Medicare IRMAA Explained — the 2026 Income Surcharge on Part B and Part D
If your income is above a threshold, Medicare charges you extra for Parts B and D — a surcharge called IRMAA. It catches people off guard because it's based on income from two years ago, and because each bracket is a cliff. Here's how it works in 2026, the exact brackets, and what you can do about it.
- IRMAA = an income surcharge on Medicare Part B and Part D for higher earners.
- It's based on your MAGI from two years ago — 2026 premiums use your 2024 income.
- Each bracket is a cliff: one dollar over a threshold raises your premium for the whole year.
- If a life event (like retirement) lowered your income, you can appeal with Form SSA-44.
What IRMAA is
Most people pay the standard Part B premium — $202.90/month in 2026 — and just their plan's premium for Part D drug coverage. But if your income is above the first threshold, Medicare adds an Income-Related Monthly Adjustment Amount to both: a higher Part B premium and an extra dollar amount on top of your Part D plan. It's Medicare's way of means-testing premiums for higher earners.
The 2026 brackets
Your bracket depends on your 2024 MAGI and your filing status. For most filers (single and married filing jointly), the 2026 monthly amounts are:
| 2024 MAGI — single | 2024 MAGI — joint | Part B (total) | Part D (extra) |
|---|---|---|---|
| ≤ $109,000 | ≤ $218,000 | $202.90 | — |
| $109,001–137,000 | $218,001–274,000 | $284.10 | +$14.50 |
| $137,001–171,000 | $274,001–342,000 | $405.80 | +$37.50 |
| $171,001–205,000 | $342,001–410,000 | $527.50 | +$60.40 |
| $205,001–500,000 | $410,001–750,000 | $649.20 | +$83.30 |
| > $500,000 | > $750,000 | $689.90 | +$91.00 |
Part B figures are the full monthly premium (standard + surcharge); the Part D column is the surcharge added on top of your drug plan's own premium. Married-filing-separately beneficiaries who lived with their spouse face a steeper schedule (a large jump above $109,000).
Find your exact surcharge
Our IRMAA Calculator places your income in the right bracket, shows your total Part B and Part D cost, and tells you how close you are to the next tier.
Check my 2026 IRMAA →The two-year lookback
This is the part that surprises people. Your IRMAA isn't based on this year's income or even last year's — it's based on the tax return from two years prior. Your 2026 premiums are set by your 2024 MAGI, because that's the most recent return Social Security has on file when it sets your rate. A one-time bump in 2024 — a Roth conversion, a home sale, a large capital gain — can raise your Medicare premiums in 2026 even if your income has since fallen.
What income counts
IRMAA uses MAGI = Adjusted Gross Income + tax-exempt interest. Note what it does not add back: unlike ACA subsidies, IRMAA does not count the non-taxable portion of Social Security. The two programs define MAGI differently — a common and costly mix-up, which we cover in MAGI: ACA vs IRMAA.
Why it's a cliff
IRMAA brackets are all-or-nothing. There's no gradual phase-in: cross a threshold by a single dollar and you pay the full higher amount for the entire year. Going from the base tier into the first IRMAA tier in 2026 adds about $81/month to Part B plus $14.50 to Part D — roughly $1,150 for the year, per person. For a couple where both are on Medicare, that's about $2,300. The lesson: near a threshold, a few hundred dollars of income can cost you over a thousand.
Appealing IRMAA (Form SSA-44)
Because IRMAA looks back two years, it can hit you on income you no longer have. If a life-changing event reduced your income, you can ask Social Security to use a more recent year instead. Qualifying events include marriage, divorce, death of a spouse, work stoppage or reduction (including retirement), loss of income-producing property, or loss of a pension. File Form SSA-44 with documentation. This is one of the most under-used ways to lower Medicare costs for the newly retired.
Planning around it
- Mind the two-year delay. Income decisions today affect Medicare premiums two years out — so the year you do a Roth conversion or realize a big gain is the year to check the brackets.
- Watch thresholds, not just tax brackets. Because IRMAA is a cliff, staying a few hundred dollars under a threshold can be worth more than the income itself.
- Spread income. Splitting a large Roth conversion or sale across years can keep you out of a higher tier.
See your numbers
Enter your income and filing status to see your 2026 Part B and Part D totals, your tier, and the distance to the next bracket.
Open the IRMAA Calculator →Frequently asked questions
What's the standard Part B premium in 2026?
$202.90 per month. IRMAA adds a surcharge on top of that for higher-income beneficiaries.
Which income year does 2026 IRMAA use?
2024 — the two-year lookback. If your income has dropped due to a life event, file Form SSA-44 to use a newer year.
Does Social Security count for IRMAA income?
No — IRMAA MAGI is AGI plus tax-exempt interest only. (ACA MAGI is different and does add Social Security back.)
If I cross a bracket, do I pay more all year?
Yes. IRMAA is a cliff — over a threshold by a dollar means the full higher premium for the whole year.
Sources
- CMS — 2026 Medicare Parts A & B premiums & Part D IRMAA fact sheets
- Social Security Administration — Medicare premiums & higher-income beneficiaries, Form SSA-44, and POMS HI 01101.020 (brackets)
- Medicare — Medicare costs
We verify these figures annually against the CMS fact sheet — see our methodology. Educational only, not tax or financial advice.