Do Husband and Wife Pay Separate Medicare Premiums?
While Medicare premiums are paid individually, a couple's shared income and tax filing status directly determine the monthly cost for each spouse.
Married couples often ask whether they will pay Medicare premiums jointly or as individuals. Medicare operates as an individual insurance program, meaning each spouse has a separate premium obligation. However, the amount each person pays can be influenced by the couple’s combined income.
Medicare Premiums as an Individual Responsibility
Medicare is structured as individual coverage, so each enrolled spouse has their own premium responsibilities. Couples will not receive a single joint bill; instead, each person is accountable for their own monthly payments for the parts of Medicare they are enrolled in.
For Medicare Part A, which covers inpatient hospital care, most individuals do not pay a monthly premium. This “premium-free Part A” is available to those with at least 40 quarters of Medicare-covered employment, about ten years of work. An individual can also qualify for premium-free Part A based on their spouse’s work history. Those who do not meet this requirement pay a monthly premium in 2025 of $285 or $518, depending on their work history.
Responsibility for Medicare Part B, covering doctor visits and outpatient services, is also individual, and each person enrolled pays their own monthly premium. For 2025, the standard monthly premium is $185.00. This premium is typically deducted from Social Security or Railroad Retirement Board benefits, but if an individual is not yet receiving these benefits, they will be billed directly by Medicare.
How Joint Income Determines Premium Amounts
While premiums are paid individually, a married couple’s combined income helps determine the final monthly cost for both Medicare Part B and the Part D prescription drug plan. This is due to the Income-Related Monthly Adjustment Amount (IRMAA). IRMAA is an additional charge that higher-income beneficiaries pay on top of the standard Part B premium and their specific Part D plan premium.
The Social Security Administration (SSA) determines who pays IRMAA based on a beneficiary’s Modified Adjusted Gross Income (MAGI), which is the Adjusted Gross Income (AGI) from a tax return plus certain tax-exempt interest income. The SSA uses the MAGI from the federal income tax return filed two years prior. For example, 2025 Medicare premiums are determined by the MAGI on your 2023 tax return.
For a couple filing taxes jointly, the SSA uses their combined MAGI to determine the IRMAA for each spouse. The resulting IRMAA is applied to each spouse’s premium individually. If a couple’s joint income exceeds the established thresholds, both individuals will see their premiums increase. For 2025, couples filing jointly with a MAGI of $212,000 or less pay the standard $185.00 Part B premium.
As joint income rises, the IRMAA increases through a series of brackets. A couple with a joint MAGI between $212,000.01 and $266,000 will each pay an additional $74.00, for a total monthly Part B premium of $259.00 per person. The highest bracket for joint filers, with a MAGI of $750,000 or more, results in a total monthly Part B premium of $628.90 for each spouse. A similar tiered adjustment is added to each person’s Part D premium, ranging from an extra $13.70 to $85.80 per month in 2025.
The Effect of Married Filing Separately Status
Medicare premium costs change for married individuals who file separate tax returns. The income thresholds for triggering IRMAA are structured differently and are less favorable for the “Married Filing Separately” status. This choice often results in higher Medicare premiums for each spouse, even with modest individual incomes.
When filing separately, the income brackets that determine IRMAA are much lower, meaning a person is more likely to be subject to IRMAA. For 2025, an individual using this filing status with a MAGI between $106,000.01 and $394,000 will face a higher Part B premium adjustment than a joint filer with a similar household income. The highest premium bracket applies to those filing separately with a MAGI of $394,000.01 or more.
Requesting a Premium Reassessment After a Life-Changing Event
If your income has decreased significantly, you can request a new determination of your IRMAA based on your current financial situation. This request is prompted by what the Social Security Administration (SSA) defines as a “Life-Changing Event” (LCE). These are specific circumstances recognized as valid reasons for a premium reassessment.
Qualifying LCEs include:
- Marriage, divorce, or annulment
- Death of a spouse
- Full work stoppage for you or your spouse
- Reduction in work hours for you or your spouse
- Loss of an income-producing property due to a disaster or other event beyond your control
- Loss or reduction of certain types of pension income
To request a new IRMAA decision, you must submit Form SSA-44, “Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event.” On the form, you will specify which LCE you have experienced and provide an estimate of your new, lower MAGI for the year. The form is available on the SSA’s website or at a local office.
You must also provide evidence of both the event and the resulting income reduction. For a work stoppage, this could be a letter from a former employer, while a reduction in hours requires recent pay stubs. Once the form and documentation are submitted to the SSA, they will review your case and issue a new determination, which could lower or eliminate your IRMAA.