| Beneficiaries who file individual tax returns with modified adjusted gross income |
Beneficiaries who file joint tax returns with modified adjusted gross income |
Income-Related Monthly Adjustment Amount |
Monthly Premium |
| Less than or equal to $106,000 |
Less than or equal to $212,000 |
$0.00 |
$185.00 |
| Greater than $106,000 and less than or equal to $133,000 |
Greater than $212,000 and less than or equal to $266,000 |
$74.00 |
$259.00 |
| Greater than $133,000 and less than or equal to $167,000 |
Greater than $258,000 and less than or equal to $322,000 |
$185.00 |
$370.00 |
| Greater than $167,000 and less than or equal to $200,000 |
Greater than $322,000 and less than or equal to $386,000 |
$295.90 |
$480.90 |
| Greater than $200,000 and less than $500,000 |
Greater than $386,000 and less than $750,000 |
$406.90 |
$591.90 |
| Greater than or equal to $500,000 |
Greater than or equal to $750,000 |
$443.30 |
$628.90 |