Medicare Premiums & IRMAA Brackets
Income-related monthly adjustment amounts for Medicare Part B and Part D premiums
Key Numbers
Part B Standard
$202.90/mo
IRMAA Starts
$109K (Single)
Lookback
2-Year Lag
Max Surcharge
$487/mo (Part B)
IRMAA (Income-Related Monthly Adjustment Amount) is a surcharge on Medicare Part B and Part D premiums paid by higher-income beneficiaries. About 8% of Medicare enrollees pay IRMAA. Your 2026 surcharge is based on your 2024 tax return — a two-year lookback — and is recalculated every year.
Want to see your exact surcharge? Use the Medicare IRMAA Calculator — enter your 2024 income and filing status to see your 2026 Part B and Part D costs, how close you are to the next bracket cliff, and spouse-adjusted totals.
How is IRMAA calculated?
Two-year lookback: SSA uses your MAGI from 2 years prior. Your 2024 return determines your 2026 premiums.
Based on MAGI: Modified Adjusted Gross Income = AGI + tax-exempt interest (includes wages, pensions, RMDs, Roth conversions, capital gains, muni bond interest).
Cliff effect: IRMAA is not progressive — exceeding a threshold by $1 triggers the full surcharge for that tier.
Annual redetermination: Recalculated each year. If income drops, surcharge decreases after the 2-year lag.
Bracket indexing: Tiers 1–4 adjust annually for CPI-U inflation. The Tier 5 threshold ($500K single / $750K MFJ) is legislatively frozen until 2028.
Cliff example: A married couple with MAGI of $218,001 vs. $218,000 pays an extra ~$2,296/year combined in Part B alone — triggered by a single dollar over the threshold.
What counts toward MAGI for IRMAA?
Included in MAGI
Wages, pensions, IRA/401(k) distributions, RMDs, Roth conversions, capital gains, dividends, interest, tax-exempt interest (munis), rental income, taxable Social Security
Not included in MAGI
Qualified Roth withdrawals, qualified HSA withdrawals, return of basis, life insurance proceeds, gifts, inheritances, reverse mortgage proceeds
Muni bond trap: Tax-exempt interest from municipal bonds is excluded from federal AGI but added back for IRMAA MAGI. Retirees holding large muni positions often face higher surcharges than expected.
Part B Premiums & IRMAA
2026 standard Part B premium: $202.90/month (up from $185.00 in 2025 — a $17.90/month increase). Annual deductible: $283.
2026 Part B IRMAA brackets
| Single filer (2024 MAGI) | Married filing jointly | Monthly total | Surcharge | Extra/year |
|---|---|---|---|---|
| ≤ $109,000 | ≤ $218,000 | $202.90 | $0 | — |
| $109,001 – $138,000 | $218,001 – $276,000 | $284.10 | +$81.20 | +$974 |
| $138,001 – $174,000 | $276,001 – $348,000 | $405.70 | +$202.80 | +$2,434 |
| $174,001 – $220,000 | $348,001 – $440,000 | $527.30 | +$324.40 | +$3,893 |
| $220,001 – $500,000 | $440,001 – $750,000 | $648.90 | +$446.00 | +$5,352 |
| > $500,000 | > $750,000 | $689.90 | +$487.00 | +$5,844 |
Year-over-year change: 2025 → 2026
| Tier | 2025 single threshold | 2026 single threshold | Threshold change | 2026 monthly | Monthly change |
|---|---|---|---|---|---|
| Standard | ≤ $106,000 | ≤ $109,000 | +$3,000 | $202.90 | +$17.90 |
| Tier 1 | $106,001 – $133,000 | $109,001 – $138,000 | +$3,000–5,000 | $284.10 | +$25.40 |
| Tier 2 | $133,001 – $167,000 | $138,001 – $174,000 | +$5,000–7,000 | $405.70 | +$35.70 |
| Tier 3 | $167,001 – $200,000 | $174,001 – $220,000 | +$7,000–20,000 | $527.30 | +$46.50 |
| Tier 4 | $200,001 – $500,000 | $220,001 – $500,000 | +$20,000 | $648.90 | +$57.30 |
| Tier 5 | > $500,000 | > $500,000 | frozen | $689.90 | +$61.40 |
Bracket thresholds increased ~3% for inflation (CPI-U through Aug 2025). Surcharge dollar amounts increased ~9% — faster than the premium floor — reflecting rising Part B program costs.
Married filing separately — the MFS penalty
Bracket compression: Spouses who file separately and lived together at any point during the year face a severely compressed structure. Income above $109,000 jumps directly to the Tier 4 premium ($648.90/month) — skipping Tiers 1, 2, and 3. An MFS filer at $120,000 MAGI pays the same as an MFJ filer at $440,000. The per-person penalty vs. filing jointly can exceed $4,000/year.
| MAGI — married filing separately | Monthly Part B | Extra/year vs. standard | Extra vs. MFJ at same income |
|---|---|---|---|
| ≤ $109,000 | $202.90 | $0 | — |
| $109,001 – $391,000 | $648.90 | +$5,352/yr | +$974 to +$4,378/yr |
| > $391,000 | $689.90 | +$5,844/yr | +$492/yr |
Spouses who were separated or lived apart for the entire year are subject to standard single-filer brackets, not the MFS compressed brackets. The MFS penalty applies only when both spouses lived together at any time during the tax year.
Part D Surcharges
Part D base premium varies by plan (~$46.50/month avg in 2026). IRMAA surcharges are added on top and billed directly by Medicare — not by your plan. Part D uses the same income thresholds as Part B.
2026 Part D IRMAA surcharges
| Single filer | Married filing jointly | Monthly surcharge | Extra/year |
|---|---|---|---|
| ≤ $109,000 | ≤ $218,000 | $0 | — |
| $109,001 – $138,000 | $218,001 – $276,000 | +$14.50 | +$174 |
| $138,001 – $174,000 | $276,001 – $348,000 | +$37.40 | +$449 |
| $174,001 – $220,000 | $348,001 – $440,000 | +$60.30 | +$724 |
| $220,001 – $500,000 | $440,001 – $750,000 | +$83.20 | +$998 |
| > $500,000 | > $750,000 | +$91.00 | +$1,092 |
Combined Annual Cost (Part B + D)
Total annual IRMAA exposure per person and per couple (assumes both spouses enrolled in Medicare with both Part B and a Part D plan).
| Tier | Part B extra/yr | Part D extra/yr | Per person | Per couple* |
|---|---|---|---|---|
| Standard | $0 | $0 | $0 | $0 |
| Tier 1 | $974 | $174 | $1,148 | $2,296 |
| Tier 2 | $2,434 | $449 | $2,883 | $5,766 |
| Tier 3 | $3,893 | $724 | $4,617 | $9,234 |
| Tier 4 | $5,352 | $998 | $6,350 | $12,700 |
| Tier 5 | $5,844 | $1,092 | $6,936 | $13,872 |
*Couple assumes both spouses enrolled in Medicare with Part B + Part D.
2027 Projected Brackets
Why plan ahead? Because of the 2-year lookback, income decisions you make in 2025 determine your 2027 premiums. Roth conversions, capital gain timing, and RMD management in 2025 all need approximate 2027 thresholds as a planning target.
The 2027 brackets (based on 2025 income) will be finalized by CMS in Q4 2026, once average CPI-U data through August 2026 is available. The ranges below show two inflation scenarios. Tier 5 thresholds ($500K single / $750K MFJ) are frozen by statute until 2028.
2027 single filer projections
| Tier | 2026 confirmed | 2027 est. @ 0% inflation | 2027 est. @ 3% inflation |
|---|---|---|---|
| Standard ceiling | ≤ $109,000 | ≤ $109,000 | ≤ $112,000 |
| Tier 1 ceiling | $138,000 | ~$138,000 | ~$142,000 |
| Tier 2 ceiling | $174,000 | ~$174,000 | ~$179,000 |
| Tier 3 ceiling | $220,000 | ~$220,000 | ~$227,000 |
| Tier 4 ceiling | $500,000 | $500,000 (frozen) | $500,000 (frozen) |
2027 married filing jointly projections
| Tier | 2026 confirmed | 2027 est. @ 0% inflation | 2027 est. @ 3% inflation |
|---|---|---|---|
| Standard ceiling | ≤ $218,000 | ≤ $218,000 | ≤ $224,000 |
| Tier 1 ceiling | $276,000 | ~$276,000 | ~$284,000 |
| Tier 2 ceiling | $348,000 | ~$348,000 | ~$358,000 |
| Tier 3 ceiling | $440,000 | ~$440,000 | ~$453,000 |
| Tier 4 ceiling | $750,000 | $750,000 (frozen) | $750,000 (frozen) |
Projections apply the same CPI-U rounding methodology used by CMS (thresholds rounded up to the nearest $1,000). Actual 2027 brackets will be confirmed in Q4 2026. Surcharge dollar amounts (monthly premiums per tier) are not projected here — use 2026 surcharge amounts as a conservative planning floor.
IRMAA Reduction Strategies
Because IRMAA uses a 2-year lookback, income planning must start before age 63 to affect premiums at Medicare enrollment (age 65). Strategies that reduce MAGI in a given year reduce surcharges two years later.
| Strategy | How it reduces MAGI | Best timing |
|---|---|---|
| Roth conversions | Qualified Roth withdrawals don't count toward MAGI — converting now builds a tax-free pool that avoids future MAGI spikes from RMDs | Before age 63; low-income years |
| Capital gains timing | Spread large asset sales across years; harvest losses to offset realized gains near bracket cliffs | Near thresholds |
| QCDs (age 70½+) | Qualified Charitable Distributions satisfy RMDs up to $105,000/year without the distribution appearing in MAGI | Age 70½+ |
| Muni bond review | Tax-exempt interest is excluded from AGI but added back into MAGI for IRMAA — large muni positions may cost more than expected | Ongoing |
| HSA contributions | Contributions reduce MAGI dollar-for-dollar while still working with an HSA-eligible high-deductible health plan | Pre-Medicare enrollment |
| Deferred comp timing | Distributing deferred compensation or bonuses before Medicare enrollment avoids IRMAA on that income entirely | Before age 63 |
How to appeal IRMAA — Form SSA-44
If your income dropped due to a qualifying life-changing event, you can request that SSA use a more recent year's income instead of the 2-year lookback. File Form SSA-44 within 60 days of your IRMAA determination notice.
Qualifying life-changing events
Marriage, divorce or annulment, death of spouse, work stoppage or reduction, loss of income-producing property, loss of pension, employer settlement payment
What you'll need
Completed Form SSA-44, documentation of the life-changing event, estimate of current-year MAGI, supporting tax documents or pay stubs
Retirement counts as a "work stoppage" — the most common successful appeal. New retirees with high 2024 W-2 income who now live on a fixed pension can use Form SSA-44 to substitute estimated 2025 or 2026 income for the 2024 return.
Tax deductibility: IRMAA surcharges are Medicare premiums and may be deductible as medical expenses on Schedule A if total medical costs exceed 7.5% of AGI. They do not themselves reduce MAGI for future IRMAA calculations.
Model the impact: Use the Medicare IRMAA Calculator to enter income with and without a Roth conversion, QCD, or capital gain and see the exact tier difference and annual dollar savings.
This content is for educational and informational purposes only and does not constitute financial, tax, or legal advice. Consult a qualified professional for guidance tailored to your situation.