Short answer: Medicare Advantage usually does not replace your Part B premium. Whether you choose Original Medicare or Medicare Advantage, you generally keep paying Part B. Most people who receive Social Security or Railroad Retirement Board (RRB) benefits have Part B deducted automatically from those payments. If you receive neither benefit, Medicare generally sends a bill. Other charges—an Advantage plan premium, a stand-alone Part D premium, Medigap, and Part D IRMAA—are separate and may be paid to different organizations.
First separate the charges you may owe
“My Medicare premium” can mean several different bills. Identifying each charge is the key to understanding what Social Security withholds. A deduction on a Social Security statement is not necessarily the only Medicare-related amount you owe, and a plan’s advertised premium is not a complete measure of annual cost.
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| Charge | What it pays for | Who may owe it | Typical payment destination |
|---|---|---|---|
| Part B premium | Outpatient medical insurance, including doctors, testing and durable medical equipment | Most people enrolled in Part B | Usually deducted from Social Security or RRB benefits; otherwise billed by Medicare |
| Medicare Advantage plan premium | The private plan’s benefits and administration | Only if the selected plan charges one | The plan, using a plan bill, bank/card payment or an arrangement for Social Security withholding |
| Stand-alone Part D premium | Prescription-drug coverage purchased alongside Original Medicare | People who enroll in a separate drug plan | The drug plan; payment methods vary |
| Part D IRMAA | An income-related surcharge on Part D coverage | Higher-income beneficiaries in Part D, whether the drug coverage is stand-alone or included in Medicare Advantage | Often billed directly by Medicare, although Social Security determines eligibility and sends a notice |
| Medigap or other supplemental premium | Supplemental coverage that helps pay some Original Medicare cost sharing | People who buy a supplemental policy | The supplemental insurer; it is not the Part B deduction |
Amounts and billing arrangements depend on your benefit situation, plan and location. Your Medicare notices and plan materials control the amount you actually owe. Keep each notice with the corresponding bill or bank authorization so you can tell which payment covers which coverage.
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How Part B is paid under either choice
When Social Security or RRB automatically withholds it
Medicare says most people get their Part B premium deducted automatically from their Social Security benefit payment (or Railroad Retirement Board benefit payment). The deduction is normally visible on the benefit statement rather than as a separate Medicare transaction. The same basic rule applies whether you have Original Medicare or Medicare Advantage, because Advantage enrollment generally requires continued Part B enrollment.
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For 2026, Medicare.gov lists the standard Part B premium as $202.90 per month. That is the standard amount, not a guarantee of what every beneficiary pays: income-related adjustments and other circumstances can raise it, and Medicare can change the standard premium in a later year. If your statement shows a different amount, compare it with your current Medicare notice rather than assuming an error.
A Part B deduction may begin, stop or change after a coverage or benefit change. The effective month and the amount shown on the benefit statement are important when checking whether a plan’s promised Part B reduction has appeared. A plan reduction does not necessarily appear as a separate deposit; it may affect the net amount withheld or otherwise be handled under the plan’s stated process.
When Medicare sends a bill
If you are not receiving Social Security or RRB benefits, Medicare generally bills you for Part B. A Part B-only bill is generally issued every three months. The CMS-500 bill can also include a Part A premium, when applicable, and Part D IRMAA. This is why a person who expected a simple Part B invoice may see several lines on one statement.
The first CMS-500 can be larger than expected because it may cover upcoming months plus past months when coverage began before the first bill, a payment was missed, or the premium changed. Medicare says payment is due by the 25th of the month printed on the bill. Check the coverage months and due date rather than assuming the amount represents one month. Save confirmation of payment and review the next bill to make sure the balance was credited.
What changes when you choose Medicare Advantage
You generally still pay Part B
Medicare Advantage is a way to receive Medicare-covered Part A and Part B services through a private plan. Joining one generally does not stop the Part B premium. Unless your plan specifically provides a reduction, you continue paying Part B through the usual Social Security deduction or Medicare bill. Leaving Original Medicare’s claims administration for a private plan does not by itself cancel Part B enrollment.
A plan premium is a separate charge
An Advantage plan may charge a monthly premium in addition to Part B (and any applicable Part A premium). Some plans charge no additional plan premium; that does not mean Part B is free. A zero-dollar plan premium describes the plan’s charge, not your total Medicare premium obligation. You can therefore have a zero-premium plan and still see Part B withheld every month, plus cost sharing when you use services.
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Some plans offer a Part B premium reduction, sometimes called a Part B giveback or reduction. Medicare says this benefit is not offered in every area. It is plan-specific: it may reduce the amount of Part B you ultimately pay, but it does not mean every plan pays Part B for every member. Confirm the amount, eligibility conditions and how the reduction appears in your benefit payment before relying on it. A reduction can be limited by the plan’s service area, enrollment rules or other terms, so read the plan’s current materials rather than relying on a sales presentation or a prior year’s offer.
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How the Advantage plan collects its own premium
If the plan charges a premium, the plan—not necessarily Medicare—sets up collection. Medicare describes options that can include a bank-account deduction, credit or debit card, or a bill from the plan. A plan may also arrange Social Security withholding. If it does, the plan tells you when the withholding starts. Do not assume that every Advantage premium is automatically taken from Social Security; many members pay the plan separately.
Separate collection can produce two deductions or bills in the same month: one for Part B and another for the plan. Check the payer name, amount and effective date on each notice. If you change plans, confirm when the old plan’s collection ends and when the new plan’s collection begins so you do not mistake overlapping timing for a duplicate obligation.
Drug coverage is usually built in
Most Medicare Advantage plans include Part D prescription-drug coverage. Consequently, an enrollee often does not buy a separate stand-alone Part D plan or pay a second ordinary Part D plan premium. The Advantage plan can still charge its own premium, and a member may owe Part D IRMAA in addition to the plan’s ordinary charges.
Drug coverage inside an Advantage plan follows that plan’s formulary, pharmacy network and utilization rules. A low plan premium does not guarantee that every prescription is on the formulary or that every pharmacy has the same cost. Check the plan’s drug list and cost-sharing tiers before enrolling, especially if you take maintenance medications.
How Original Medicare and stand-alone Part D work together
Original Medicare’s basic structure
Original Medicare consists of Part A and Part B. Part B is handled through the automatic deduction or Medicare billing process described above. Part A is premium-free for many people, but a person who does not qualify for premium-free Part A can have a separate Part A premium. If Part A is billed, it may appear with Part B on a CMS-500 rather than on a Social Security deduction.
Adding prescription coverage
With Original Medicare, you can enroll in a stand-alone Part D drug plan. That plan’s ordinary premium is separate from Part B and is paid to the drug-plan sponsor. The plan may accept electronic bank payment, a card, a plan bill or, if arranged, Social Security withholding. Review the plan’s payment instructions because the method and timing are not universal. A stand-alone Part D premium is not automatically included in the Part B amount shown on a Social Security statement.
Adding a supplement
A Medigap policy is optional supplemental insurance for people who remain in Original Medicare. Its premium is paid to the Medigap insurer and is distinct from both the Part B deduction and any Part D premium. A supplement can change your out-of-pocket exposure, but it does not convert into Medicare Advantage and does not eliminate Part B. If you have both Medigap and a drug plan, expect separate communications and payment schedules from each insurer.
Part D IRMAA: the income-related amount that is not the ordinary drug premium
Part D IRMAA is an extra income-related amount added to the ordinary Part D plan premium. It can apply to a stand-alone Part D plan or to Part D coverage included in a Medicare Advantage plan. It is therefore possible to have an Advantage plan with a low or zero plan premium and still owe Part D IRMAA.
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Fix the driver behind crashes, sound loss and screen glitchesFind Drivers →Repair Windows errors before they cause bigger problemsFix Now →Social Security uses income information from the Internal Revenue Service to determine whether the surcharge applies and sends a notice when it does. Medicare lists Part D IRMAA among amounts that may be billed directly. The surcharge is separate from the plan’s advertised premium and from Part B. Paying the plan’s ordinary premium does not automatically satisfy an IRMAA bill.
Do not use an older year’s income thresholds to predict a 2026 charge. The thresholds and surcharge amounts can change, so use the current notice and the instructions that accompany it. If your income has fallen because of a qualifying life-changing event, follow the appeal or reduction process described in your notice rather than simply stopping payment. A notice will identify the process and deadline; keep documentation supporting an income change.
What Social Security is—and is not—usually withholding
- Usually withheld: your Part B premium, and in some cases a Part D plan premium or another amount when the relevant plan or agency has established withholding.
- Not automatically combined into one charge: an Advantage plan premium, a stand-alone Part D premium, Part D IRMAA and a Medigap premium. Each can have a different payee and payment schedule.
- Not proof of a plan’s total cost: seeing a Part B deduction does not tell you what copayments, coinsurance, deductibles or prescription costs you will incur during the year.
When a plan sets up Social Security withholding for its own premium, the plan should tell you when the deduction begins. If the timing or amount does not match the notice, contact the plan and Social Security rather than assuming one has replaced the other. Medicare can explain Part B billing, but the private plan is the right source for its own premium, collection method and start date.
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Premiums are only one part of the Medicare decision
A lower monthly premium can produce higher costs or less flexibility elsewhere. Compare the plan’s Evidence of Coverage and current Medicare plan-comparison information for the plan year and service area. The same plan name can have different premiums, networks or benefits in different locations or years.
| Decision factor | Original Medicare | Medicare Advantage |
|---|---|---|
| Doctors and hospitals | Generally lets you use any doctor or hospital that accepts Medicare. | Usually uses a plan network for non-emergency care; the plan has a defined service area. |
| Specialist referrals | Usually no referral is required for a specialist. | A plan may require a referral, depending on its rules. |
| Part B cost sharing | Generally 20% coinsurance for Part B-covered services after the deductible. | Copayments and coinsurance vary by plan and service. |
| Prescription drugs | Requires a separate Part D plan if you want Medicare drug coverage. | Most plans include Part D, although coverage rules and formularies differ. |
| Annual out-of-pocket limit | No annual limit for covered Medicare services unless you have supplemental or other coverage. | Has an annual limit for covered Medicare services; the limit is set by the plan for the year. |
Network restrictions, prior authorization, formularies and cost-sharing tiers can matter more than a small premium difference. Check whether your doctors, hospitals and prescriptions are covered, what approvals are required, and how costs accumulate toward the plan’s annual limit. Also verify the plan’s service area if you spend part of the year in another state; routine non-emergency care outside the network may be handled differently.
Examples of how the payment pieces can fit together
Original Medicare with drug and supplemental coverage: Part B may be deducted from Social Security. A stand-alone Part D sponsor may bill you separately or arrange its own withholding. A Medigap insurer sends another premium bill. If you are subject to Part D IRMAA, Medicare may send a separate charge even though the drug plan already collects its ordinary premium.
Medicare Advantage with an ordinary plan premium: Part B continues through Social Security or a CMS-500. The Advantage plan sends a bill, charges a card or bank account, or arranges withholding for its own premium. Because drug coverage is commonly included, there may be no separate ordinary Part D bill, but Part D IRMAA can still apply.
Medicare Advantage with a Part B reduction: The plan’s materials describe the reduction and its conditions. You still need to monitor the Part B amount and the net benefit payment. The reduction is not a universal Medicare rule and does not automatically cover other premiums or cost sharing.
A practical way to identify your own payment setup
- Read your latest Social Security or RRB statement. Look for a Part B deduction and note the amount and effective month.
- Check whether Medicare sent a CMS-500. Read the coverage months, any Part A or Part D IRMAA line, and the payment due date. A quarterly bill may include past months.
- Read your plan’s premium notice. For Medicare Advantage or stand-alone Part D, confirm whether the plan charges an ordinary premium and whether it is collected by bill, bank/card payment or Social Security withholding.
- Look for a separate IRMAA notice. Part D IRMAA is not the same as the plan’s listed premium. Use the current notice’s appeal or income-change instructions if the income information is no longer representative.
- Compare the full plan design. Review networks, referrals, drug coverage, deductibles, copayments, coinsurance, prior authorization and the annual out-of-pocket limit—not just the monthly premium.
- Contact the correct payer. Ask Medicare about Part B or CMS-500 billing, Social Security about benefit deductions, and your plan about its own premium or withholding arrangement.
Common payment mistakes to avoid
- Assuming a zero-dollar Advantage premium means you owe nothing for Medicare.
- Canceling a Part B payment because an Advantage plan advertises a Part B reduction without confirming the plan’s terms.
- Paying a plan’s ordinary drug premium and overlooking a separate Part D IRMAA notice.
- Assuming a quarterly CMS-500 is a one-month bill when it includes several coverage months.
- Using last year’s premium, income thresholds or plan brochure to estimate a current-year obligation.
- Comparing plans only by premium while ignoring provider networks, referrals, formularies, cost sharing and the annual out-of-pocket limit.
Program scale is not a withholding statistic
Medicare.gov reports that 67.6 million people were covered and total expenditures were just over $1.1 trillion in 2024. Those figures describe the program’s size and spending; they do not show how many beneficiaries had premiums withheld from Social Security. No withholding percentage should be inferred from them.
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Frequently Asked Questions
Will Medicare premiums come out of my Social Security check?
Usually, if you receive Social Security or Railroad Retirement Board benefits, Medicare deducts your Part B premium automatically. If you receive neither, Medicare generally sends a bill, often quarterly. A private plan may separately arrange withholding for its own premium, but that is not automatic for every plan.
Do I still pay Part B with Medicare Advantage?
Generally yes. Medicare Advantage enrollment normally requires Part B enrollment and payment. A plan may offer a Part B premium reduction in some areas, but that benefit is plan-specific and is not available everywhere.
Does a zero-premium Medicare Advantage plan mean Medicare is free?
No. Zero refers only to the plan’s own monthly premium. You may still owe Part B, Part D IRMAA if applicable, and copayments or coinsurance when you receive care.
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1Repair Windows errors before they cause bigger problems2Scan for outdated or missing drivers - takes under a minute3Clear out junk files and repair common Windows errorsDoes Medicare Advantage include the Part D premium?
Most Medicare Advantage plans include Part D drug coverage, so you often do not pay a separate stand-alone Part D plan premium. The plan can still charge its own premium, and Part D IRMAA is a separate possible charge.
What is Part D IRMAA, and is it withheld from Social Security?
Part D IRMAA is an income-related surcharge added to the ordinary Part D premium. It can apply to stand-alone Part D or drug coverage inside Medicare Advantage. Social Security determines whether it applies using IRS income information and sends a notice; Medicare may bill the amount directly.
Why is my first Medicare bill larger than expected?
A CMS-500 may cover upcoming months plus past months, a missed payment or a premium change. Read the coverage months and the due date printed on the bill; Medicare says payment is due by the 25th of the month shown.
Who should I call about a deduction or bill?
Ask Medicare about Part B and CMS-500 billing, Social Security about the amount or timing of a benefit deduction, and your Medicare Advantage or Part D plan about its own premium, payment method and withholding start date.
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What should I compare besides monthly premiums?
Check provider networks and service area, referral rules, deductibles, copayments, coinsurance, prescription formularies, prior authorization and the annual out-of-pocket limit. Original Medicare generally offers broad provider choice but has no annual limit without supplemental coverage; Medicare Advantage plans have plan networks and an annual limit for covered Medicare services.
The Bottom Line
Think of Part B, the Medicare Advantage premium, a stand-alone Part D premium, Part D IRMAA and Medigap as separate charges. Part B is usually withheld from Social Security or RRB benefits, while other amounts may be billed or collected by a private plan. Confirm your own amounts in current Medicare, Social Security and plan notices, then compare coverage and out-of-pocket rules—not premiums alone.
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