Medicare Advantage

2027 Income Rules for Part B & Part D in San Antonio

Bexar County has 98 Medicare Advantage plans for 2027. Compared with 2026, 28 plans are not coming back, 26 are new, and 36 continuing plans changed in some way you should check before December 7, 11 of them under a new name. This guide covers what those numbers mean for San Antonio, not which plan to pick.

SAN ANTONIO — As Medicare's Annual Enrollment Period runs through Dec. 7, higher-income retirees across South Texas are getting a fresh look at how their tax returns can change what they pay for Part B and Part D in 2027. CMS typically publishes the 2027 Part B premium and the updated IRMAA income brackets later in the fall, and understanding where you land can help you plan ahead — especially if your income changed after retirement.

San Antonio retirees, take note: 2027 income limits are coming

San Antonio is in Bexar County, where thousands of people age into Medicare each year. While plan choices are set at the county level, the income rules we're covering here apply the same way nationwide.

What IRMAA is, in plain English

IRMAA stands for the Income-Related Monthly Adjustment Amount. It's an extra charge added to your Part B and Part D premiums if your income is above a certain level. Most people don't pay it — it only kicks in for higher earners.

Here's the key thing to know: Social Security looks at your tax return from two years ago to decide. So your 2027 IRMAA is based on your 2025 tax return.

For 2026, the surcharge starts when a single filer's modified adjusted gross income goes above $109,000. For married couples filing jointly, it starts above $218,000. The higher your income climbs above those lines, the higher the surcharge — there are several tiers.

How the extra charge shows up

If IRMAA applies to you, you'll get a letter from Social Security explaining the amount. The Part B surcharge is usually taken right out of your Social Security check. The Part D surcharge is separate from your drug plan's premium — you pay it to Medicare, not to your plan.

Some people are surprised by this in their first year of Medicare because a big one-time event two years earlier — selling a home, cashing out investments, or a Roth conversion — bumped up their income.

Life changes can lower what you owe

If your income has gone down since that tax return — because you retired, lost a spouse, got divorced, or had another qualifying life event — you can ask Social Security to reconsider. The form is called SSA-44, and it's free to file. Many people don't know this option exists.

You'll need documentation of the change. If Social Security agrees, they'll recalculate your surcharge using your more recent income.

What else is new for Part D in 2027

Even if IRMAA doesn't apply to you, Part D itself is changing in ways worth knowing:

• The out-of-pocket cap for prescription drugs is $2,100 in 2026 and $2,400 in 2027. Once your covered drug spending hits that amount, you pay nothing for covered drugs the rest of the year.
• The maximum Part D deductible is $615 for 2026 and $700 for 2027.
• The old "donut hole" coverage gap is gone as of 2025. Part D now has three phases instead of four.
• The Medicare Prescription Payment Plan lets you spread your drug costs across the calendar year in monthly bills instead of paying big amounts at the pharmacy counter. It's optional and free to join.

Dates San Antonio readers should circle

• Oct. 15 – Dec. 7: Annual Enrollment Period. This is when you can join, switch, or drop a Medicare Advantage or Part D plan for 2027.
• Jan. 1 – March 31: Medicare Advantage Open Enrollment. If you're already in a Medicare Advantage plan, you get one chance to switch to a different one or return to Original Medicare.