaching $560 or more per month for the highest earners.

You can find the exact premium amount for your income level on the Medicare.gov website or by calling Social Security at 1-800-772-1213. Social Security will tell you what amount will be deducted starting the month you turn 65 or the month you claim benefits, whichever comes first.

Part D premiums and how they fit into your deduction

Part D is prescription drug coverage, and it is optional — you do not have to enroll. However, if you go without Part D coverage and later decide you want it, you may pay a permanent penalty for each month you were not enrolled. The penalty is added to your Part D premium for life.

Part D premiums vary widely depending on which plan you choose. Plans range from roughly $7 to $100 per month, though the average is around $30 to $40. Unlike Part B, Part D premiums do not have income-based surcharges, so your income does not affect the amount you pay. You choose your Part D plan during the annual enrollment period (October 15 to December 7), and the premium is deducted from Social Security starting January 1.

If you are already taking prescription medications, comparing Part D plans before you turn 65 is worth your time. The plan that covers your specific drugs at the lowest cost may not be the cheapest plan overall. Medicare's Plan Finder tool lets you enter your medications and see which plans cover them and at what cost.

Income-related surcharges (IRMAA) and when they apply

If your income is above the thresholds mentioned earlier, Medicare adds an Income-Related Monthly Adjustment Amount to your Part B and Part D premiums. This surcharge can add $70 to $560 per month to your Part B premium alone, depending on how far above the threshold your income is. Part D also has IRMAA surcharges, though they are typically smaller.

The income used to calculate IRMAA is your modified adjusted gross income from two years before. So when you turn 65 in 2025, Medicare looks at your 2023 tax return. This two-year lag matters: if you had a large income in 2023 but retired in 2024, you will still pay the surcharge based on 2023 income. You can request that Medicare recalculate your IRMAA if your income dropped significantly due to retirement, but you must file a form and provide proof of the change.

The surcharge brackets adjust annually for inflation. For 2024, the brackets started at $97,000 for single filers, but they will be higher in 2025. You can check the current year's brackets on Medicare.gov or ask Social Security what your specific surcharge will be.

What happens if you delay Social Security but turn 65

You can enroll in Medicare at 65 even if you have not yet claimed Social Security. Many people do this because Medicare enrollment is separate from Social Security claiming. If you delay Social Security to earn delayed retirement credits (which increase your benefit), you can still sign up for Medicare at 65 without penalty.

When you eventually claim Social Security — whether at 66, 70, or any age after 65 — your Medicare premiums will be deducted from that first payment. If you have been paying Part B premiums directly to Medicare while waiting to claim Social Security, those payments will be refunded or credited against future premiums once the deduction begins.

This strategy makes sense if you can afford to pay Medicare premiums out of pocket while you wait for Social Security to grow. The longer you delay Social Security (up to age 70), the larger your monthly benefit will be, and the larger the amount from which Medicare premiums are deducted — but also the larger your take-home amount after premiums.

Choosing to pay Medicare premiums separately instead

You do not have to let Medicare deduct premiums from Social Security. You can request to pay Part B and Part D premiums directly to Medicare instead. This is useful if your Social Security benefit is very small and you want to keep the full amount, or if you prefer to manage payments separately.

To pay premiums directly, you contact Medicare at 1-800-MEDICARE (1-800-633-4227) and request a separate bill. Medicare will mail you an invoice each month, or you can set up automatic payments from your bank account. Part D premiums are handled through your prescription drug plan, not Medicare directly, so you would pay that plan separately as well.

Most people allow the automatic deduction because it is simpler and ensures the premium is paid on time. If you miss a direct payment to Medicare, your Part B coverage can be suspended, and you may face a late enrollment penalty if you want to re-enroll later.

When Medicare premiums exceed your Social Security benefit

In rare cases, your Medicare premiums are larger than your Social Security benefit. This can happen if you have a very small Social Security benefit (for example, if you worked part-time or had gaps in your work history) and high income-based surcharges.

If this occurs, Social Security will deduct the full amount of your benefit toward Medicare premiums, and you will owe the remaining balance directly to Medicare. Medicare will send you a separate bill for the amount not covered by Social Security. You are responsible for paying that bill on time to keep your coverage active.

You can request a recalculation of your IRMAA surcharge if your income has dropped, or you can appeal the amount if you believe it is incorrect. Social Security and Medicare both have appeals processes, though they take time. In the meantime, you are still responsible for paying the full premium to avoid a lapse in coverage.

Frequently Asked Questions

Can I see how much will be deducted from my Social Security before I turn 65?

Yes. Call Social Security at 1-800-772-1213 and ask what your Part B premium will be based on your income. You can also create an account on Medicare.gov to see estimated premiums. Social Security will give you a specific dollar amount, not a range.

What if I do not want Part D coverage right now?

You can decline Part D when you turn 65, but if you enroll later, you will pay a permanent penalty added to your premium for every month you were not covered. The penalty is roughly 1% of the national average Part D premium per month of non-coverage. If you are certain you will never need prescription coverage, you can skip it, but most people enroll to avoid the penalty.

Does my spouse's income affect my Medicare premiums?

Only your own income affects your Part B and Part D premiums, not your spouse's. However, if you file taxes jointly, your combined modified adjusted gross income is used to determine IRMAA surcharges. Married couples filing separately may pay lower surcharges, though this depends on your specific situation.

What if my income dropped after I retired?

You can request that Medicare recalculate your IRMAA based on your current income instead of the two-year-old tax return. You must file Form SSA-44 with Social Security and provide documentation of the income change, such as a recent tax return or a letter from your employer. The recalculation takes several weeks.

Will my Social Security benefit increase if I wait to claim?

Yes, your benefit increases by roughly 8% per year if you delay claiming between your full retirement age and age 70. However, your Medicare premiums will still be deducted once you claim, so the net increase to your take-home amount is smaller than the benefit increase itself.