Most people who have Medicare Part B pay a standard monthly premium. However, some Medicare beneficiaries pay more based on their income. This extra amount is called the Income-Related Monthly Adjustment Amount, commonly known as IRMAA.
IRMAA is not a penalty. It is an additional monthly charge added to Medicare Part B, and sometimes Medicare Part D, for people whose income is above certain limits. In 2026, the standard Medicare Part B premium is $202.90 per month, and the annual Part B deductible is $283.
The important thing to know is this: IRMAA is based on your income from two years ago. For 2026 Medicare premiums, Social Security generally looks at your 2024 tax return to determine whether IRMAA applies.
Medicare Part B helps cover doctor visits, outpatient care, preventive services, durable medical equipment, and other medically necessary services. While most people pay the standard Part B premium, higher-income beneficiaries pay the standard premium plus IRMAA.
| Medicare Part B Cost | 2026 Amount |
|---|---|
| Standard monthly Part B premium | $202.90 |
| Annual Part B deductible | $283 |
In simple terms, your Medicare Part B premium may be higher if your income is above the threshold set by Medicare and Social Security.
The chart below shows how Medicare Part B premiums increase as income rises. These amounts are based on 2024 modified adjusted gross income, also called MAGI.
| Individual Tax Return | Joint Tax Return | Married Filing Separately | 2026 Monthly Part B Premium |
|---|---|---|---|
| $109,000 or less | $218,000 or less | $109,000 or less | $202.90 |
| Above $109,000 up to $137,000 | Above $218,000 up to $274,000 | Not applicable | $284.10 |
| Above $137,000 up to $171,000 | Above $274,000 up to $342,000 | Not applicable | $405.80 |
| Above $171,000 up to $205,000 | Above $342,000 up to $410,000 | Not applicable | $527.50 |
| Above $205,000 and less than $500,000 | Above $410,000 and less than $750,000 | Above $109,000 and less than $391,000 | $649.20 |
| $500,000 or above | $750,000 or above | $391,000 or above | $689.90 |
Source: Medicare 2026 cost information and CMS 2026 Part B premium tables.
| 2026 Monthly Part B Premium | Visual Comparison |
|---|---|
| $202.90 | ███████ |
| $284.10 | ██████████ |
| $405.80 | ██████████████ |
| $527.50 | ███████████████████ |
| $649.20 | ███████████████████████ |
| $689.90 | █████████████████████████ |
This chart shows why IRMAA can surprise retirees. A relatively small increase in taxable income can move someone into a higher Medicare premium bracket.
IRMAA is based on your modified adjusted gross income, or MAGI. For Medicare IRMAA purposes, MAGI generally includes your adjusted gross income plus tax-exempt interest income. SSA’s Form SSA-44 instructions explain that MAGI includes adjusted gross income from IRS Form 1040 plus tax-exempt interest income from Form 1040.
Income that may affect IRMAA can include:
This is why retirees may see IRMAA after selling property, taking large retirement withdrawals, converting funds to a Roth IRA, or having a one-time spike in investment income.
Yes. IRMAA can also apply to Medicare Part D prescription drug coverage. If you owe Part D IRMAA, it is charged in addition to your Part D plan premium.
| Individual Tax Return | Joint Tax Return | Monthly Part D IRMAA |
|---|---|---|
| $109,000 or less | $218,000 or less | $0 |
| Above $109,000 up to $137,000 | Above $218,000 up to $274,000 | $14.50 |
| Above $137,000 up to $171,000 | Above $274,000 up to $342,000 | $37.50 |
| Above $171,000 up to $205,000 | Above $342,000 up to $410,000 | $60.40 |
| Above $205,000 and less than $500,000 | Above $410,000 and less than $750,000 | $83.30 |
| $500,000 or above | $750,000 or above | $91.00 |
Part D IRMAA is paid to Medicare, not to the insurance company that provides the Part D plan.
IRMAA often surprises people because it is based on income from two years earlier. A person may have retired, reduced work hours, lost a spouse, or had lower income since then, but Medicare may still be using an older tax return.
For example:
Mary filed an individual tax return in 2024 showing income of $125,000. In 2026, Medicare uses that 2024 income to determine her Part B premium.
Because her income was above $109,000 but not above $137,000, Mary’s 2026 Medicare Part B premium would be $284.10 per month instead of the standard $202.90.
That means Mary pays an extra $81.20 per month, or $974.40 more for the year, for Part B.
Yes. If your income has gone down because of certain life-changing events, you may be able to ask Social Security to review your IRMAA amount.
Common life-changing events may include:
Social Security uses Form SSA-44 for Medicare IRMAA life-changing event requests. The form explains that if SSA used your 2024 income to determine your 2026 IRMAA, you may request that SSA use more recent income information if your income was reduced because of a qualifying life-changing event.
If you receive an IRMAA notice, do not ignore it. Review it carefully and check:
If the information is correct and your income is still in the higher bracket, the IRMAA amount may apply. If your income has significantly changed, you may want to contact Social Security or complete Form SSA-44.
IRMAA planning is really income planning. Since Medicare looks back two years, it is helpful to think ahead before making financial decisions that could increase your taxable income.
Here are a few planning ideas to discuss with your financial or tax professional:
A licensed insurance agent can help you understand Medicare plan options, but tax planning should be reviewed with a qualified tax advisor or financial professional.
IRMAA is an extra Medicare charge for people with higher income. It can affect both Medicare Part B and Medicare Part D. For 2026, most people pay a standard Part B premium of $202.90 per month, but higher-income beneficiaries may pay as much as $689.90 per month for Part B.
The most important points to remember are:
Medicare costs can be confusing, especially when income-related adjustments are involved. If you have questions about Medicare Part B premiums, Medicare Advantage, Medicare Supplement plans, or prescription drug coverage, our office can help you review your options and understand how the pieces fit together.
Call Harris Advisors today to schedule a Medicare review.
Phone: 770-941-6154
Website: https://www.HarrisAdvisorsGA.com
