In October 2025 the Centers for Medicare & Medicaid Services announced that the standard Medicare Part B premium for 2026 will be $185.00 a month. That is an increase of $10.30 from the 2025 rate of $174.70.
For the 88 percent of beneficiaries who pay the standard amount, the news is straightforward. For everyone else the real number depends on modified adjusted gross income reported on their 2024 tax return.
A couple filing jointly with income above $206,000 will pay as much as $594.00 a month each. These income-related monthly adjusted amounts, known as IRMAA, have become one of the largest unexpected costs in retirement planning.
How the Government Sets the Part B Premium
Each year the Medicare trustees calculate the expected cost of physician services, outpatient care, and preventive benefits. In 2026 the program will cover about 59 million people.
The standard premium is set to cover roughly 25 percent of total Part B spending. The remaining 75 percent comes from general tax revenue. The 2026 standard rate of $185 reflects higher projected use of cancer drugs, cardiology services, and the continued rollout of new weight-loss and Alzheimer treatments that Medicare now covers.
Congress passed the Inflation Reduction Act in 2022, which capped insulin at $35 a month for Part D and let Medicare negotiate drug prices starting in 2026. Those savings are already figured into the premium math.
IRMAA Brackets for 2026
The government uses your modified adjusted gross income from two years earlier. For 2026 premiums, 2024 tax returns set the bracket. Single filers with MAGI of $106,000 or less and joint filers with $212,000 or less pay the base $185.
The first surcharge tier begins at $106,001 single or $212,001 joint and adds $74.00 per month. The top tier for individuals above $500,000 or couples above $600,000 adds $419.00 per month on top of the base, bringing the total to $604 per person.
These five brackets affect about 8 percent of enrollees but account for a sizable share of Part B revenue. Once you are in an IRMAA bracket you stay there for one full year.
Real Dollar Impact on Retirees
A retired couple both age 68 with $240,000 joint income in 2024 will each pay $259 a month in 2026, or $6,216 together for the year. That is $2,088 more than the base rate.
A single retiree with a $450,000 pension distribution in 2024 will pay $483.50 monthly, adding almost $3,600 a year compared with the standard premium. These amounts come straight out of Social Security checks for those who receive them.
People who do not get Social Security are billed quarterly. Many retirees first discover the surcharge only after they file taxes and receive the letter from Social Security.
Strategies That Can Lower Future IRMAA
Roth conversions done before age 73 can move money into tax-free accounts and reduce reportable income later. Qualified charitable distributions from an IRA after age 70½ satisfy required minimum distributions without raising adjusted gross income.
Selling taxable investments in a low-income year can reset the cost basis before a future high-income year. Medicare allows a one-time reconsideration if you have a life-changing event such as marriage, divorce, death of a spouse, or loss of pension income.
The SSA Form SSA-44 must be filed with proof. Many tax advisors now run multi-year projections that include both Medicare surcharges and tax brackets.
Part D and Medigap Interaction
Part B premiums are separate from Part D drug plan costs, which averaged $55.50 a month in 2025 and are expected to stay near that level in 2026 because of the $2,000 out-of-pocket cap that began in 2025. Medigap policies that pay the Part B deductible and coinsurance do not cover the IRMAA surcharge.
Therefore a couple paying high IRMAA still faces the full extra cost even if they buy the most expensive Medigap plan F or G. Medicare Advantage plans usually include Part D and often advertise $0 premiums, but many shift costs to copays that can reach thousands of dollars for hospital or cancer care.
Historical Growth of the Surcharge
IRMAA was created by the Medicare Modernization Act of 2003 and first applied in 2007 to about 4 percent of beneficiaries. By 2025 roughly 8 percent paid extra. The income thresholds are no longer inflation-adjusted after the 2010 Affordable Care Act froze them until 2020 and then again until legislation in 2024 began modest adjustments.
As a result more middle-income retirees are pulled into higher brackets each year. Between 2015 and 2025 the top monthly surcharge rose from $335.70 to $594.00, an increase of 77 percent while the standard premium rose only 38 percent.
What to Do Before December 31
Open enrollment for 2026 runs from October 15 to December 7. During this window you can switch from original Medicare to Medicare Advantage or vice versa and change drug plans.
If your 2024 income was unusually high because of a one-time IRA conversion or home sale, gather documents now for a potential IRMAA appeal in early 2026. Review last year’s tax return and estimate 2025 income so you are not surprised in the fall of 2026 when 2027 premiums are set.
Income Brackets That Trigger Higher 2026 Premiums
| Filing Status | 2024 MAGI Range | Monthly Premium |
|---|---|---|
| Single | $0 - $106,000 | $185 |
| Single | $106,001 - $133,000 | $259 |
| Single | $133,001 - $167,000 | $370 |
| Single | $167,001 - $200,000 | $462 |
| Single | $200,001 - $500,000 | $544 |
| Single | Above $500,000 | $604 |
Medicare Part B costs are no longer a set-it-and-forget-it number. Because premiums are tied to income from two years earlier, thoughtful tax planning in your late 60s and early 70s can save thousands of dollars over a decade.
Sit down with last year’s tax return, map out your expected income for the next two years, and talk with a tax advisor who understands Medicare surcharges. A few hundred dollars spent on good advice can protect far more in lower monthly premiums for the rest of your retirement.
Sources
- Centers for Medicare & Medicaid Services, '2026 Medicare Parts A & B Premiums and Deductibles,' October 2025
- Social Security Administration, 'Medicare Income-Related Monthly Adjusted Amount,' 2025
- Medicare Payment Advisory Commission, 'Report to Congress on Medicare Payment Policy,' March 2025
- Kaiser Family Foundation, 'Medicare Part B Premiums and the Impact of IRMAA,' 2024
- Internal Revenue Service, 'Form SSA-44 Instructions,' 2025