Modified Adjusted Gross Income (MAGI) | Part B monthly premium amount | Prescription drug coverage monthly premium amount |
| Individuals with a MAGI of $85,000 or less
Married couples with a MAGI of $170,000 or less | 2013 standard premium = $104.90 | Your plan premium |
| Individuals with a MAGI above $85,000 up to $107,000
Married couples with a MAGI above $170,000 up to $214,000 | Standard premium + $42.00 ($146.90 total) | Your plan premium + $11.60 |
| Individuals with a MAGI above $107,000 up to $160,000
Married couples with a MAGI of $214,000 up to $320,000 | Standard premium + $104.90 ($209.80 total) | Your plan premium + $29.90 |
| Individuals with a MAGI above $160,000 up to $214,000
Married couples with a MAGI above $320,00 up to $428,000 | Standard premium + $167.80 ($272.70 total) | Your plan premium + $48.30 |
| Individuals with a MAGI above $214,000
Married couples with a MAGI above $428,000 | Standard premium + $230.80 ($335.70 total) | Your plan premium + $66.60 |