Medicare Part D

2027 Medicare IRMAA Brackets: Sacramento, CA

Sacramento, California — If your income has climbed in the last couple of years, your 2027 Medicare bill might come with a surprise line item. It's called IRMAA — the Income-Related Monthly Adjustment Amount — and it's the extra amount higher-income beneficiaries pay on top of their standard Part B and Part D premiums. With the fall Annual Enrollment Period running October 15 through December 7, this is the right moment to check whether you'll cross a bracket next year.

Here in Sacramento County, where retirees weigh Original Medicare, Medigap, and Medicare Advantage each fall, IRMAA is one of the most misunderstood parts of the program. Let's break it down.

What IRMAA actually is

IRMAA is not a separate bill from a private company. It's an adjustment set by the Social Security Administration and collected alongside your Medicare premiums. If your income is above a set threshold, you pay more each month for Part B (doctor visits and outpatient care) and Part D (prescription drugs). Everyone else pays the standard premium.

The important detail: IRMAA is based on your modified adjusted gross income (MAGI) from two years ago. So your 2027 surcharge is calculated from your 2025 tax return. That two-year lookback catches many people off guard, especially after a one-time income event like selling a home, taking a large IRA withdrawal, or cashing in stock.

The 2027 income thresholds

For 2026, IRMAA kicks in above $109,000 for a single filer and above $218,000 for a married couple filing jointly. From there, the surcharge steps up through several higher brackets, with the largest adjustments hitting single filers with income at or above $500,000 and joint filers at or above $750,000.

Both Part B and Part D have their own surcharge amounts at each bracket. If you owe IRMAA, you'll owe it on both parts — even if you get your drug coverage through a Medicare Advantage plan that includes Part D. For the exact dollar figures at each bracket, check the "Costs" section at medicare.gov, which is updated as CMS finalizes the year's numbers.

How you'll be notified — and how to appeal

Social Security mails an "initial determination" letter in late fall explaining your IRMAA for the coming year. Read it carefully. If you disagree with the amount, or if your income has dropped since 2025 because of a life-changing event, you can appeal.

Qualifying life-changing events include:

• Marriage, divorce, or the death of a spouse
• You or your spouse stopping work or reducing hours
• Loss of income-producing property (not due to a sale)
• Loss or reduction of a pension
• A settlement from a former employer

You'd file Form SSA-44 with documentation. If approved, Social Security recalculates your surcharge using more current income — which can make a real difference for someone who just retired.

Why this matters during Annual Enrollment

IRMAA itself doesn't change based on which plan you pick — it applies whether you choose Original Medicare with a standalone Part D plan, or a Medicare Advantage plan that includes drug coverage. But knowing your total 2027 cost picture is essential when comparing options during AEP (Oct. 15–Dec. 7) or the Medicare Advantage Open Enrollment Period (Jan. 1–March 31).

A few 2027 program-level facts worth pairing with your IRMAA number:

• The Part D out-of-pocket cap is $2,100 in 2026 and $2,400 in 2027 — once you hit it, you pay nothing for covered drugs the rest of the year.
• The Part D maximum deductible is $615 in 2026 ($700 in 2027).
• The coverage gap ("donut hole") is gone, replaced by a simpler three-phase drug benefit that started in 2025.
• The Medicare Prescription Payment Plan lets you spread drug costs across the calendar year in monthly installments — helpful if a big prescription bill hits in January.

Sacramento is in Sacramento County, where dozens of Medicare Advantage and standalone Part D plans are offered each year. IRMAA applies the same way across all of them.

Planning ahead: what you can control

You can't rewrite your 2025 tax return, but you can think ahead. Actions taken in 2026 will shape your 2028 IRMAA. Common planning moves people discuss with a tax professional include:

• Timing Roth conversions to avoid pushing over a bracket
• Spreading large capital gains across tax years
• Using qualified charitable distributions (QCDs) from IRAs to reduce MAGI
• Coordinating spousal income if one partner is still working

IRMAA is a "cliff" — crossing a threshold by even $1 moves you to the next surcharge tier. That's why it's worth a conversation with a CPA or fee-only financial planner before year-end.