Part D (Prescription Drug) Cost Details

The chart below shows your estimated part B monthly premium based on your income as reported on your IRS tax return. If your income is above a certain limit, you'll pay an income-related monthly adjustment amount in addition to your part B premium.

 If your filing status and yearly income in 2019 was
 File individual tax return File joint tax return File married & separate tax return You pay each month (in 2021)
 $88,000 or less $176,000 or less $88,000 or less your plan premium
 above $88,000 up to $111,000 above $176,000 up to $222,000 not applicable $12.30 + your plan premium
 above $111,000 up to $138,000 above $222,000 up to $276,000 not applicable $31.80 + your plan premium
 above $138,000 up to $165,000 above $276,000 up to $330,000 not applicable $51.20 + your plan premium
 above $165,000 and less than $500,000 above $330,000 and less than $750,000 above $88,000 and less than $412,000 $70.70 + your plan premium
 $500,000 or above $750,000 and above $412,000 and above $77.10 + your plan premium


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