What you pay for Medicare depends on your income and work history, not on SSI alone

If you receive Supplemental Security Income (SSI), you may still owe Medicare premiums — but the amount depends on whether you also receive Social Security retirement or disability benefits. SSI itself does not automatically cover Medicare costs. The Social Security Administration (SSA) will tell you what you owe based on your specific situation when you turn 65 or become may be able to access through disability.

Most people on SSI have very low income, which can lower or eliminate what they pay. However, if you have other income sources — wages, pensions, or Social Security benefits — your Medicare premium may be higher. Understanding how your income affects your costs helps you plan your monthly budget.

Key Takeaways

  • SSI recipients who also receive Social Security retirement or disability benefits pay Medicare Part B premiums based on their combined income from both programs.
  • If SSI is your only income source and it falls below the threshold, you may pay a reduced Part B premium or nothing at all.
  • Medicare Part A (hospital insurance) is free for most people who have worked long enough to earn Social Security credits, regardless of SSI status.
  • The SSA will notify you of your Medicare premium amount before coverage begins, and you can request a reduction if your income drops.
  • Part D (prescription drug coverage) has its own premium separate from Part B, and low-income SSI recipients may receive subsidies to lower this cost.

How SSI and Social Security benefits affect your Medicare premium

If you receive both SSI and Social Security retirement or disability benefits, Medicare Part B premiums are calculated using your combined income from both sources. The SSA uses your Modified Adjusted Gross Income (MAGI) — which includes your Social Security benefits plus any other income — to determine your premium amount. In 2024, the standard Part B premium is higher for people with income above certain thresholds, and it increases further at higher income levels.

For example, if you receive $900 per month in SSI and $400 per month in Social Security Disability Insurance (SSDI), your total monthly income is $1,300. The SSA uses this combined figure to calculate what you owe for Part B. If your income is below the threshold, you pay the standard premium. If it is above, you pay an Income-Related Monthly Adjustment Amount (IRMAA) on top of the standard premium.

The income thresholds that trigger higher premiums change each year. You can contact the SSA at 1-800-772-1213 to learn the current thresholds and what your specific premium will be.

Medicare Part A and Part B costs for SSI recipients

Part A (hospital insurance) covers inpatient hospital stays, skilled nursing facility care, and some home health services. Most people do not pay a monthly premium for Part A if they or their spouse worked long enough to earn 40 Social Security credits (roughly 10 years of work). If you do not have enough work credits, you may still obtain Part A by paying a monthly premium, which varies based on how many credits you have.

Part B (medical insurance) covers doctor visits, outpatient services, and preventive care. Part B requires a monthly premium that everyone pays, though the amount varies. The standard premium in 2024 is $164.90 per month for most beneficiaries, but people with higher income pay more through IRMAA surcharges. If your only income is SSI and it is below the income threshold, you pay the standard premium amount.

If you cannot afford the Part B premium, you can ask the SSA to pay it for you through a program called Medicaid Buy-In or similar state programs. may be able to access varies by state, so contact your state Medicaid office to learn whether you may have access to.

When SSI is your only income source

If SSI is your sole source of income and you have no other earnings, pensions, or Social Security benefits, your Medicare premium is based on that SSI amount alone. Since SSI payments are typically very low — the federal maximum is $943 per month in 2024, though many states add supplements — your income may fall below the threshold that triggers higher premiums. You would pay the standard Part B premium, not an IRMAA surcharge.

However, you still owe the Part B premium itself unless your state or a federal program covers it for you. Some states use Medicaid to pay Medicare premiums for low-income beneficiaries. To find out whether your state does this, contact your state Medicaid agency or call 1-800-MEDICARE.

Part D prescription drug coverage and low-income subsidies

Part D covers prescription medications through private insurance plans. Like Part B, Part D has a monthly premium that varies by plan. If you receive SSI, you may be may be able to access for the Low-Income Subsidy (LIS) program, which reduces or eliminates your Part D premium and out-of-pocket drug costs.

To receive the LIS subsidy, your income must be at or below 150% of the federal poverty level, and your resources (savings, investments, property other than your home) must be under $15,510 for an individual or $31,020 for a couple in 2024. Most SSI recipients fall within these limits. You do not need to explore separately; the SSA automatically screens you for the subsidy when you turn 65 or become may be able to access for Medicare through disability.

If you are approved for LIS, your Part D premium may be zero, and you pay a small copay for each prescription — typically $1.35 to $4.00 depending on the drug tier. Without the subsidy, Part D premiums range from $7 to $100+ per month depending on the plan you choose.

How income changes affect your Medicare costs

If your income drops — for example, if you lose a job or a pension payment ends — your Medicare premium may decrease. You can contact the SSA to report the change and request a recalculation of your IRMAA. The SSA uses your tax return from two years prior to calculate IRMAA, so changes take time to process, but you can ask for a reduction based on current circumstances if your income has dropped significantly.

Conversely, if your income increases, your Medicare premium will likely increase as well. The SSA will notify you of any changes to your premium before they take effect, usually in a letter sent in October or November for changes that begin in January.

Frequently Asked Questions

Does SSI pay my Medicare premiums automatically?

No. SSI does not cover Medicare premiums. However, some states use Medicaid to pay Part B and Part D premiums for low-income beneficiaries. Contact your state Medicaid office to learn whether your state offers this program.

What if I cannot afford my Medicare premium?

Contact your state Medicaid agency to ask about premium information programs. You can also call 1-800-MEDICARE to learn about programs in your state. If you may have access to for the Low-Income Subsidy for Part D, that program reduces or eliminates your drug coverage premium.

Will my SSI payment decrease if I enroll in Medicare?

No. Enrolling in Medicare does not change your SSI payment amount. However, if Medicare premiums are deducted from your Social Security benefits (if you receive both), your net monthly payment may be lower. SSI and Social Security are separate programs with separate payment amounts.

How do I know what my Medicare premium will be?

The SSA will send you a notice before your Medicare coverage begins, stating your premium amount. You can also call 1-800-772-1213 to ask the SSA what you will owe based on your current income and work history.

Can I delay Medicare enrollment if I am on SSI?

If you are under 65 and receive SSI due to disability, you are automatically enrolled in Medicare Part A and Part B after 24 months of receiving SSDI or being on the SSI disability rolls. You cannot delay this enrollment. If you turn 65, you should enroll in Medicare even if you are still on SSI, as coverage gaps can result in penalties.