Medicare Part D

Earning Over $109K? How IRMAA Adds to Your 2026 Medicare Bill

OTTUMWA, Iowa — As Medicare's Annual Enrollment Period runs through Dec. 7, higher-income retirees in southeast Iowa are getting a fresh look at a rule that surprises many people the first time it hits: the income-related monthly adjustment amount, better known as IRMAA. For 2026, the extra charges kick in once a single filer's income tops $109,000 — or $218,000 for a married couple filing jointly.

If that sounds like a threshold worth knowing before you finalize your Part B and Part D choices this fall, you're right. Here's how IRMAA works, what triggers it, and where to get help in Wapello County.

What IRMAA actually is

IRMAA stands for Income-Related Monthly Adjustment Amount. It's not a separate program — it's an extra amount tacked onto your monthly Medicare Part B premium and your Part D drug plan premium if your income is above a set threshold.

Most people pay only the standard Part B premium. But roughly the top slice of Medicare enrollees — the folks with higher reported incomes — pay more. The Social Security Administration figures this out for you; there's no form to fill out to opt in.

The 2026 income thresholds

For 2026, IRMAA starts above these income levels, based on modified adjusted gross income (MAGI):

• Single filer: more than $109,000
• Married filing jointly: more than $218,000
• Married filing separately: a much lower cutoff applies

From there, the surcharge climbs through several tiers as income rises. The higher your income, the higher the add-on to both Part B and Part D. For the full 2026 bracket chart, Medicare.gov posts the exact tiers and dollar amounts each year on its "Costs" page.

Why 2024 income matters for 2026

Here's the part that catches people off guard: IRMAA in 2026 is based on your 2024 tax return. Social Security looks back two years because that's usually the most recent return the IRS has finalized.

That two-year lag matters a lot around retirement. If 2024 was your last big earning year — or the year you sold a house, cashed out stock, or converted a traditional IRA to a Roth — that income can push you into IRMAA territory in 2026, even if your income has since dropped.

What to do if your income has changed

If you've had a "life-changing event," you can ask Social Security to use more recent income instead. Qualifying events include:

• Retirement or reduced work hours
• Marriage, divorce, or the death of a spouse
• Loss of pension income
• Loss of income-producing property from a disaster

You'll file Form SSA-44 with proof of the change. If approved, Social Security recalculates your IRMAA using your current income. This is one of the most useful — and most overlooked — tools for recent retirees.

How this ties into your fall decisions

Ottumwa is in Wapello County, where Medicare beneficiaries choose during Annual Enrollment (Oct. 15 – Dec. 7) between Original Medicare with a stand-alone Part D plan, or a Medicare Advantage plan that usually includes drug coverage.

IRMAA applies either way. The Part B surcharge follows you regardless of which path you pick, and the Part D surcharge applies whether your drug coverage comes through a stand-alone plan or is bundled inside Medicare Advantage. So the choice between Original Medicare and Advantage doesn't change your IRMAA — but it does change how the rest of your costs are structured, including the new $2,100 Part D out-of-pocket cap for 2026 and the $615 maximum Part D deductible.

Where to get help in Ottumwa

For personalized answers, three free resources stand out:

• Medicare.gov for the official 2026 IRMAA brackets and enrollment tools.
• 1-800-MEDICARE (1-800-633-4227), available 24/7.
• Iowa SHIIP (Senior Health Insurance Information Program), the state's free, unbiased counseling service for Medicare beneficiaries. SHIIP counselors can walk you through an IRMAA appeal or help you compare coverage during AEP.