Medicare Income Limits: What You Can Earn and Still Qualify

When people talk about Medicare income limits, the earnings thresholds that determine eligibility for extra financial help with Medicare costs. Also known as Medicare Savings Program limits, these rules don’t stop you from getting Medicare itself—but they decide if you get help paying for premiums, deductibles, and prescriptions. Most people assume Medicare is free once you turn 65, but that’s only half the story. If your income is above a certain level, you could pay hundreds more each month just to keep your coverage. And if you’re under 65 and on Medicare due to disability, those limits hit even harder.

Medicare itself doesn’t have income limits to enroll—you get Part A for free if you’ve paid payroll taxes long enough. But Medicare Part B premiums, the monthly charge for doctor visits and outpatient care. Also known as standard Medicare premiums, it> go up if your income is above $103,000 for individuals or $206,000 for couples. That’s called IRMAA—Income-Related Monthly Adjustment Amount. It’s not a penalty. It’s a sliding scale. The higher your income, the more you pay. And if you’re on Supplemental Security Income (SSI), you automatically qualify for extra help with drug costs through the Low-Income Subsidy program.

Then there’s Medicaid, a state-run program that covers low-income people and can pay Medicare costs for those who qualify. Also known as Medicare Savings Programs, it> steps in when your income is below federal poverty levels. In 2025, that’s about $1,134 a month for a single person in most states. But here’s the catch: some states let you earn more and still qualify if you have high medical bills. Medicaid doesn’t just cover nursing home care—it can pay your Medicare Part B premium, cover your Part D drug costs, and even pay for dental and vision you won’t find in standard Medicare.

People often mix up Medicare and Medicaid. Medicare is federal, based on age or disability. Medicaid is state-run, based on income. But they work together. If you qualify for both, you’re called a "dual eligible." That means you get full Medicare coverage with almost no out-of-pocket costs. The trick is knowing how your income is calculated. Social Security benefits count. Pension income counts. Even tax-exempt interest counts. But gifts, inheritances, and certain housing assistance don’t. And if your income drops after retirement, you can appeal your IRMAA surcharge—many people don’t know that.

There’s no one-size-fits-all answer. In Alaska, the income limit for extra help is higher than in Mississippi. Some states have expanded Medicaid under the Affordable Care Act, letting more people qualify. Others haven’t. Your zip code matters as much as your bank balance. And if you’re still working past 65, your income might look higher than it really is—especially if you’re taking large 401(k) withdrawals or selling property. That’s why people get caught off guard. They think they’re fine, then get a bill for $200 extra on their Part B premium and don’t know why.

The real question isn’t just "Do I make too much?" It’s "Can I afford to pay for my care?" If you’re spending more than 20% of your income on medical bills, you’re likely eligible for help—even if you didn’t think you qualified. The government doesn’t send out checks to everyone who needs them. You have to ask. Fill out the form. Talk to your local State Health Insurance Assistance Program (SHIP). They don’t charge a dime. And if you’re on a fixed income, those savings can mean the difference between taking your meds or skipping them.

Below, you’ll find real stories and practical guides on how people navigate these rules—what works, what doesn’t, and how to get the help you’re already entitled to. No fluff. No jargon. Just what you need to know to keep your health—and your wallet—intact.