Medicare Part D
Pahrump IRMAA: Part B & Part D Income Surcharges
PAHRUMP, Nev. — As Medicare's fall Annual Enrollment Period runs through Dec. 7, higher-income retirees in Nye County are getting a fresh look at something that catches many people off guard: the income-related surcharges that can raise Part B and Part D premiums.
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Key takeaways
- Medicare's fall Annual Enrollment Period runs through Dec. 7, and it's a good time to check if income-related surcharges called IRMAA apply to you.
- For 2026, IRMAA is based on your 2024 income (MAGI) and starts if you're a single filer above $109,000 or a married couple filing jointly above $218,000, with higher tiers up to $500,000 (single) or $750,000 (joint).
- IRMAA adds an extra monthly amount to both Part B and Part D premiums, even if your drug coverage comes through a Medicare Advantage plan.
- If a life-changing event like retirement, a spouse's death, divorce, or lost pension income has lowered your income since 2024, you can file form SSA-44 with Social Security to ask for a recalculation.
The surcharge is called IRMAA — the Income-Related Monthly Adjustment Amount. It's not a penalty or a punishment. It's simply an add-on that certain higher earners pay on top of the standard Medicare premiums. The 2027 income thresholds have not yet been released; CMS typically publishes them later in the fall, usually in November. Knowing where you land can save you a surprise on your Social Security statement.
What IRMAA is, in plain English
Most people on Medicare pay the standard Part B premium and whatever their Part D drug plan charges. But if your income is above a certain level, Medicare adds an extra monthly amount to both Part B and Part D. That extra amount is IRMAA.
Social Security looks at your tax return from two years ago to decide. So your 2027 premiums will be based on your 2025 income — specifically, your Modified Adjusted Gross Income (MAGI), which is your adjusted gross income plus any tax-exempt interest.
The IRMAA income thresholds
For 2026, IRMAA kicks in when a single filer's MAGI is above $109,000, or above $218,000 for a married couple filing jointly. Below those numbers, you pay the standard premiums with no add-on.
Above those thresholds, IRMAA is tiered. The higher your income, the higher the surcharge — and the top tier applies to single filers with income at or above $500,000 (or $750,000 for joint filers). The surcharge applies to both Part B and Part D, even if you get your drug coverage through a Medicare Advantage plan.
You can see the current brackets and dollar amounts on Medicare.gov under "Costs."
Why this matters in Pahrump right now
Pahrump sits in Nye County, where many residents are retirees living on a mix of Social Security, pensions, IRA withdrawals, and investment income. A one-time event in 2025 — selling a home, converting a traditional IRA to a Roth, taking a large Required Minimum Distribution, or cashing out an investment — could push you over an IRMAA threshold for 2027, even if your normal income is well below it.
That's a common surprise. People who feel "middle income" can still trigger IRMAA in a year with an unusual bump.
What to do if your income has dropped
IRMAA is based on a two-year-old return, so it doesn't always reflect your current reality. If you've had a life-changing event — retirement, the death of a spouse, divorce, loss of pension income, or a work stoppage — you can ask Social Security to recalculate.
The form is SSA-44, "Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event." You submit it with documentation to your local Social Security office. If approved, they'll use your more recent income instead.
This is one of the most under-used tools in Medicare. If your 2025 income was high but your 2026 income is much lower, it's worth the paperwork.
Other program numbers worth knowing
While you're reviewing your coverage this fall, a few other program-level figures apply to everyone on Medicare:
- The Part D out-of-pocket cap is $2,100 in 2026 and $2,400 in 2027. Once your out-of-pocket drug spending hits that amount, you pay nothing more for covered drugs the rest of the year.
- The Part D maximum deductible is $615.
- The old coverage gap ("donut hole") is gone — Part D now has three simpler phases.
- The Medicare Prescription Payment Plan lets you spread your drug costs over monthly installments if you'd rather smooth them out instead of paying big amounts at the pharmacy counter.
None of these are IRMAA-related, but they're the backdrop for every enrollment decision this season.
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 Nye County
(MA penetration in Nye 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
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
Does IRMAA go away if my income drops later?
Is IRMAA taken out of my Social Security check?
Does IRMAA apply if I have a Medicare Advantage plan?
- CMS — Medicare costs & IRMAA (medicare.gov)
For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.