| 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 $103,000 |
Less than or equal to $206,000 |
$0.00 |
$174.70 |
| Greater than $103,000 and less than or equal to $129,000 |
Greater than $206,000 and less than or equal to $258,000 |
$69.90 |
$244.60 |
| Greater than $129,000 and less than or equal to $161,000 |
Greater than $258,000 and less than or equal to $322,000 |
$174.70 |
$349.40 |
| Greater than $161,000 and less than or equal to $193,000 |
Greater than $322,000 and less than or equal to $386,000 |
$279.50 |
$454.20 |
| Greater than $193,000 and less than $500,000 |
Greater than $386,000 and less than $750,000 |
$384.30 |
$559.00 |
| Greater than or equal to $500,000 |
Greater than or equal to $750,000 |
$419.30 |
$594.00 |