Medicare IRMAA (2026–2027): Will Your Income Raise Premiums?
Bottom Line
Income above Medicare's IRMAA thresholds adds surcharges to Part B and Part D premiums, generally using income from two years earlier. A qualifying life event that lowers income may support a review, but relief isn't guaranteed.
Yes — if your modified adjusted gross income is above a set threshold, Medicare adds an income-related monthly adjustment amount (IRMAA) to your Part B and Part D premiums. For 2026, that threshold starts at $109,000 for individuals filing single returns and $218,000 for married couples filing jointly. Only about 8% of Part B enrollees pay the surcharge, so most people pay the standard premium of $202.90 per month for Part B and no extra on top of their Part D plan premium.
IRMAA affects Part B and Part D separately. It adds to premiums without changing your plan’s covered benefits or point-of-service charges. If a business lender requires life insurance for an SBA loan, budget for that separate requirement independently.
What IRMAA Actually Is
Since 2007, higher-income Part B enrollees have paid a larger share of Part B’s cost, and since 2011 the same concept has applied to Part D. CMS calls the extra amount an income-related monthly adjustment amount. Roughly 8% of people with Medicare pay it, according to CMS.
Three things worth understanding up front:
- IRMAA is based on your tax return’s modified adjusted gross income (MAGI), not your current paycheck or bank balance.
- The same income thresholds are used for both Part B and Part D, but the surcharge amounts differ.
- You pay IRMAA in addition to your plan premiums. For Part D, the surcharge goes to Medicare (usually deducted from your Social Security check) even though your plan premium goes to your plan.
2026 Part B Premiums by Income
The standard 2026 Part B premium is $202.90 per month. Higher-income beneficiaries pay the following total monthly premiums:
| Individual MAGI (single filer) | Joint MAGI (married filing jointly) | Total monthly Part B premium |
|---|---|---|
| $109,000 or less | $218,000 or less | $202.90 |
| $109,001–$137,000 | $218,001–$274,000 | $284.10 |
| $137,001–$171,000 | $274,001–$342,000 | $405.80 |
| $171,001–$205,000 | $342,001–$410,000 | $527.50 |
| $205,001–$499,999 | $410,001–$749,999 | $649.20 |
| $500,000 or more | $750,000 or more | $689.90 |
There is a harsher bracket structure for one filing situation: if you are married and lived with your spouse at any point in the tax year but file separately, you pay the standard premium only up to $109,000 in MAGI. Above $109,000 but below $391,000 the surcharge jumps to $446.30, making your total Part B premium $649.20 per month — the same amount a much higher-income joint filer pays. $391,000 or more brings a total of $689.90.
2026 Part D IRMAA Amounts
For Part D, you pay the IRMAA surcharge on top of whatever premium your own drug plan charges. Plan premiums vary widely, so the surcharge is the only fixed figure:
| Individual MAGI | Joint MAGI | Added monthly Part D surcharge |
|---|---|---|
| $109,000 or less | $218,000 or less | $0 |
| $109,001–$137,000 | $218,001–$274,000 | $14.50 |
| $137,001–$171,000 | $274,001–$342,000 | $37.50 |
| $171,001–$205,000 | $342,001–$410,000 | $60.40 |
| $205,001–$499,999 | $410,001–$749,999 | $83.30 |
| $500,000 or more | $750,000 or more | $91.00 |
Married-filing-separately enrollees who lived together face the same compressed thresholds for Part D: $0 through $109,000, $83.30 above $109,000 but below $391,000, and $91.00 at $391,000 or more.
IRMAA does not change your drug coverage itself. Your plan’s deductible (no more than $615 in 2026), copays and coinsurance still follow its terms. You reach catastrophic coverage at $2,100 in 2026 in qualifying out-of-pocket costs for covered Part D drugs; premiums do not count toward that threshold.
Which Tax Year Counts
Your IRMAA is set from the MAGI on a recent tax return that the IRS provides to Social Security, generally for the tax year two years before the coverage year. That timing matters most around retirement: someone who retires in 2026 with IRMAA based on 2024 income may be paying a surcharge on income they no longer earn. The IRMAA itself can also change year to year, since CMS recalculates brackets and premiums annually.
What To Do If Your Income Has Dropped
If a life event — retirement, a spouse’s death, divorce, work stoppage — has reduced your income since the tax year Social Security used, you are not stuck with the surcharge automatically. Social Security has a documented review process where you submit evidence of the change and request a new determination. Success is not guaranteed; the outcome depends on your circumstances and documentation. For a walk-through of the evidence and filing steps, see our guide on requesting an IRMAA review after retirement.
Do not simply stop paying the surcharge while you wait. Nonpayment can put your Medicare coverage at risk, so keep paying and pursue the review in parallel.
IRMAA and the Rest of Your Medicare Budget
IRMAA is one line item in a larger picture. When you plan for your full Medicare costs, remember that the standard premiums are only the start: you may also have a Medigap or Medicare Advantage premium, drug plan premium, deductibles, and cost sharing on services. Original Medicare has no annual out-of-pocket limit. Supplemental coverage can reduce eligible costs, and Medicare Advantage has its own limit on covered medical services, so the rest of your budget matters as much as your premium bracket.
A practical exercise is adding up your total monthly Medicare costs: start with your Part B premium (standard or IRMAA-adjusted), add your Part D plan premium plus any Part D surcharge, then layer in supplemental coverage premiums and realistic out-of-pocket spending for the year. A simple worked example — clearly illustrative, not a personal estimate — looks like this for 2026:
| Item | Illustrative amount |
|---|---|
| Part B premium (second bracket) | $284.10 |
| Part D IRMAA surcharge (second bracket) | $14.50 |
| Part D plan premium (varies by plan and ZIP code) | set by your plan |
| Medigap or Advantage premium (varies) | set by your plan |
| Deductibles and copays for the year | depends on your usage |
Your own numbers will differ based on the plans available where you live and the care you expect to use, so treat any example as a worksheet rather than a quote.
Married Couples: Budget Each Spouse Separately
IRMAA is determined per person, not per household enrollment. If you and your spouse are both on Medicare, each of you has your own Part B premium, your own Part D surcharge (if any), and your own plan choices. For couples whose joint income sits above the threshold, both spouses can end up paying IRMAA — each spouse pays the applicable surcharge separately. That makes budgeting for each spouse’s Medicare coverage its own step before you combine totals into one household number.
The married-filing-separately trap is worth flagging again for couples: filing separately while living together can push a moderate-income spouse into the top surcharge brackets. If you are in that situation, it is worth discussing tax filing strategy with a qualified tax professional before the return is filed.
Key Takeaways
- Most people with Medicare pay no IRMAA; it applies above $109,000 individual / $218,000 joint MAGI in 2026.
- The 2026 standard Part B premium is $202.90; top-bracket IRMAA can bring it to $689.90.
- Part D IRMAA runs from $14.50 to $91.00 per month in 2026, added to whatever your plan charges.
- Surcharge amounts come from a prior tax return, so a recent income drop may qualify you for a review.
- Spouses are assessed individually, and each spouse’s coverage should be budgeted separately.
Before your next enrollment decision, pull together your most recent tax return, your current premium notices, and a list of the prescriptions and providers you expect to use. Comparing actual plan options in your area against your IRMAA-adjusted premiums is the fastest way to see your real bottom line — and the right next step is to gather those documents and compare the plans available where you live side by side.