Most retirees on Medicare pay $202.90 a month for Part B coverage in 2026. A smaller group pays $689.90. That gap of nearly $487 a month stems from IRMAA (Income-Related Monthly Adjustment Amount), a rule that catches many retirees off guard because of financial decisions made years earlier. About 8% of Part B enrollees pay an IRMAA surcharge, according to the Centers for Medicare & Medicaid Services, meaning the vast majority never see the added cost. For those who do, the impact can be substantial.
Your 2024 Tax Return Sets Your 2026 Premium
Medicare looks back two years. Your 2026 Part B premium is based on your 2024 Modified Adjusted Gross Income (MAGI). For single filers, the standard $202.90 premium applies only when 2024 MAGI was $109,000 or below. Cross that line by one dollar and the surcharge kicks in immediately.
A single filer at $109,001 pays $284.10 a month, an $81.20 jump triggered by one dollar of extra income. Over a year, that comes to $974 more in premiums. For a couple where both spouses are on Medicare, the same one-dollar overage costs $1,948 extra per year.
The 2026 tier structure for single filers:
- $109,000 or below: $202.90/month
- $109,001 to $137,000: $284.10/month
- $137,001 to $171,000: $405.80/month
- $171,001 to $205,000: $527.50/month
- $205,001 to $500,000: $649.20/month
- Above $500,000: $689.90/month
For married couples filing jointly, all income thresholds double. At the top tier, a beneficiary pays $8,278.80 a year for Part B alone, more than triple the standard amount.
Worth noting: IRMAA applies to Part D prescription drug coverage as well. In 2026, Part D surcharges range from $14.50 to $91.00 per month on top of a plan’s base premium, compounding the cost for retirees who cross an income threshold.
Three Income Events That Trigger Higher Tiers
What you don’t know can cost you. A large Roth conversion adds directly to MAGI in the year it happens, showing up in your Medicare premium two years later. Selling a home with gains above the $500,000 couples exclusion pushes the excess into MAGI. Required minimum distributions (RMDs), which retirees must take from traditional IRAs starting at age 73, can nudge income over a threshold without any change in spending.
The 2026 standard premium reflects a 9.7% increase from 2025, a jump of $17.90 per month that consumed a significant share of the 2.8% COLA applied to Social Security benefits this year. For the average retired worker receiving roughly $2,076 a month, that math leaves little cushion before IRMAA surcharges begin to sting. The Part B annual deductible also rose to $283 in 2026, up $26 from the prior year, adding another layer of out-of-pocket cost.
Appeal Your Surcharge If Your Income Dropped
The rules include meaningful exceptions. If income fell significantly due to retirement, the death of a spouse, or divorce, you can ask Social Security to use your current-year income instead of the two-year-old return. The form is SSA-44, and filing it can eliminate or reduce a surcharge that no longer reflects your actual finances.
The most common mistake is accepting the IRMAA determination without questioning it. Retirees who left high-paying jobs and are still being charged based on peak earning years have every reason to appeal. The savings can reach several thousand dollars a year. Separately, the “hold harmless” provision that protects most Social Security recipients from seeing their monthly check shrink does not apply to IRMAA payers, meaning those at higher income tiers absorb every dollar of premium increase.
Every situation differs. A strategy that keeps one retiree below the $109,000 threshold might not work for someone with a pension, rental income, or a large IRA. Small planning decisions made years before Medicare enrollment can show up as higher Part B premiums long after the original choice has been forgotten.
Editor’s note: This article corrects the 2026 Social Security COLA from 2.5% to 2.8%, the figure confirmed by the Social Security Administration, and adds context on Part D IRMAA surcharges ($14.50 to $91.00 per month), the 2026 Part B annual deductible of $283, and CMS data showing that roughly 8% of Part B enrollees pay an IRMAA surcharge.
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