Medicare Part D
2026 IRMAA Brackets: Who Pays More for Medicare Next Year
ST. LOUIS — As Medicare's Annual Enrollment Period runs through Dec. 7, higher-earning retirees across St. Louis are getting a fresh look at something that often catches people off guard: the income-related monthly adjustment amount, better known as IRMAA. For 2026, the surcharge kicks in above $109,000 in income for a single filer, and it applies to both Part B and Part D premiums.
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Key takeaways
- For 2026, an extra Medicare charge called IRMAA starts once a single filer's income is above $109,000, or above $218,000 for a married couple filing jointly.
- IRMAA isn't a penalty; it's an added amount on top of the standard Part B and Part D premiums for higher-income beneficiaries, with the surcharge rising through additional brackets as income goes up.
- The Annual Enrollment Period runs Oct. 15 through Dec. 7, giving people a chance to check that their Part D or Medicare Advantage coverage still fits and to understand their full 2027 costs, including any IRMAA.
- Missouri's SHIP program, called CLAIM, offers free one-on-one counseling to help explain how IRMAA and other Medicare choices might affect your situation.
St. Louis retirees, here's what the 2027 IRMAA brackets mean for you
If your income has climbed — from a home sale, a Roth conversion, a strong investment year, or simply required minimum distributions — this is the season to understand how those numbers can follow you into your Medicare bill two years later.
What IRMAA actually is
IRMAA is not a penalty. It's an extra amount added to your standard Part B and Part D premiums when your income is above certain thresholds. Everyone on Medicare pays the base premium; higher-income beneficiaries pay that base plus a surcharge.
Two important things to know:
- It's based on a tax return from two years ago. Your 2027 IRMAA is generally based on your 2025 modified adjusted gross income (MAGI), which is the figure the IRS shared with the Social Security Administration.
- It applies separately to Part B and Part D. If you're above the threshold, you'll see a higher Part B premium from Social Security and a Part D adjustment billed directly by Medicare, even if your drug plan premium itself is modest.
The 2027 income thresholds
For 2026, the first IRMAA tier begins above $109,000 in MAGI for a single filer (and above $218,000 for a married couple filing jointly). From there, the surcharge steps up in additional brackets as income rises, all the way up to a top tier for the highest earners.
A few points St. Louis readers ask about often:
- The brackets are cliffs, not slopes. Going one dollar over a threshold moves you into the next tier for the whole year.
- Married filing separately has its own, much tighter set of rules.
- The thresholds are adjusted periodically for inflation. CMS publishes the 2027 brackets later in the fall, typically in November.
For the exact dollar amount of the surcharge in each tier, Medicare publishes the current chart at medicare.gov under "Part B costs" and "Part D costs."
How to decide what to do about it
You can't change your 2024 income now, but you can plan around what's coming. A few honest options to weigh:
- Check the letter. Social Security mails an IRMAA determination notice, usually late in the year. Read it carefully — it tells you which tax year it used and how to appeal.
- Appeal if you had a life-changing event. Retirement, the death of a spouse, divorce, loss of pension income, or a work stoppage can all qualify. You file Form SSA-44 with documentation. This is one of the most overlooked steps.
- Think ahead about income timing. If you're still working or managing withdrawals, talk with a tax professional about how Roth conversions, capital gains, and RMDs stack up against the next bracket cliff.
- Don't confuse IRMAA with your drug costs. The Part D program includes an annual out-of-pocket cap on covered prescriptions of $2,100 for 2026 and $2,400 in 2027, a maximum deductible of $615 for 2026 and $700 in 2027, and the option to spread drug costs monthly through the Medicare Prescription Payment Plan.
What this has to do with Open Enrollment
The Annual Enrollment Period (Oct. 15 – Dec. 7) is when you can review your Part D or Medicare Advantage coverage for 2027. IRMAA itself isn't something you "shop" — it's set by your income — but AEP is a good moment to make sure your drug coverage still fits your prescriptions and that you understand the full picture of what you'll pay in 2027: base premium, IRMAA (if it applies), deductible, and out-of-pocket exposure up to the annual cap.
If you're a Medicare Advantage member and want to switch after Jan. 1, the Medicare Advantage Open Enrollment Period runs Jan. 1 – March 31.
Local help in St. Louis
St. Louis is in St. Louis city, where Medicare plan availability — the number of Advantage and Part D plans offered — is set at the county level. For a personalized walk-through of your options and how IRMAA might affect your specific situation, Missouri's State Health Insurance Assistance Program (SHIP), called CLAIM in Missouri, offers free one-on-one counseling. It's a good first call before making changes.
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.
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 Part B figures later in the fall, usually 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: My income dropped a lot this year because I retired. Am I stuck paying the higher premium?
Q: Does IRMAA go away automatically when my income drops?
Q: I have a Medigap plan. Does IRMAA affect that?
- CMS — Medicare Part D program rules (medicare.gov)
For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.