Medicare Part D

How IRMAA Adds to Medicare Premiums for Bellevue Residents

Bellevue, Neb. — As Medicare's Annual Enrollment Period runs through Dec. 7, many people in Sarpy County are getting letters from Social Security that mention something called IRMAA. If you've never heard the term, you're not alone — and if your income has changed in the last couple of years, it's worth understanding before your 2027 premiums kick in.

IRMAA stands for the Income-Related Monthly Adjustment Amount. It's an extra charge added to your Medicare Part B and Part D premiums if your income is above a certain level. Here's what Bellevue readers should know heading into 2027.

What IRMAA is — in plain language

Most people on Medicare pay the standard Part B premium and whatever their Part D drug plan charges. But if your income is higher than the cutoff, Medicare adds a surcharge on top of both. That surcharge is IRMAA.

A few things to keep in mind:

• IRMAA is set by the federal government, not by your plan or your insurance agent.
• It applies to Part B (doctor visits, outpatient care) and Part D (prescription drugs).
• It's billed by Medicare or taken out of your Social Security check — not paid to your plan.

The IRMAA income thresholds

For 2026, IRMAA starts when your modified adjusted gross income (MAGI) is above $109,000 for a single filer or $218,000 for a married couple filing jointly. If you're below those numbers, you'll pay the standard premium with no surcharge.

Above the first threshold, IRMAA is tiered — the higher your income, the higher the surcharge. There are five income brackets in total, and the top bracket kicks in at much higher earnings (roughly $500,000 for singles and $750,000 for joint filers, based on Medicare's tiered structure).

One important detail: Medicare looks back two years to decide your IRMAA. Your 2027 surcharge will be based on your 2025 tax return. So if you had a big one-time income event in 2025 — selling a house, cashing out an investment, taking a large IRA withdrawal — that could bump you into a higher bracket for 2027 even if your income has since dropped.

How you'll find out

The Social Security Administration mails an IRMAA determination letter, usually late in the year, telling you what you'll pay the following year and why. If you're new to Medicare, the letter comes after your first tax return with Medicare eligibility is on file.

Read that letter carefully. It tells you:

• Which income bracket you fell into
• What tax year they used
• How to appeal if the information is wrong or outdated

If your income has dropped, you can appeal

This is the part many people miss. If you had a "life-changing event" that reduced your income after the tax year Medicare used, you can ask for a reconsideration. Qualifying events include:

• Retirement or reduced work hours
• Loss of a spouse
• Divorce
• Loss of pension income
• A one-time event like a property sale that won't repeat

You file Form SSA-44 with Social Security and include documentation (like a letter from an employer showing your retirement date). If approved, your IRMAA can be adjusted or removed.

What else is changing on Part D in 2027

Even outside of IRMAA, Part D looks different in 2027:

• The out-of-pocket cap on covered drugs is $2,100 in 2026 ($2,400 in 2027). Once you hit that, you pay nothing more for covered prescriptions the rest of the year.
• The maximum Part D deductible is $615 in 2026 ($700 in 2027).
• The old "donut hole" coverage gap is gone — as of 2025, Part D has three phases instead of four.
• The Medicare Prescription Payment Plan lets you spread your drug costs across the year in monthly installments instead of paying big amounts at the pharmacy counter. It's optional and free to join.

These changes apply nationwide, including to everyone in Bellevue and the rest of Sarpy County.

What to do during Annual Enrollment

The Annual Enrollment Period runs Oct. 15 through Dec. 7. Sarpy County residents have a range of stand-alone Part D plans and Medicare Advantage plans with drug coverage to compare. IRMAA doesn't change which plans you're eligible for — it just changes what you pay on top.

If you're on Medicare Advantage and want to switch, the Medicare Advantage Open Enrollment Period runs Jan. 1 through March 31.