Medicare 2026 IRMAA: What Higher Earners Will Pay for Parts B and D

Medicare premiums are not one-size-fits-all, and for roughly 8 percent of Medicare beneficiaries, 2026 brings a significant extra cost called IRMAA — the Income-Related Monthly Adjustment Amount. This surcharge applies to both Part B (medical coverage) and Part D (prescription drug coverage), and it's calculated using income data from two years prior. That means your 2026 Medicare premiums are based on what you reported on your 2024 federal tax return. If your modified adjusted gross income, or MAGI, exceeded certain thresholds in 2024, Social Security will automatically add the surcharge to your monthly Medicare bill.

The standard Part B premium in 2026 is $185.00 per month for most beneficiaries. But once your 2024 MAGI crosses $106,000 as a single filer — or $212,000 for married couples filing jointly — that number starts climbing. The first IRMAA tier adds $74.00 per month to your Part B premium, bringing it to $259.00. The second tier, which kicks in at $133,000 for singles and $266,000 for joint filers, pushes the monthly premium to $370.00. The third tier, starting at $167,000 single or $334,000 joint, raises it to $480.90. The fourth tier, beginning at $200,000 single or $400,000 joint, reaches $591.90 per month. And at the very top — income above $500,000 for singles or $750,000 for joint filers — the monthly Part B premium hits $628.90 per person. For a married couple both on Medicare at the highest bracket, that's $1,257.80 per month just for Part B alone.

Part D IRMAA surcharges work differently from Part B. Instead of replacing your plan premium, the Part D IRMAA is added on top of whatever your specific drug plan charges. So if your standalone Part D plan costs $35 per month and you fall into the first IRMAA tier, you'll pay $35 plus an additional $13.70 per month, billed separately by Social Security. The surcharge amounts for Part D in 2026 scale up across the same income brackets: $13.70 at the first tier, $35.30 at the second, $57.00 at the third, $78.60 at the fourth, and $85.80 at the top tier. These amounts are paid directly to the federal government, not to your drug plan, and they apply whether you have a standalone Part D plan or a Medicare Advantage plan that includes drug coverage.

One of the most confusing aspects of IRMAA for newly retired beneficiaries is the two-year lookback. If you retired in 2024 or 2025 and your income has dropped substantially, you may still be hit with a 2026 surcharge based on your higher working income from 2024. This is where the appeals process becomes critically important. Social Security allows you to request a new initial determination if you experienced a qualifying life-changing event — these include retirement, reduction in work hours, divorce, death of a spouse, loss of income-producing property, or a significant reduction in pension income. To appeal, you file SSA Form SSA-44 (Medicare Income-Related Monthly Adjustment Amount — Life-Changing Event) directly with your local Social Security office or by mail. You'll need to provide documentation of the income change, such as a letter from your former employer confirming your retirement date or a copy of your most recent tax return showing the lower income. If approved, Social Security will recalculate your IRMAA using a more recent estimate of your income rather than the 2024 figure.

It's also worth understanding how IRMAA interacts with Medicare Advantage plans. If you're enrolled in a Medicare Advantage plan in 2026, you still pay the Part B premium — including any IRMAA surcharge — because Medicare Advantage plans don't replace Part B, they work alongside it. Some Medicare Advantage plans offer a Part B premium reduction benefit, sometimes called a Part B giveback, where the plan pays a portion of your Part B premium on your behalf. However, this giveback applies to the base premium, not to IRMAA surcharges. So if you're in a high-income bracket, a Part B giveback plan might reduce your base $185 premium but will not offset the hundreds of dollars in IRMAA you owe on top of that.

For beneficiaries who are right on the edge of an IRMAA bracket, tax planning strategies can make a real difference. Contributing to a Health Savings Account before age 65, converting traditional IRA funds to a Roth IRA in lower-income years before Medicare begins, or timing the sale of investments to avoid large capital gains in a single year can all help keep your MAGI below a threshold. It's worth noting that MAGI for IRMAA purposes includes not just wages and pension income, but also tax-exempt interest income, capital gains, required minimum distributions from traditional IRAs and 401(k)s, and Social Security benefits. Many retirees are surprised to find that a large RMD or a home sale pushed them into an IRMAA bracket they didn't anticipate.

If you receive a letter from Social Security notifying you of an IRMAA determination and you believe it's based on incorrect information — for example, if the IRS sent Social Security an outdated tax return — you have the right to request a correction. You can do this by contacting Social Security at 1-800-772-1213 or visiting your local Social Security office. Bring your most recent tax return or an IRS tax transcript to document the correct income figure. Social Security is required to use the most recent tax data available from the IRS, but errors do occur, and beneficiaries who catch them can sometimes get their surcharge reduced mid-year.

For 2026 planning purposes, the IRMAA brackets were adjusted for inflation compared to 2025, which means some beneficiaries who were just over a threshold in 2025 may find themselves below it in 2026 if their income remained flat. The bracket thresholds typically increase by a few thousand dollars each year in line with the consumer price index. Checking your 2024 MAGI against the 2026 brackets before the year begins — ideally in the fall of 2025 during Medicare's Annual Enrollment Period from October 15 through December 7 — gives you time to plan your drug plan selection and budget accordingly. If you're uncertain about your MAGI, your 2024 Form 1040, Line 11 (adjusted gross income) plus any tax-exempt interest income from Line 2a gives you the combined figure Social Security uses.

Finally, if you're a beneficiary enrolled in both Medicare and Medicaid — known as a dual-eligible beneficiary — IRMAA does not apply to you. The Low Income Subsidy program, also called Extra Help, covers Part D costs for qualifying low-income beneficiaries, and Medicaid typically covers Part B premiums for those who qualify. IRMAA is strictly a concern for higher-income Medicare enrollees, but for those it does affect, understanding the brackets, the appeals process, and the planning strategies available can mean the difference between paying hundreds of dollars more per month than necessary and getting your premium right-sized to your actual current income.