Medicare has no income limit for eligibility. You can enroll regardless of how much you earn. However, your income directly affects how much you pay in premiums. Higher earners pay significantly more for Part B (medical insurance) and Part D (prescription drug coverage), while lower-income enrollees may qualify for programs that reduce or eliminate their costs entirely.
Medicare Eligibility Has No Income Cap
If you’re 65 or older, you qualify for Medicare no matter what your income is. The same applies if you’re under 65 with a qualifying disability or end-stage renal disease. There’s no earnings test, no means test, and no upper limit that disqualifies you. This is fundamentally different from Medicaid, which is income-based.
Part A (hospital insurance) is premium-free for most people as long as you or your spouse paid Medicare taxes for at least 10 years (40 work quarters). Part B (medical insurance) requires a monthly premium that starts at a standard rate but increases at higher income levels.
How Income Affects Your Part B Premium
Most Medicare enrollees pay the standard Part B premium. But if your income exceeds certain thresholds, Social Security adds a surcharge called the income-related monthly adjustment amount (IRMAA). Fewer than 5% of Medicare beneficiaries pay this surcharge, so the vast majority are unaffected.
For 2025, the first IRMAA bracket kicks in at $106,000 for individual filers. If you earn between $106,000 and $133,000, your monthly Part B premium jumps to $259.00 instead of the standard amount. The surcharge increases through several additional brackets above $133,000 and $167,000, with the highest earners paying substantially more. Married couples filing jointly hit the first bracket at $212,000.
The income figure Medicare uses is your modified adjusted gross income, which is your adjusted gross income (line 11 on your 1040) plus any tax-exempt interest income. Social Security pulls this number from your tax return two years prior. So your 2025 premiums are based on your 2024 tax return, and your 2026 premiums will reflect what you earned in 2024 as well.
How Income Affects Part D Costs
The same income brackets that trigger higher Part B premiums also apply to Part D prescription drug coverage. If you’re an individual filer earning between $106,000 and $133,000, you’ll pay an extra $13.70 per month on top of whatever your Part D plan charges. The surcharge rises at each income tier above that. Again, this affects fewer than 5% of enrollees.
If Your Income Dropped Recently
Because Medicare looks at your tax return from two years ago, your current premiums might not reflect your actual financial situation. If you’ve experienced a life-changing event like retirement, divorce, the death of a spouse, or a significant reduction in work hours, you can ask Social Security to use a more recent year’s income instead. This can make a real difference if you retired at 64 and your first year on Medicare is being priced based on your peak earning years.
Income Limits for Lower-Cost Programs
On the other end of the spectrum, several programs help people with limited income pay for Medicare. These have strict income and asset limits.
Medicare Savings Programs
These state-run programs help cover Part B premiums, deductibles, and copays depending on which tier you qualify for. The 2026 limits are:
- Qualified Medicare Beneficiary (QMB): Covers premiums, deductibles, and coinsurance. Income limit of $1,350/month for individuals ($1,824 for couples), with resources below $9,950 ($14,910 for couples).
- Specified Low-Income Medicare Beneficiary (SLMB): Covers Part B premiums only. Income limit of $1,616/month for individuals ($2,184 for couples), same resource limits.
- Qualifying Individual (QI): Also covers Part B premiums. Income limit of $1,816/month for individuals ($2,455 for couples), same resource limits.
These thresholds correspond to 100%, 120%, and 135% of the federal poverty level, respectively, plus a small $20 monthly disregard. Limits are slightly higher in Alaska and Hawaii. You apply through your state Medicaid office.
Extra Help With Drug Costs
If you need help affording prescriptions, the Part D Low Income Subsidy (called “Extra Help”) can dramatically reduce your copays, premiums, and deductibles for drug coverage. For 2026, you may qualify if your annual income is below $23,940 as an individual or $32,460 as a married couple, with resources under $18,090 (individual) or $36,100 (couple).
What Counts as Income and Resources
For the IRMAA surcharge on Parts B and D, income means your modified adjusted gross income: wages, Social Security benefits, pension payments, investment income, rental income, and tax-exempt interest all count. This is pulled directly from your IRS tax return.
For the savings programs and Extra Help, the calculation is different. These programs look at your current monthly income and countable resources. Resources include bank accounts, stocks, and bonds, but generally exclude your home, one car, burial plots, and personal belongings. The income thresholds for these programs are updated annually and tied to the federal poverty level.