The federal government sets the premium prices for Medicare Part A unless you are eligible to receive this coverage at no cost, and Medicare Part B. Medicare Advantage, Medicare Part D and Medigap policies are all offered by insurance companies that set prices within government guidelines. However, the government may add a monthly fee to Part D based on your 1099-reported adjusted gross income from two years prior. If you have to pay the Part D-IRMAA amount, it’s in addition to your monthly premium and funnels directly to Medicare.