Why Is My First Medicare Bill So High?

Potential Reasons for a High First Bill

Whether you choose to pay for one or three months at a time, there are a number of other factors that can increase the total of your Medicare bills.

You’re Not Drawing From Social Security Yet

In many cases, the cost of your Medicare premium is deducted from your Social Security payment, so you never receive a bill that you have to pay. You may still receive a statement from Medicare reflecting premiums that have been paid by another method, but it will be marked, “This is Not a Bill.”

If you enrolled in Medicare but haven’t started receiving Social Security payments yet, then there is nothing to draw your premiums from, and you will have to pay this monthly or quarterly amount yourself.

You Are a High Earner

Medicare is a benefit for people who typically are retired and live on set incomes. While it’s in your best interest to plan financially for your retirement, having income levels above a certain threshold can cost you when it comes to Medicare.

The Income Related Monthly Adjustment Amount (IRMAA) is an additional fee you may have to pay on Medicare Part B and Part D if you earn above a certain income level. When this fee applies to you for Part D, this fee will be charged to you monthly, and you must pay it directly to Medicare.

As of 2025, IRMAA Part D fees are charged to people who make more than $106,000 per year as an individual or $212,000 as a married couple jointly filing taxes. Social Security will let you know if you have to pay this fee, and you will have to pay it whether you have Original Medicare or Medicare Advantage. Failure to pay this fee could cause you to lose your prescription drug coverage.

IRMAA-D ranged from $13.70 to $85.80 per month in 2025.

You’re Paying Penalties

It’s important to consider signing up for Medicare when you are first eligible regardless of your current needs. While you may be able to handle your medical costs on your own when you are first eligible for Medicare, you never know what your future health may hold.

If you put off signing up for Medicare, most parts of the program will charge you late enrollment penalties that will be added to your monthly premium costs every month – often for the remainder of your enrollment. These penalties are added to both Original Medicare and Medicare Advantage plans, and are even applied to your optional Medicare Part D coverage.

The following late enrollment penalties may be added to your bill:

• Part A: A 10% penalty will be added to your monthly premium for twice the number of months you failed to sign up after you were first eligible.
• Part B: A fee that equals 10% of your premium cost for each 12-month period you were eligible for coverage but didn’t sign up. This means you would pay 10% more for your premium if you waited one year to sign up, but 30% more if you wait three years. This penalty applies for the remainder of your Medicare enrollment and never goes away.
• Part D: A formula is used to calculate the penalty for signing up for Part D late. In 2024, this was 1% of the national base beneficiary premium of $34.70 for every month you were eligible for coverage but didn’t sign up. This penalty is added to your bill every month and never goes away.

Medicare Part B first-time expenses

Paying for your first three months of Medicare Part B premiums all at once can cause some sticker shock, but depending on where you fall in the billing cycle, your “surprise” could be even worse. Medicare bills are sent every three months unless you are on a monthly payment schedule, and could include premiums for months that you were enrolled before the first billing was done. Your bill or statement will outline exactly what dates and periods you are paying for.