Medicare 2026

IRMAA for 2027: How Your Income Can Raise Your Medicare Premiums

If you're on Medicare — or getting ready to be — you've probably heard that most people pay the same monthly amount for Part B, with an extra premium for Part D if they want drug coverage. What's less well known is that higher earners pay more. That extra charge is called IRMAA, short for the income-related monthly adjustment amount. Here's how it works, how it will apply in 2027, and what you can do if your income has changed.

What IRMAA actually is

Most people on Medicare pay a standard Part B premium each month, and if they enroll in a Part D drug plan, they pay a plan premium on top of that. IRMAA is an additional amount tacked onto both of those premiums for people whose income is above a certain level. It isn't a separate bill from a private company; Social Security withholds it, usually right from your benefit payment, and the extra Part D portion is collected the same way even though your drug plan comes from a private insurer.

How Social Security decides who pays it

Social Security uses your modified adjusted gross income — essentially your adjusted gross income plus a few add-backs like tax-exempt interest — to determine whether IRMAA applies. The catch is the two-year lookback: the IRMAA you pay in a given year is based on the tax return filed two years earlier. So your 2027 IRMAA will be calculated from your 2025 income. If you had a strong income year in 2025 because of a bonus, a big capital gain, a Roth conversion, or the sale of a home or business, that could push you above a threshold for 2027 even if your current income is lower.

What we know — and don't know — about 2027 numbers

Here's where we have to be careful. CMS, the agency that runs Medicare, usually announces the next year's Part B premium, Part B deductible, and IRMAA income brackets in the fall. As of now, the 2027 figures have not been released. We won't speculate or project them.

For context only, in 2026 the standard Part B premium is $202.90 a month, and IRMAA kicks in for individuals with income above $109,000 and married couples filing jointly above $218,000 (those thresholds are based on 2024 income). The 2027 numbers will almost certainly be different, and we'll know once CMS publishes them.

We do know a few 2027 Part D numbers because they've already been announced. The annual out-of-pocket cap on covered drugs rises to $2,400 in 2027 (it's $2,100 in 2026). The most any Part D plan can charge as a deductible in 2027 is $700. And the Part D base beneficiary premium — a national figure used mainly to calculate the late-enrollment penalty — is $41.33 for 2027. Actual plan premiums are set plan by plan and vary.

Also worth noting: the Social Security Administration announced a 3.6 percent cost-of-living adjustment for benefits payable starting January 2027.

If your income has dropped: Form SSA-44

IRMAA often surprises people who've just retired. You're living on a smaller income now, but Social Security is looking at a tax return from when you were still working. The good news is there's a formal way to ask for a do-over.

If you had a "life-changing event," you can file Form SSA-44 and ask Social Security to use a more recent tax year instead. Qualifying events include things like retirement or work stoppage, the death of a spouse, marriage or divorce, loss of a pension, or loss of income-producing property due to a disaster. You'll need documentation — a letter from your former employer, a death certificate, a divorce decree, or similar proof. If approved, your IRMAA is recalculated. If your income later rebounds, it will show up on a future tax return and your premium will adjust accordingly.

Enrollment windows to keep in mind

Annual Enrollment — sometimes called Medicare Open Enrollment — runs October 15 through December 7, 2026 for coverage that starts January 1, 2027. That's the main window for choosing or changing a Part D plan or a Medicare Advantage plan.

If you have Medicaid or qualify for the Extra Help program that lowers Part D costs, you have additional flexibility. Since 2025, you've had a monthly Special Enrollment Period to move from Medicare Advantage back to Original Medicare paired with a stand-alone Part D plan, or to switch stand-alone Part D plans. If you're a full-benefit dual-eligible — meaning you have both Medicare and full Medicaid — you can also join an integrated Dual Eligible Special Needs Plan (D-SNP) in any month.

Weighing your coverage choices

A lot of people ask whether they should stick with Original Medicare plus a Medigap policy and a stand-alone Part D plan, or go with a Medicare Advantage plan that bundles everything. There's no universal right answer. Original Medicare with Medigap tends to offer broad provider access and predictable out-of-pocket costs, but Medigap premiums are an added monthly expense. Medicare Advantage plans often include extras and may have lower premiums, but they typically use networks and require prior authorization for some services. The best fit depends on your doctors, your prescriptions, your travel habits, your budget, and your tolerance for paperwork — all things only you can weigh.

Where to go next

IRMAA rules and Medicare costs change every year, and the official source is always best for the numbers that affect your bill. For current figures, enrollment help, and the latest on 2027 amounts once they're published, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227), available 24 hours a day, seven days a week.