Medicare Part D
2027 Medicare IRMAA: Sacramento Income Guide
SACRAMENTO — As Medicare's Annual Enrollment Period runs through Dec. 7, higher-earning residents across the capital region are getting a fresh look at something that catches many by surprise each year: the income-related monthly adjustment amount, better known as IRMAA. For 2027, CMS publishes the updated income thresholds later this fall, and it's worth knowing where you stand before you finalize any coverage choices.
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Click to call 855-729-3240Key takeaways
- Medicare's Annual Enrollment Period runs through Dec. 7, and higher earners should check the income-related monthly adjustment amount (IRMAA) before finalizing coverage.
- For 2026, IRMAA surcharges start when a single filer's income is above $109,000, or above $218,000 for married couples filing jointly, with the top tier hitting $500,000 or more for individuals ($750,000 or more for joint filers).
- IRMAA is based on tax returns from two years earlier, so a big income year in 2025, like selling property or cashing out stock, can affect surcharges in 2027 even if current income is lower.
- People who've had a life-changing event, such as retirement or loss of a spouse, can file Form SSA-44 with the Social Security Administration and provide documentation to request a reduction.
Sacramento retirees, take note: IRMAA thresholds shift for 2027
IRMAA isn't a penalty. It's an add-on premium that higher-income beneficiaries pay on top of the standard Part B and Part D premiums. But because it's based on a tax return from two years ago, it can arrive without warning — especially for people who recently retired, sold a home, or took a large Roth conversion.
What IRMAA is, in plain English
Most people on Medicare pay the standard Part B premium and whatever their Part D drug plan charges. If your income is above a certain level, Social Security tacks on an extra monthly amount for both Part B and Part D. That extra amount is IRMAA.
Two things to remember:
- It's based on your Modified Adjusted Gross Income (MAGI) from two years back. For 2027, Social Security looks at your 2025 tax return.
- It's tiered. The higher your income, the higher the surcharge — in five steps.
The 2026 income thresholds
For 2026, IRMAA surcharges kick in when a single filer's MAGI is above $109,000, or above $218,000 for a married couple filing jointly. Below those numbers, you pay only the standard premiums.
Above those thresholds, the surcharges climb in brackets, with the top tier reaching individuals earning $500,000 or more (or $750,000 or more for joint filers). The exact dollar amount added to your premium depends on which bracket you fall into. Medicare.gov posts the full 2026 bracket chart under "Costs."
Why 2025 income matters for your 2027 premium
This two-year lookback trips up a lot of newly retired Sacramentans. If 2025 was a big year — maybe you sold a rental in Land Park, cashed out stock, or drew heavily from an IRA — that income can push you into an IRMAA bracket in 2027, even if your income today is much lower.
The good news: if you've had a life-changing event (retirement, work stoppage, divorce, death of a spouse, loss of pension income, or certain others), you can file Form SSA-44 with the Social Security Administration to ask for a reduction. Bring documentation.
By the numbers
Medicare Part B premium, 2006–2026
The standard monthly Part B premium has climbed from $88.50 in 2006 to $202.90 in 2026. Hover any point for that year’s premium.
Source: CMS. Standard premium shown; in some hold-harmless years many existing enrollees paid less. Confirm at Medicare.gov.
By the numbers
How people get Medicare in Sacramento County
(MA penetration in Sacramento County)
MA penetration from CMS enrollment data; Medigap share is an estimate. U.S. average is about 54% Medicare Advantage. These are area-level figures, not plan-specific.
What's changing elsewhere in Medicare for 2027
IRMAA isn't the only thing to know before you sign anything this fall:
- The Part D out-of-pocket cap is $2,100 in 2026 and $2,400 in 2027. Once your covered drug spending hits that ceiling, you pay nothing for covered drugs the rest of the year.
- The Part D maximum deductible is $615 for 2026 and $700 for 2027.
- The old "donut hole" is gone. Part D now has three phases: deductible, initial coverage, and catastrophic.
- The Medicare Prescription Payment Plan lets you spread your drug costs across the calendar year in monthly installments instead of paying a big bill at the pharmacy counter. It's optional and free to opt into.
Sacramento-area coverage: where to look
Sacramento is in Sacramento County, where Medicare Advantage and standalone Part D plan availability is set at the county level by CMS. That means two neighbors on the same block generally see the same menu of plans, but a friend across the river in Yolo or Placer County may see a different list.
To see what's available in your ZIP code, use the Plan Finder at Medicare.gov. It pulls county-level data and lets you compare plans by your specific drug list and preferred pharmacies.
Key deadlines to circle
- Oct. 15 – Dec. 7: Medicare Annual Enrollment Period. Change Part D or Medicare Advantage; changes take effect Jan. 1.
- Jan. 1 – March 31: Medicare Advantage Open Enrollment. If you're already in a Medicare Advantage plan, you get one switch during this window.
Higher-income surcharges
2026 IRMAA income brackets
If your income is above a threshold, you pay an income-related surcharge (IRMAA) on top of your Part B and Part D premiums. Your 2027 surcharge is based on your 2025 tax return. CMS publishes the 2027 bracket amounts later this fall, typically in November.
| Income — single filer | Income — married, joint | Part B monthly premium | Part D surcharge |
|---|---|---|---|
| $109,000 or less | $218,000 or less | $202.90 | Plan premium only |
| $109,001 – $137,000 | $218,001 – $274,000 | $284.10 | + $14.50 |
| $137,001 – $171,000 | $274,001 – $342,000 | $405.80 | + $37.40 |
| $171,001 – $205,000 | $342,001 – $410,000 | $527.50 | + $60.40 |
| $205,001 – $500,000 | $410,001 – $750,000 | $649.30 | + $83.30 |
| Above $500,000 | Above $750,000 | $689.90 | + $91.00 |
Standard Part B premium is $202.90/month. Part D surcharges are added to your drug plan’s premium. Married-filing-separately uses a different, compressed schedule. Confirm current amounts at Medicare.gov.
Try it
How the 2026 Part D drug cap works
Slide to your estimated yearly prescription costs and see how the new $2,100 out-of-pocket cap protects you. This illustrates the standard Part D benefit; your plan may structure costs differently.
Once your out-of-pocket spending on covered drugs reaches $2,100, you pay nothing more for the rest of 2026. Confirm details at Medicare.gov.
Explore
When can you enroll? An interactive year
Enrollment windows are federal and the same nationwide. Confirm your personal dates at Medicare.gov or 1-800-MEDICARE.
Good to know
Frequently asked questions
Q: I just retired in 2026. Will Social Security still use my 2025 income for 2027 IRMAA?
Q: Does IRMAA apply if I only have Part B and no drug coverage?
Q: How will I know if I owe IRMAA in 2027?
- CMS — Medicare Part D program rules (medicare.gov)
For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.