IRMAA starts in 2026 once modified adjusted gross income is above $109,000 for a single filer or $218,000 for a couple filing jointly.
Those thresholds are measured on your 2024 tax return, because Medicare always looks two years back. One dollar over a line moves you into the whole next bracket, and the surcharge applies to Part B and Part D separately.
| Single filer | Joint filers | Total Part B | Part D add-on |
|---|---|---|---|
| Up to $109,000 | Up to $218,000 | $202.90 | $0.00 |
| $109,001 – $137,000 | $218,001 – $274,000 | $284.10 | $14.50 |
| $137,001 – $171,000 | $274,001 – $342,000 | $405.80 | $37.50 |
| $171,001 – $205,000 | $342,001 – $410,000 | $527.50 | $60.40 |
| $205,001 – $499,999 | $410,001 – $749,999 | $649.20 | $83.30 |
| $500,000 or more | $750,000 or more | $689.90 | $91.00 |
Source: CMS, published 14 November 2025
What CountsWhat counts as income for IRMAA
Modified adjusted gross income is your adjusted gross income plus any tax-exempt interest. That takes in wages, taxable Social Security, pension and IRA withdrawals, capital gains, dividends and rental income — and municipal bond interest, even though it is not taxed. It is the single figure that decides your bracket.
The CostWhat a bracket costs you
Crossing the first line as a single filer adds $81.20 a month to Part B and $14.50 to Part D — about $1,150 over a year for one dollar of income. At the top the total Part B premium is $689.90 a month against a standard $202.90. That is why a one-off capital gain or a large retirement account distribution is worth timing carefully.
Next StepsWhat to do if your income has dropped
The two-year lookback catches people who retire at 65 and get a bill based on their last full working year. That is appealable. File form SSA-44 with Social Security naming the life-changing event — work stoppage or reduction, marriage, divorce, death of a spouse, loss of a pension or of income-producing property — and provide evidence of your newer, lower income.
More QuestionsPeople also ask
Is IRMAA based on this year’s income?
No. Your 2026 bracket comes from your 2024 tax return. Medicare looks two years back because that is the most recent return the IRS has settled.
Does IRMAA apply if I have Medicare Advantage?
Yes. You still pay the Part B premium and its surcharge, and the Part D surcharge is added if your plan includes drug coverage.
How is the surcharge collected?
The Part B surcharge comes out of your Social Security benefit with the premium. The Part D surcharge is billed separately, not by your drug plan.
This page explains officially published figures. It is not an insurance quote and not an eligibility determination. Only HealthCare.gov, Medicare.gov, Social Security or the carrier can determine your eligibility and your actual price.
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