Medicare IRMAA in 2026, Higher Premiums and the Income Lookback
Medicare Part B costs $202.90 a month for most people in 2026, but if your income is above $109,000 (single) or $218,000 (married filing jointly), you pay more. The surcharge is called the income-related monthly adjustment amount, or IRMAA. It applies to Part B and to Medicare prescription drug coverage. Numbers here are from SSA and Medicare.gov, as of October 2026.
1. How SSA decides
SSA uses your modified adjusted gross income (MAGI), which it defines as your adjusted gross income plus tax-exempt interest. It looks at the most recent federal tax return the IRS provides. For 2026 premiums, that is generally the return filed in 2025 for tax year 2024. Sometimes the IRS only has the tax year 2023 return, in which case SSA uses that one.
For most people the government pays about 75% of the Part B premium and the beneficiary pays 25%. Higher-income beneficiaries pay 35%, 50%, 65%, 80%, or 85% of the total cost.
2. The 2026 tiers (single or joint filers)
| MAGI, single | MAGI, married filing jointly | Part B per month | Part D add-on per month |
|---|---|---|---|
| $109,000 or less | $218,000 or less | $202.90 | none |
| Above $109,000 to $137,000 | Above $218,000 to $274,000 | $284.10 | + $14.50 |
| Above $137,000 to $171,000 | Above $274,000 to $342,000 | $405.80 | + $37.50 |
| Above $171,000 to $205,000 | Above $342,000 to $410,000 | $527.50 | + $60.40 |
| Above $205,000 to under $500,000 | Above $410,000 to under $750,000 | $649.20 | + $83.30 |
| $500,000 or more | $750,000 or more | $689.90 | + $91.00 |
The Part B figures are the $202.90 standard premium plus SSA's published surcharges ($81.20, $202.90, $324.60, $446.30, $487.00). The Part D amount is added to your plan's own premium. A married person who lived with their spouse at any time in the tax year but files separately uses a different, harsher chart: above $109,000 and under $391,000 adds $446.30 to Part B (and $83.30 to drug coverage), and $391,000 or more adds $487.90 (and $91.00). The $487.90 is the figure printed on SSA's chart, even though the joint chart's top tier is $487.00.
3. A threshold is a cliff
The tiers are not gradual. Take a single filer with assumed MAGI of $109,001 versus $109,000, who also has drug coverage:
- Part B surcharge: $81.20 x 12 = $974.40 a year.
- Part D surcharge: $14.50 x 12 = $174.00 a year.
- Total extra cost for one dollar of income: $1,148.40 a year.
The total Part B premium at that level is $284.10 x 12 = $3,409.20, compared with $202.90 x 12 = $2,434.80 at the standard rate.
This is why one-time income, such as a large capital gain or a big withdrawal, is worth understanding. Because of the lookback, income two years earlier is what sets the premium, so a spike in one year shows up in premiums two years later.
4. When income has dropped
SSA says you can ask for a new decision if your income went down because of a life-changing event. The listed events are marriage or divorce or the death of a spouse, you or your spouse stopping or reducing work, loss of income-producing property in a disaster, a scheduled employer pension plan termination or reorganization, and a settlement from an employer's closure or bankruptcy. You show documentation, such as a death certificate or a letter from your employer about your retirement, and can use Form SSA-44 to request the reduction.
If you disagree with the MAGI amount the IRS sent, SSA says you must correct it with the IRS. You can appeal other decisions online or with Form SSA-561-U2.
5. How you pay it
If you are a higher-income beneficiary, SSA deducts the drug-coverage surcharge from your Social Security payment no matter how you pay your plan premium. If the amount exceeds your payment, or you receive no payments, you get a separate bill.
6. Key takeaways
- IRMAA starts above $109,000 (single) or $218,000 (joint) MAGI in 2026.
- It uses your tax return from two years earlier, and it adds to both Part B and Part D.
- Each tier is a cliff: one dollar over a line moves you into the next surcharge.
- Life-changing events let you ask SSA to use a lower, more current income.
- Standard Part B is $202.90 a month in 2026; thresholds change yearly.
This is general information, not personal advice.