Most conversations about Social Security center on claiming age because it sets your base benefit. That choice is important, but another rule can carry more weight as the years pass: Medicare premiums are usually deducted directly from your monthly payment.
At first, the deduction may feel routine and manageable. Over time, rising health care costs and income-based premium adjustments can increase the amount withheld, which reduces what actually reaches your bank account.
For anyone planning for retirement, it helps to look beyond the headline benefit amount and understand what you truly take home. Here is how this rule works and why it can matter more later in retirement.
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The automatic deduction built into the system
For most retirees, Medicare premiums are taken out before the Social Security payment reaches their account.
If you are enrolled in Medicare Part B, the Social Security Administration (SSA) deducts the Part B premium from your benefit each month. Medicare Part A, which covers hospital care, is usually premium-free for people who qualify based on work history.
In 2026, the standard Part B premium is $202.90 per month, and that amount is withheld automatically. If you enroll in a Part D prescription drug plan or a Medicare Advantage plan, those premiums can often be deducted as well, depending on your selection and payment setup.
The result is that your Social Security deposit reflects your benefit after Medicare costs. As premiums rise over time, the portion of your check devoted to health coverage can increase, leaving less available for other expenses in retirement.
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Why higher-income retirees pay even more
Some retirees pay more than the standard Medicare premium because of the IRMAA rule (Income-Related Monthly Adjustment Amount). This surcharge applies when income rises above certain levels.
In 2026, higher premiums apply if your 2024 Modified Adjusted Gross Income (MAGI) was above $109,000 for single filers or $218,000 for married couples filing jointly.
Instead of the standard $202.90 for Part B, the monthly premium increases in steps. Depending on income, the surcharge can add roughly $81 to $487 per month. Part D drug coverage has its own IRMAA charge, adding about $14 to $91 per month.
Crucially, the Social Security Administration looks at your income from two years ago to set these charges. That means a high income in your 60s or early 70s can trigger extra Medicare costs when you’re older, even if your paychecks have since stopped.
How the deduction grows over time
For most retirees, Medicare becomes more expensive as the years pass. The standard Part B premium, for instance, has climbed from $164.90 in 2023 to $174.80 in 2024, $185.00 in 2025, and $202.90 in 2026.
That matters because Social Security cost-of-living adjustments (COLAs) often move more slowly. Over the past decade, Part B premiums increased by about 5.3% per year on average, faster than typical COLAs. When health care costs grow faster than benefits, part of each increase goes toward Medicare instead of your monthly deposit.
Income levels can further increase expenses as retirement progresses. Required Minimum Distributions (RMDs) begin at age 73 for most retirement accounts. Those withdrawals increase taxable income, which can push some retirees into IRMAA brackets and raise Medicare premiums further.
Consider a retiree with $100,000 in income at age 68, below the IRMAA threshold. At 73, a $30,000 RMD could raise total income to $130,000, potentially triggering an income-related surcharge and significantly increasing premiums. As RMDs grow over time, the likelihood of crossing into a higher bracket can rise as well.
The effect tends to build gradually. What begins as a modest deduction can take up a larger share of your benefit as premiums increase and income shifts, widening the gap between your stated benefit and what you actually receive each month.
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The hold harmless protection and its limits
Medicare includes a safeguard known as the hold harmless provision. In basic terms, it prevents a Part B premium increase from reducing your Social Security check below the prior year’s amount solely because of that premium change.
The protection helps many retirees, but it does not apply in several common situations:
Higher-income retirees paying IRMAA
People newly enrolled in Medicare Part B
Anyone whose costs rise because of income-based surcharges
When income moves into a higher IRMAA bracket, the extra premium is deducted even if it reduces the monthly deposit. The hold harmless rule does not limit those increases.
This is why the issue becomes more important over time. As retirement income changes from withdrawals, part-time work, or RMDs, the protection many retirees expect may no longer apply.
Bottom line
When you claim Social Security matters, but what happens to your benefit over time matters just as much. Medicare premiums are automatically deducted, and as costs rise or income changes, a larger share of your check can go toward health coverage.
Understanding how premiums, IRMAA, and income changes affect your net benefit helps you set realistic expectations, plan your budget, and make the right moves before the difference becomes a surprise.
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