Medicare is partially means-tested: premiums for Part B and Part D rise with income, while eligibility and the benefits themselves do not change no matter what you earn or own. The mechanism is IRMAA — the Income-Related Monthly Adjustment Amount — which adds surcharges of $95.70 to $578.00 a month once modified adjusted gross income passes $109,000 for single filers or $218,000 for joint filers, per the Social Security Administration.
Revised: 7/24/26
Jason Baar
Fee-Only Medicare Advisor
NPN #2033715
It shows where Medicare’s five income lines sit in 2026, what counts toward them, and the timing moves that can keep you under.
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The long answer
It is an income test, not an asset test. The size of your savings, portfolio, or home never enters the calculation — only modified adjusted gross income, meaning adjusted gross income plus tax-exempt interest, taken from your federal return of two years earlier.
The means testing touches a minority: roughly 8% of people on Medicare pay an IRMAA surcharge, per the Centers for Medicare & Medicaid Services. Part A, hospital insurance, is untouched by income — it remains premium-free for most people at every income level.
The practical consequence of income-based rather than asset-based testing is control. Retirees decide, to a meaningful degree, what their measured income is each year — which account a withdrawal comes from, when a gain is realized, whether a conversion happens now or later. That is why the same portfolio can produce very different Medicare premiums depending on how it is drawn down.
Printed from JasonKnowsMedicare.com — “Medicare Means Testing: How Income Sets Your Premiums”. The free IRMAA Planning Guide is available at tally.so/r/81gEEA · Questions: (850) 810-1000
This page is educational information, not personal financial, tax, or legal advice. For decisions about your own situation, talk with a qualified professional.