A 67-year-old retiree shops for Part D coverage during open enrollment and finds a $0-premium drug plan available in her ZIP code. It looks like an easy decision. Then January arrives, and her Social Security check is smaller than expected. Medicare deducted $60.40 a month for prescription drug coverage even though her plan charges no premium. The surprise is a separate Medicare surcharge that many beneficiaries do not realize exists until it appears on their benefit statement.
That surcharge is the Part D Income-Related Monthly Adjustment Amount, or IRMAA. It rides on top of whatever the drug plan charges, gets paid directly to Medicare (usually pulled from Social Security), and applies even when the plan’s own premium is zero. If your modified adjusted gross income from two years ago landed above the threshold, switching to a cheaper plan does not get rid of it.
Who this actually hits
Roughly 8% of Medicare beneficiaries with Part D coverage pay an IRMAA surcharge. If your 2024 modified adjusted gross income was $109,000 or less as a single filer, or $218,000 or less as a married couple filing jointly, your 2026 Part D IRMAA is $0 and the rest of this article does not apply to you. Above those thresholds, the surcharge applies separately to each Medicare beneficiary, remains in place for the entire year, and follows you regardless of which Part D plan you choose.
For IRMAA purposes, modified adjusted gross income means adjusted gross income from Form 1040, line 11, plus tax-exempt interest reported on line 2a. That second piece catches many retirees by surprise. Municipal bond interest may be exempt from federal income tax, but Medicare still counts it when determining IRMAA. As a result, some beneficiaries discover they crossed a surcharge threshold only after the deduction appears in their Social Security check.
The 2026 Part D IRMAA table
The Centers for Medicare & Medicaid Services published the 2026 surcharges on November 14, 2025. Every figure below is per person, per month, added to the plan premium.
| 2024 MAGI (single) | 2024 MAGI (joint) | 2026 Part D surcharge |
|---|---|---|
| ≤ $109,000 | ≤ $218,000 | $0.00 |
| $109,001 to $137,000 | $218,001 to $274,000 | $14.50 |
| $137,001 to $171,000 | $274,001 to $342,000 | $37.50 |
| $171,001 to $205,000 | $342,001 to $410,000 | $60.40 |
| $205,001 to under $500,000 | $410,001 to under $750,000 | $83.30 |
| ≥ $500,000 | ≥ $750,000 | $91.00 |
A married couple both on Medicare pays twice. At the top tier that is $91.00 each, or $182 a month, $2,184 a year in Part D IRMAA alone. Stack the matching $487.00 per person Part B surcharge on top and the household is paying close to $14,000 a year in Medicare income surcharges before a single drug or doctor visit.
The 2024 income that did this to you
The 2026 surcharge keys off your 2024 tax return. A Roth conversion you ran in 2024 to “clean up the IRA before RMDs” is the bill arriving now. Same for a 2024 home sale with a large capital gain, a 2024 severance check, or a 2024 inherited IRA distribution. The lookback is locked. You cannot reshape 2024 income from 2026.
What you can shape is 2025 and 2026 income, which drives 2027 and 2028 premiums. The 2.8% 2026 Social Security COLA raised gross benefits, but for high earners a chunk of that increase walks straight back out as a higher IRMAA deduction.
The survivor trap
When a spouse dies, the survivor files as a single taxpayer the following year. The single IRMAA brackets are much lower than the joint brackets, which means a surviving spouse can face Medicare surcharges even if household income falls after the death. Consider a couple with household MAGI of $200,000. While married, they remain below the first joint IRMAA threshold of $218,000 and pay no surcharge. After one spouse dies, the survivor may still have income near $150,000 from Social Security, pensions, dividends, and required minimum distributions. That income now falls well above the $137,000 single threshold, triggering both Part B and Part D IRMAA. The income declined, but the brackets shrank even faster.
What to do
- If your IRMAA was triggered by a qualifying life event, file Form SSA-44 with documentation: marriage, divorce, death of spouse, work stoppage, work reduction, loss of pension, loss of income-producing property, or an employer settlement. SSA-44 does not reverse a voluntary Roth conversion or a home sale, no matter how much they raised MAGI.
- Model 2025 and 2026 MAGI now against the brackets above, including tax-exempt interest. If you are within $5,000 of a tier line, a deferred capital gain or a Qualified Charitable Distribution (age 70½ and up) can keep you under it.
- Re-shop Part D anyway. The IRMAA is fixed for the year, but the plan premium and formulary are not. Auto-renewal locks you into last year’s pharmacy network and drug list. Run the Medicare.gov Plan Finder against your current prescription list every fall.
Figures reflect the 2026 plan year. Premiums, deductibles, coinsurance: CMS, “2026 Medicare Parts A & B Premiums and Deductibles,” November 14, 2025. IRMAA brackets and SSA-44: Social Security Administration.
Top Gaining Stocks
Top Losing Stocks