Medicare Part D
IRMAA & Medicare Part B/D in Des Moines, IA 2027
Des Moines, Iowa — As Medicare's Annual Enrollment Period runs through Dec. 7, higher-income retirees across Polk County are getting a closer look at something that catches many people off guard: the income-related monthly adjustment amount, or IRMAA. It's the surcharge that can raise what you pay for Part B and Part D in 2027 — and it's based on the tax return you filed two years ago.
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Click to call 855-729-3240Key takeaways
- IRMAA is a surcharge added to Part B and Part D premiums for higher-income Medicare enrollees, based on the tax return filed two years earlier.
- For 2026, the surcharge starts above $109,000 in modified adjusted gross income for single filers, with roughly double that for married couples filing jointly, and higher tiers carry bigger surcharges.
- Part D changes for 2027 include a new $2,400 out-of-pocket cap and a maximum deductible of $700, though plans can set the deductible lower.
- If a life-changing event like retirement, divorce, or losing a spouse lowered your income, you can ask Social Security to reconsider your IRMAA using Form SSA-44, and the Annual Enrollment Period to make coverage changes ends Dec. 7.
Here's what to know before you finalize your coverage choices this fall.
What IRMAA is, in plain terms
IRMAA stands for "Income-Related Monthly Adjustment Amount." If your income is above a set threshold, Medicare adds a surcharge on top of the standard Part B premium and on top of whatever Part D premium your drug plan charges.
A few key points:
- The surcharge applies to both Part B and Part D if you cross the threshold.
- Social Security typically deducts the Part B surcharge from your monthly benefit. The Part D surcharge is billed separately, even if your plan premium is paid another way.
- IRMAA is recalculated every year based on new tax data, so it can go up, go down, or disappear entirely from one year to the next.
The 2027 IRMAA income thresholds
For 2026, IRMAA kicks in above $109,000 in modified adjusted gross income (MAGI) for a single filer. For married couples filing jointly, the first threshold is roughly double that.
Medicare uses your 2025 tax return (the most recent one on file with the IRS) to decide your 2027 surcharge. That's the piece a lot of people miss — a big income year two years back can still follow you into next year's premium. CMS publishes the 2027 IRMAA brackets later this fall, typically in November.
There are higher tiers above the first threshold, each with a larger surcharge. The top tier applies to the highest-income filers. Current-year figures for every tier are posted on Medicare.gov under "Costs."
Why this matters more in 2027
Two things are changing at the same time:
1. Part D has a new $2,400 out-of-pocket cap for 2027. Once your covered drug costs hit that limit, you pay nothing more for the rest of the year for covered drugs. 2. The Part D deductible max is $700 for 2027. Plans can set a lower deductible, but not higher.
Those are real improvements for people with expensive prescriptions. But if you're near an IRMAA threshold, the surcharge you pay on Part D could offset some of what the cap saves you. It's worth doing the math both ways.
You can also opt into the Medicare Prescription Payment Plan, which spreads your drug costs across the calendar year in monthly installments — helpful if a big pharmacy bill would land all at once in January or February.
How to decide what to do this fall
If you live in Des Moines and think IRMAA might affect you in 2027, here's a practical way to work through it:
1. Pull your 2024 tax return. Look at your MAGI — that's your adjusted gross income plus any tax-exempt interest. Compare it to the $109,000 single / roughly $218,000 joint starting point.
2. Ask whether a life-changing event applies. If your income dropped because you retired, lost a pension, got divorced, or lost a spouse, you can ask Social Security to reconsider using Form SSA-44. IRMAA doesn't have to be permanent when your situation genuinely changed.
3. Weigh Part D carefully. Des Moines is in Polk County, where a range of stand-alone Part D plans and Medicare Advantage plans with drug coverage are available. If you're paying an IRMAA surcharge on Part D, the plan you pick still matters — the surcharge sits on top of the plan's own premium.
4. Don't let AEP slip past. The Annual Enrollment Period ends Dec. 7. If you're already in Medicare Advantage, you also get a second window from Jan. 1 to March 31 to make one change.
Where to get personal answers
IRMAA questions get individual fast — the right answer depends on your tax return, your household, and any life changes. Free, unbiased help is available:
- Medicare.gov — official cost tables, plan finder, and IRMAA rules.
- 1-800-MEDICARE (1-800-633-4227) — 24/7.
- Iowa SHIIP (Senior Health Insurance Information Program) — free one-on-one counseling for Iowans, including Des Moines-area residents. Call 1-800-351-4664.
- Social Security — 1-800-772-1213 for IRMAA appeals and SSA-44.
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 Polk County
(MA penetration in Polk 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.
Higher-income surcharges
2027 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 brackets and surcharge 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
Find your 2026 Medicare premium
Most people pay the standard Part B premium. If your 2024 income was higher, an income-related surcharge (IRMAA) applies. Enter your details to see your bracket.
Surcharges are added to your premiums and based on your 2024 tax return. Married-filing-separately uses a different schedule. Confirm 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.
Good to know
Frequently asked questions
Q: I retired in 2025. Why is Medicare still looking at my 2024 income?
Q: Does IRMAA apply if I only have Part B and not Part D?
Q: If I hit the $2,100 Part D cap, does IRMAA go away?
- CMS — Medicare costs & IRMAA (medicare.gov)
For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.