Medicare Part D
How tax returns lift 2027 Medicare premiums in University City
UNIVERSITY CITY, Mo. — As Medicare's Annual Enrollment Period runs through Dec. 7, higher-income retirees here are getting a fresh look at how their tax returns can quietly raise their 2027 Part B and Part D premiums.
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Key takeaways
- Medicare's Annual Enrollment Period runs through Dec. 7, and this is a good time to check how your income affects your premiums.
- Your 2027 Medicare Part B and Part D premiums are based on your income from your 2025 tax return, so a higher income two years ago can mean a bigger bill in the new year.
- The extra income-based charge, called IRMAA, has several tiers, with the highest surcharge starting at income above roughly $500,000 for single filers and $750,000 for joint filers.
- Switching Medicare plans during enrollment won't remove an IRMAA surcharge, but filing form SSA-44 after a life-changing event like retirement or a spouse's death may lower or remove it.
What's changing this fall in University City
The extra charge is called IRMAA — the Income-Related Monthly Adjustment Amount. It isn't new, but the income brackets and the base premiums shift each year, and 2027 is no exception. If your income crossed a threshold two years ago, your Medicare bill in the new year may look different than a neighbor's, even if you're both on the same coverage.
Here's a plain-language guide to how it works, what is known about the 2027 thresholds, and what to do if your income has dropped.
How IRMAA actually works
Medicare uses your modified adjusted gross income (MAGI) from two years back to decide whether you owe a surcharge. For your 2027 premiums, that means Social Security looks at your 2025 tax return.
If your income is under the first threshold, you pay the standard Part B premium and no Part D surcharge. If it's above, you pay the standard amount plus an IRMAA add-on. The surcharge applies to both:
- Part B (doctor visits and outpatient care), and
- Part D (prescription drug coverage) — even if your drug plan comes bundled inside a Medicare Advantage plan.
The surcharge is billed by Medicare, not by your plan. For Part D, it comes as a separate charge on top of whatever premium your drug plan sets.
The 2026 income thresholds
For 2026, IRMAA begins when income (from your 2024 return) is above:
- $109,000 for someone filing as single, or
- $218,000 for a married couple filing jointly.
From there, the surcharge climbs through five tiers. The highest tier — the biggest add-on — kicks in at incomes above roughly $500,000 (single) and $750,000 (joint). Married people who file separately have their own, tighter thresholds and reach the top surcharge much sooner.
If you're just barely over a bracket, it can be worth talking to a tax advisor before year-end. A small change in taxable income today can matter for premiums two years from now.
What this looks like for University City residents
University City is in St. Louis County, where retirees choose between Original Medicare (Parts A and B, often paired with a standalone Part D drug plan and sometimes a Medigap policy) or a Medicare Advantage plan that bundles those pieces together.
IRMAA works the same way in either path. Whether you keep Original Medicare or enroll in an Advantage plan through your ZIP code in St. Louis County, the income surcharge is set by Social Security based on your federal tax return — not by any insurance company.
That's worth remembering during Annual Enrollment (Oct. 15 – Dec. 7). Switching plans won't get rid of an IRMAA surcharge; only a change in your income or a successful appeal will.
Other 2027 numbers worth knowing
Even if IRMAA doesn't apply to you, a few program-wide figures are set for 2027:
- Part D out-of-pocket cap: $2,100 in 2026 and $2,400 in 2027. Once your covered drug spending hits that amount, you pay nothing for covered prescriptions the rest of the year.
- Part D maximum deductible: $615 in 2026 and $700 in 2027. Plans can set a lower deductible, but not higher.
- The old "donut hole" is gone. As of 2025, Part D has three simpler phases instead of four.
- Medicare Prescription Payment Plan. This optional program lets you spread your yearly drug costs into smoother monthly payments, at no extra charge. You can opt in through your drug plan.
What to do if your income has dropped
If your 2024 income was high but your situation has changed — retirement, a spouse's death, divorce, loss of a pension, or the sale of a business — you can ask Social Security to recalculate your IRMAA.
The form is SSA-44, "Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event." You'll need documentation of the change. Approved requests can lower or remove the surcharge for the current year.
Don't ignore the IRMAA letter Social Security sends in the fall. It explains the amount, the income figure used, and how to appeal.
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 St. Louis County
(MA penetration in St. Louis 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
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 2026 surcharge is based on your 2024 tax return.
| 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 just retired this year. Why am I still paying an IRMAA surcharge?
Q: Does IRMAA apply if I have a Medicare Advantage plan?
Q: Do Roth conversions count toward the income Medicare looks at?
- CMS — Medicare costs & IRMAA (medicare.gov)
For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.