Medicare Part B premiums and IRMAA in 2026

By Tom, CPA · Updated October 25, 2026

TL;DR: The 2026 standard Part B premium is $202.90 a month with a $283 deductible. If your MAGI from 2024 was above $109,000 single or $218,000 joint, you pay IRMAA surcharges up to $689.90 a month for Part B, plus Part D surcharges.

Educational only, not tax, legal, or investment advice. Examples are illustrations, not predictions. Rules and limits change; verify current figures and talk to a qualified professional about your situation.

The surcharge that reads your tax return from two years ago. Medicare's Income-Related Monthly Adjustment Amount, IRMAA, is a premium surcharge for higher-income beneficiaries. It's set using your modified adjusted gross income from two years before, which means the Roth conversion you did at 63 shows up on your Medicare bill at 65. Conversions, big capital gains and the sale of a house can all trigger it.

About 8% of people with Part B pay IRMAA, according to CMS. Here are the 2026 figures and how to plan around them.

CPA Warning Label: IRMAA is a cliff, not a slope. One dollar over the line costs the whole next tier, per person, for a full year.

Standard premium and deductible

CMS set the 2026 standard monthly Part B premium at $202.90, up from $185.00 in 2025, and the annual Part B deductible at $283, up from $257. For Part A, the 2026 inpatient deductible is $1,736, and most people pay no Part A premium.

IRMAA brackets for 2026

From CMS's 2026 fact sheet, based on 2024 MAGI:

Married filing separately and lived with a spouse at any time during the year: $109,000 or less pays $202.90; above $109,000 and under $391,000 pays $649.20; $391,000 or more pays $689.90.

Part D has its own IRMAA surcharges on top of your plan premium, using the same income tiers. They're shown on CMS's fact sheet and on your Social Security notice.

The two-year lookback

Social Security uses the most recent tax return the IRS provides, usually from two years earlier. For 2026 premiums, that's 2024 MAGI. For IRMAA, MAGI is adjusted gross income plus tax-exempt interest.

That two-year delay is why IRMAA planning starts at 63. Income at 63 affects premiums at 65, income at 64 affects 66, and so on. Early retirees doing heavy conversions in their early 60s for ACA reasons need to stop thinking about the ACA cliff at 63 and start thinking about IRMAA tiers instead.

The cliff effect

Illustration: a married couple, both on Medicare, with 2024 MAGI of $218,500. They're $500 over the first threshold. Each pays $284.10 instead of $202.90, an extra $81.20 a month each. Over 12 months for two people that's $1,948.80, plus Part D surcharges, triggered by $500 of income. Had they harvested $1,000 less in gains or converted $1,000 less, they'd have avoided it entirely.

Each tier adds roughly $81 to $122 a month per person. Moving up a tier is usually tolerable if it buys a large conversion at a low tax rate; landing a few dollars over a line is just waste.

Planning moves

• Map thresholds into your conversion plan. Fill your bracket up to just under an IRMAA line, not past it.
• Qualified charitable distributions from IRAs after 70½ satisfy giving and RMDs without adding to AGI.
• Watch one-time events: home sales above the exclusion, business sales, large capital gain distributions from funds in taxable accounts.
• Bunch income. If a tier jump is unavoidable, it may be better to take a bigger hit in one year than a small one in several.
• Remember inflation adjustment. Thresholds are indexed, but you won't know the exact ones for your premium year when you earn the income. Leave a buffer.

Appealing with SSA-44

If your income dropped because of a life-changing event, you can ask Social Security to use a more recent year using Form SSA-44. Qualifying events include marriage, divorce, death of a spouse, work stoppage or reduction, loss of income-producing property, loss of pension income and certain employer settlement payments. Retirement itself counts as work stoppage, which is useful for people who retire at 65 with high wages two years earlier.

A Roth conversion or a big capital gain is not a life-changing event. You can also request a new determination if the IRS data was wrong or you amended your return.

Illustration: a conversion plan around the tiers

Illustration: Raj and Priya are 63 and 62 in 2026. They expect pensions, dividends and Social Security to give them about $120,000 of MAGI starting at 65. They also have $900,000 in traditional IRAs and want to convert some to Roth before required distributions start.

If they convert $90,000 in 2026, MAGI lands near $210,000, just under the $218,000 joint threshold (using 2026 thresholds as a rough guide, since 2028 thresholds will be indexed upward). If they convert $110,000, MAGI reaches $230,000, putting both of them in the second tier two years later, about $81 more per person per month, or about $1,950 for the year.

Is $20,000 of extra conversion worth $1,950 of surcharge? That's about a 9.7% extra cost on the marginal dollars, on top of the regular tax bracket. Sometimes yes, if their future bracket is much higher; often no. The point is to make the comparison, not to fear the tier. Before 65 they also need to weigh the ACA cliff, which is far steeper; see the ACA subsidy cliff.

What counts and what doesn't

• Counts: wages, pensions, traditional IRA and 401(k) distributions, Roth conversions, taxable Social Security, interest, dividends, capital gains, rental income, and tax-exempt municipal bond interest.
• Doesn't count: qualified Roth IRA withdrawals, HSA withdrawals for qualified medical expenses, qualified charitable distributions, return of basis, and loan proceeds.

That list explains why a Roth bucket is so useful after 65: you can fund a big expense from it without touching your IRMAA tier. Municipal bonds, by contrast, are tax-free for income tax but still count here, which surprises plenty of retirees.

Married couples and widowhood

IRMAA is charged per person, so a married couple in a surcharge tier pays it twice. When one spouse dies, the survivor often files single within a year or two while income falls less than expected, since many pensions and IRAs continue. Single thresholds are half the joint ones, so survivors can jump tiers. Death of a spouse is a life-changing event for SSA-44, which can help in the transition year, but long-term planning, such as Roth conversions while both are alive, is the more durable fix.

Part B premium and your Social Security check

If you collect Social Security, Part B premiums are usually deducted from your benefit. The 2026 COLA of 2.8% partly offsets the premium increase. For some low-benefit recipients, a "hold harmless" rule prevents the premium increase from reducing their net check, but it doesn't protect people paying IRMAA or those new to Medicare.

Related: Medicare enrollment timeline and IRMAA calculator.

A yearly IRMAA routine

1. Each fall, estimate this year's MAGI, including capital gain distributions that funds announce in November and December.
2. Compare it with the latest IRMAA thresholds, leaving a buffer of a few thousand dollars because future thresholds are not yet known.
3. Decide on conversions, gain harvesting or QCDs before December 31; after that, the number is locked.
4. When the IRMAA notice arrives in late fall, check it against your actual return two years back.
5. If a life-changing event applies, file SSA-44 promptly with documentation.

Twenty minutes a year keeps a surprise from running for twelve months.