Higher-income Medicare beneficiaries pay more for Part B and Part D through IRMAA, the Income-Related Monthly Adjustment Amount. In 2026, Part B runs from the standard $202.90 a month up to $689.90 a month at the top income tier, per the Centers for Medicare & Medicaid Services, and a separate Part D surcharge of up to $91.00 a month is added on top of whatever your drug plan charges.
Revised: 7/24/26
Jason Baar
Fee-Only Medicare Advisor
NPN #2033715
This free printable PDF explains the Medicare surcharge in plain language for people seeing it for the first time, with the Part B and Part D tables in one place. No email address or form.
The long answer
“High income” starts lower than many people expect: modified adjusted gross income above $109,000 for a single filer or $218,000 for a couple filing jointly, measured from your tax return of two years earlier. Six tiers follow, and at the very top the combined surcharges add up to about $6,936 a year per person.
That per-person point matters for couples. IRMAA applies to each spouse on Medicare individually, so a couple whose joint income sits in a surcharge tier pays the added amount twice — once on each set of premiums.
What you get for the higher premium is unchanged: the same Part B and the same drug coverage as everyone else. That is why, in my fee-only practice, I treat IRMAA as a cost to be measured and managed with income timing — not a reason to change how you get your Medicare coverage.
For IRMAA, income means modified adjusted gross income, which is adjusted gross income plus tax-exempt interest. In 2026, IRMAA starts above $109,000 for a single filer and $218,000 for a married couple filing jointly. Later tier lines are $137,000, $171,000, $205,000 and $500,000 for single filers, and $274,000, $342,000, $410,000 and $750,000 for joint filers, according to the Social Security Administration. A person with higher income gets the same Medicare coverage as everyone else, but pays more for Part B and Part D.
Printed from JasonKnowsMedicare.com — “High-Income Medicare Premiums”. The free guide What Medicare Actually Costs at Higher Incomes is available at JasonKnowsMedicare.com/pages/free-medicare-guides · Questions: (850) 810-1000
You can find all 10 free Medicare guides as PDFs on the Free Medicare Guides page.
This page is educational information, not personal financial, tax, or legal advice. For decisions about your own situation, talk with a qualified professional.