Medicare costs and IRMAA: what you pay and how income changes it

Key points

• IRMAA is an income-related surcharge on the Part B and Part D premiums. In 2026 it starts above $109,000 of modified adjusted gross income (MAGI) on a single return and $218,000 on a joint return.
• It uses your tax return from two years earlier. 2026 premiums generally use 2024 income, so 2027 premiums will generally use 2025 income.
• Each bracket is a cliff: one dollar over a line moves you into the whole next tier, for a full year. In 2026 the Part B premium ranges from the standard $202.90 to $689.90 a month.
• If your income fell after a life-changing event, such as retirement or a spouse’s death, you can ask Social Security to lower IRMAA with Form SSA-44.
• The 2027 IRMAA brackets, Part B premium and Part A amounts had not been published when we last checked, on November 5, 2026. The 2027 drug coverage limits are out: a $700 maximum deductible and a $2,400 out-of-pocket cap.

Medicare costs more than most people expect, and for higher earners it costs a good deal more. On top of the standard premiums, about 8% of people with Part B pay an extra income-related monthly adjustment amount, known as IRMAA. For someone with both Part B and drug coverage in 2026, it adds anywhere from $1,148.40 to $6,936.00 a year.

This guide covers IRMAA in depth and every other Medicare cost briefly, with a link to our full guide on each. It covers federal rules only. We checked every figure against CMS, Medicare.gov, Social Security, IRS and statute sources on November 4, 2026, and checked them again on November 5, 2026. They are listed at the end.

What is IRMAA?

IRMAA stands for income-related monthly adjustment amount. The law requires people with higher incomes to pay more for Part B, which covers doctors and outpatient care, and for Medicare drug coverage (Part D).

The idea is a sliding share of the cost. For most people, the government pays about 75% of the cost of Part B and the person pays 25% through the standard premium. With IRMAA you pay 35%, 50%, 65%, 80% or 85% of the total cost, depending on your income.

Social Security, not Medicare, decides whether you owe it. It sends you a letter with your premium amounts and the reason. CMS says roughly 8% of people with Part B, and about 8% of people with Part D, pay IRMAA.

IRMAA applies separately to Part B and to drug coverage, and only to the one you have. Medicare says you also pay the drug coverage IRMAA if you are in a Medicare Advantage plan that includes drug coverage.

IRMAA brackets for 2026

These are the official 2026 amounts. Your bracket comes from your 2024 MAGI.

2024 MAGI, single return	2024 MAGI, joint return	Part B IRMAA	Total Part B premium	Part D IRMAA
$109,000 or less	$218,000 or less	$0	$202.90	$0
Above $109,000 up to $137,000	Above $218,000 up to $274,000	$81.20	$284.10	$14.50
Above $137,000 up to $171,000	Above $274,000 up to $342,000	$202.90	$405.80	$37.50
Above $171,000 up to $205,000	Above $342,000 up to $410,000	$324.60	$527.50	$60.40
Above $205,000 and less than $500,000	Above $410,000 and less than $750,000	$446.30	$649.20	$83.30
$500,000 or more	$750,000 or more	$487.00	$689.90	$91.00

Amounts are per person, per month. A married couple who both have Medicare each pay. The Part D IRMAA is added to whatever your drug plan charges.

Married filing separately. If you are married, lived with your spouse at any time in the year and file a separate return, the table is much steeper. Up to $109,000 you pay the standard $202.90. Above $109,000 and less than $391,000, Part B is $649.20 and Part D IRMAA is $83.30. At $391,000 or more, Part B is $689.90 and Part D IRMAA is $91.00.

Our IRMAA brackets guide covers the tables and what changes for 2027, and our Part B premium guide explains the standard premium and who pays less.

How Social Security works out your IRMAA

The income measure. IRMAA uses modified adjusted gross income (MAGI). For this purpose, MAGI is your adjusted gross income (line 11 of the 2024 Form 1040, line 11a on the 2025 form) plus tax-exempt interest (line 2a). Tax-exempt interest therefore counts toward IRMAA even though it is not taxed.

The year. Social Security uses the most recent federal tax return the IRS gives it. For 2026 that is generally your 2024 return, filed in 2025. Sometimes the IRS only has the 2023 return. If Social Security used 2023 and you have filed a 2024 return, or did not need to file one, call or visit Social Security and it will update its records.

Amended returns. If you amend a return and it changes your MAGI, tell Social Security. It needs a copy of the amended return and your acknowledgment receipt from the IRS, and it will correct or remove your IRMAA as appropriate.

The thresholds move with inflation. By law, the single and joint bracket lines rise each year with consumer prices (the CPI for all urban consumers, 12 months ending in August of the year before) and are rounded to the nearest $1,000. The top line is the exception: $500,000 on a single return, and $750,000 on a joint return, which the law sets at 150% of the single amount. It is not adjusted until years after 2027. The married-filing-separately top line works the other way: it is $500,000 minus the first single line ($500,000 minus $109,000 is $391,000 for 2026), so it falls when that line rises.

Each IRMAA bracket is a cliff

The brackets do not phase in. Each line is “less than or equal to” a dollar amount, so $1 over the line puts you in the whole next tier, for Part B and Part D, for every month of the year.

All people and incomes in these examples are hypothetical. They use the official 2026 amounts.

Example (2024 MAGI)	IRMAA a month	IRMAA a year
Single, $109,001 instead of $109,000	$81.20 + $14.50 = $95.70	$1,148.40
Single, $150,000	$202.90 + $37.50 = $240.40	$2,884.80
Married filing jointly, $300,000, both on Part B and Part D	$240.40 each, $480.80 together	$5,769.60
Single, $500,000 or more	$487.00 + $91.00 = $578.00	$6,936.00

The couple at $300,000 pays $811.60 a month in Part B premiums between them, before any drug plan. The top-bracket single person pays $689.90 a month for Part B alone, or $8,278.80 for the year.

Because the year that counts is two years back, income spikes matter. A large one-off item in one year can raise your premiums for one year two years later, then drop back. Our guide on how to avoid IRMAA explains the income rules around the lines and their trade-offs, and our RMD guide explains how required withdrawals from retirement accounts add to income later in retirement.

How IRMAA is paid

Part B IRMAA is part of a higher Part B premium. If you get Social Security, it comes out of your monthly payment with the rest of the Part B premium.

Part D IRMAA is paid to the government, not your plan. Social Security ties it to the national base beneficiary premium, not your plan’s price, and deducts it from your Social Security payment whatever way you pay your plan. If your payment is too small to cover it, or you do not get payments yet, you get a separate bill from CMS or the Railroad Retirement Board.

No hold-harmless protection. A rule called “hold harmless” normally stops a Part B premium increase from shrinking your Social Security payment. People who pay IRMAA are not protected by it.

Our guide to Medicare deducted from Social Security explains the deductions and the hold-harmless rule in full.

How to lower or challenge IRMAA

There are three routes, and they are different.

1. A life-changing event. If your income has gone down because of one of these events, Social Security can make a new decision using a more recent year:

• You married, divorced, or your spouse died.
• You or your spouse stopped working or cut back your hours.
• You or your spouse lost income-producing property because of a disaster or other event beyond your control.
• You or your spouse lost pension income because an employer’s pension plan had a scheduled end, was terminated or was reorganized.
• You or your spouse received a settlement from an employer because of its closure, bankruptcy or reorganization.

You ask with Form SSA-44 and send documents that show the event and the drop in income. For stopping or cutting back work, the form asks for an original signed statement from your employer or copies of pay stubs. Our SSA-44 guide walks through the form.

2. Wrong or outdated information. If Social Security used an old tax year or you amended your return, give it the newer information. If you think the income figure the IRS sent is wrong, you must correct it with the IRS.

3. An appeal. If you disagree with the decision itself, you have the right to appeal, online or in writing with a Request for Reconsideration (Form SSA-561-U2). You do not need an appeal to report a life-changing event. Social Security is at 1-800-772-1213.

IRMAA in 2027: what we know

When we last checked, on November 5, 2026, CMS had not published the 2027 IRMAA brackets, the 2027 Part B premium or the 2027 Part A amounts. CMS released the 2026 amounts on November 14, 2025. Social Security said each person’s 2027 premium would appear in their online Social Security account message center starting in late November.

What is already settled:

• 2027 IRMAA will generally use your 2025 tax return.
• The single and joint bracket lines will rise with inflation under the formula above, except the $500,000 and $750,000 top lines, which stay fixed until after 2027. The $391,000 married-filing-separately line will fall by as much as the first single line rises.
• Social Security benefits rise 3.6% in January 2027.
• The Part D numbers for 2027 are official. The base beneficiary premium, which the Part D penalty and Part D IRMAA are tied to, is $41.33.

We will update this guide when the 2027 tables are published.

Every other Medicare cost, in brief

Here is the rest of the bill. All figures are official 2026 amounts unless marked 2027. Our guide to how much Medicare costs works through a full year, with a hospital stay.

Part A (hospital). About 99% of people pay no Part A premium. If you must buy it, it costs $311 or $565 a month. The hospital deductible is $1,736 for each benefit period. Days 61 to 90 cost $434 a day, and days 21 to 100 in a skilled nursing facility cost $217 a day.

Part B (medical). The standard premium is $202.90 a month, or $2,434.80 a year, up from $185.00 in 2025. The deductible is $283. After that you usually pay 20% of each bill, and Original Medicare has no yearly cap on what you pay.

Part D (drugs). Each plan sets its own premium. CMS projects the average stand-alone plan at $36 a month in 2027. In 2027 no plan may have a deductible above $700, you pay 25% after it, and your out-of-pocket costs for covered drugs stop at $2,400 for the year. Our Part D cost guide works through the stages month by month.

Medicare Advantage or Medigap. Medicare Advantage plans come from private companies approved by Medicare as an alternative to Original Medicare. Costs vary by plan, each plan has a yearly out-of-pocket limit, and you keep paying Part B. CMS projects the average Medicare Advantage premium at $12.00 a month in 2027. Medigap policies sit on top of Original Medicare and help pay costs like the 20% coinsurance. The federal Medigap Open Enrollment Period is the 6 months starting the first day of the month you are 65 or older and signed up for Part B; after it, a policy may be harder to buy and cost more. Our guide to Medigap vs Medicare Advantage sets out the trade-offs. We do not recommend plans or companies.

Long-term care. Medicare does not pay for long-term care, also called custodial care, such as help with dressing, bathing and using the bathroom. Medicaid can, under state rules that vary. See our guides to whether Medicare covers long-term care and Medicaid spend-down.

Signing up on time, and the penalties

Late enrollment can add a penalty for as long as you have Medicare, on top of any IRMAA.

• Initial Enrollment Period. Generally the 7 months that start 3 months before the month you turn 65 and end 3 months after it. Our guide to when to apply for Medicare has the details.
• Still working. If you have health coverage from your own or your spouse’s current job, you can usually delay Part B. Your 8-month Special Enrollment Period runs from when you or your spouse stop working or the job-based coverage ends, whichever happens first, even if you choose COBRA. See our guides to employer insurance and Medicare and COBRA and Medicare.
• Missed it. You may have to wait for the General Enrollment Period, January 1 to March 31, with coverage starting the month after you sign up.
• Part B penalty. 10% of the standard premium for each full 12-month period you could have had Part B but did not, for as long as you have Part B.
• Part D penalty. 1% of the national base beneficiary premium for each full month you were eligible but went without Medicare drug coverage or other creditable drug coverage, rounded to the nearest $0.10. For example, in 2027 a penalty for 14 uncovered months is 14% of $41.33, which is $5.79, rounded to $5.80 a month. You generally pay it for as long as you have Medicare drug coverage.

Our late enrollment penalty guide covers the penalties in full. Once you are in, Open Enrollment each year, October 15 to December 7, is when you can change plans for January 1; see our Medicare Open Enrollment guide.

Help paying Medicare costs

• Medicare Savings Programs are run by states and help pay Medicare premiums, deductibles and coinsurance for people with limited income and resources.
• Extra Help lowers drug costs. For 2027 Medicare lists a $0 plan premium, a $0 deductible, and up to $5.80 for each generic drug and $14.40 for each brand-name drug at your plan’s pharmacies. The $0 premium applies to plans priced at or below a benchmark amount CMS sets for your region; in a more expensive plan you pay the difference.
• Free counseling comes from your State Health Insurance Assistance Program (SHIP), which helps you choose a plan, understand costs and apply for Extra Help. Medicare is at 1-800-MEDICARE (1-800-633-4227).

Medicare, your Social Security and your HSA

Your Social Security check. Most people have the Part B premium, and any IRMAA, deducted from their Social Security payment. Drug plan premiums come out only if you ask your plan.

Your HSA. You cannot contribute to a health savings account from the first month you are enrolled in Medicare, and premium-free Part A can be backdated up to 6 months, but not before the first month you were eligible for Medicare. Our guide to HSAs and Medicare explains when to stop contributing.

Your taxes. Part B and Part D premiums, including any IRMAA, count as medical expenses if you itemize, but only medical costs above 7.5% of your adjusted gross income are deductible.

About this guide

Written by the Diversify Guy editorial desk. Diversify Guy is a pen name. It is the byline of our editorial team, not a single individual. We do not publish personal trading records or claim to be your adviser. We tell you where every figure came from so you can check it yourself. How we work and how we get paid.

This guide explains federal Medicare rules as published by CMS, Medicare.gov and Social Security. It is general information, not insurance, tax or legal advice for your situation. Plan premiums and benefits vary, and some states add their own rules.

Diversify Guy earns affiliate commissions and advertising fees from companies featured elsewhere on the site. This page carries no ads and no affiliate links.

Sources and check dates

All sources were fetched and checked on November 4, 2026, and checked again on November 5, 2026.

• CMS fact sheet, 2026 Medicare Parts A and B Premiums and Deductibles; 2026 Medicare Part D Income-Related Monthly Adjustment Amounts (November 14, 2025): https://www.cms.gov/newsroom/fact-sheets/2026-medicare-parts-b-premiums-deductibles
• CMS, address checked for a 2027 version of that fact sheet (page not found on November 4 and November 5, 2026): https://www.cms.gov/newsroom/fact-sheets/2027-medicare-parts-b-premiums-deductibles
• CMS, Announcement of Calendar Year 2027 Medicare Advantage Capitation Rates and Part C and Part D Payment Policies (April 6, 2026): https://www.cms.gov/files/document/2027-announcement.pdf
• CMS fact sheet, Medicare Part D 2027 National Average Monthly Bid Amount Information (July 28, 2026): https://www.cms.gov/newsroom/fact-sheets/medicare-part-d-2027-national-average-monthly-bid-amount-information
• CMS press release, Medicare Advantage and Medicare Prescription Drug Programs Expected to Remain Stable in 2027 (September 28, 2026): https://www.cms.gov/newsroom/press-releases/medicare-advantage-medicare-prescription-drug-programs-expected-remain-stable-2027
• SSA, Medicare Premiums: Rules for Higher-Income Beneficiaries: https://www.ssa.gov/benefits/medicare/medicare-premiums.html
• SSA, Form SSA-44, Medicare Income-Related Monthly Adjustment Amount, Life-Changing Event: https://www.ssa.gov/forms/ssa-44.pdf
• SSA Program Operations Manual System, HI 01101.010 (MAGI): https://secure.ssa.gov/poms.nsf/lnx/0601101010, HI 01101.020 (IRMAA tables): https://secure.ssa.gov/poms.nsf/lnx/0601101020 and HI 01001.004 (hold harmless): https://secure.ssa.gov/poms.nsf/lnx/0601001004
• Social Security Act section 1839, including (i) on income-related premiums: https://www.ssa.gov/OP_Home/ssact/title18/1839.htm
• SSA press release, Social Security Announces 3.6 Percent Benefit Increase for 2027 (October 14, 2026): https://www.ssa.gov/news/en/press/releases/2026-10-14.html
• Medicare.gov, Medicare costs: https://www.medicare.gov/basics/costs/medicare-costs
• Medicare.gov, “How much does Medicare drug coverage cost?”: https://www.medicare.gov/health-drug-plans/part-d/basics/costs
• Medicare.gov, “When can I sign up for Medicare?”: https://www.medicare.gov/basics/get-started-with-medicare/sign-up/when-can-i-sign-up-for-medicare
• Medicare.gov, Open Enrollment: https://www.medicare.gov/health-drug-plans/open-enrollment and “When can I buy Medigap?”: https://www.medicare.gov/health-drug-plans/medigap/ready-to-buy/when
• Medicare.gov, Long-term care: https://www.medicare.gov/coverage/long-term-care
• Medicare.gov, How to pay premiums: https://www.medicare.gov/basics/costs/pay-premiums, Extra Help: https://www.medicare.gov/basics/costs/help/drug-costs and Talk to someone: https://www.medicare.gov/talk-to-someone
• Medicare & You 2027, the official Medicare handbook: https://www.medicare.gov/publications/10050-medicare-and-you.pdf
• 42 CFR 408.22, increased premiums for late enrollment: https://www.ecfr.gov/current/title-42/section-408.22
• SSA Program Operations Manual System, HI 03001.005 (Extra Help premium subsidy and regional benchmark): https://secure.ssa.gov/poms.nsf/lnx/0603001005 and CMS partner tip sheet 11221, Reassignment to a new Medicare drug plan (July 2026): https://www.cms.gov/outreach-and-education/outreach/partnerships/downloads/11221-p.pdf
• IRS Form 1040 (2025): https://www.irs.gov/pub/irs-pdf/f1040.pdf
• IRS Publication 969 (2025), Health Savings Accounts: https://www.irs.gov/pub/irs-pdf/p969.pdf and Publication 502 (2025), Medical and Dental Expenses: https://www.irs.gov/pub/irs-pdf/p502.pdf