Medicare Part D

Pinehurst Medicare premiums rise when income crosses IRMAA lines

PINEHURST, N.C. — As Medicare's Annual Enrollment Period runs through Dec. 7, many local retirees are seeing an income-related surcharge added to their Part B and Part D premiums in 2026 benefit notices. If your income has crossed a new threshold, or if a one-time event like a home sale pushed it up two years ago, you could owe more in 2027 than you do in 2026.

The extra charge is called IRMAA — the Income-Related Monthly Adjustment Amount. It isn't a penalty, and it isn't tied to your health. It's based on the tax return the IRS sent to Social Security, usually from two years earlier. For 2027, that means your 2025 income.

What IRMAA actually is

Most people pay the standard Part B premium and whatever their Part D plan charges. But if your modified adjusted gross income (MAGI) is above a set threshold, Medicare adds a surcharge to both. The surcharge is billed on top of your Part B premium and added to your Part D premium — even if the Part D plan itself is inexpensive.

IRMAA has five income tiers. The higher the tier, the higher the surcharge. It's recalculated every year based on your most recent tax return on file with the IRS.

The 2026 income thresholds (2027 figures pending) (2027 figures pending)

For 2026, IRMAA kicks in at these MAGI levels, based on your 2024 tax return:

• Single filers: surcharges begin above $109,000.
• Married filing jointly: surcharges begin above $218,000.
• Married filing separately: a separate, much lower threshold applies — check medicare.gov for the exact figure.

Each tier steps up from there, with the highest surcharges hitting incomes above roughly $500,000 (single) or $750,000 (joint). Medicare publishes the full table each fall at medicare.gov.

Why your 2024 income matters now

This is the part that catches people off guard. Medicare doesn't look at your current paycheck or your retirement income today. It uses the most recent federal tax return the IRS has processed — which, for 2027 premiums, will usually be your 2025 return.

That means a Roth conversion, a large capital gain, the sale of a second home, or an inherited IRA distribution taken in 2025 can drive up your 2027 Medicare premiums, even if your income is much lower now.

When you can ask for a do-over

If your income has genuinely dropped because of a specific life event, you can appeal. Social Security calls these "life-changing events," and they include:

• Marriage, divorce, or the death of a spouse
• You or your spouse stopping work or reducing hours (including retirement)
• Loss of income-producing property
• Loss or reduction of a pension
• A settlement from a former employer due to bankruptcy or reorganization

The form is SSA-44. You submit it to Social Security with documentation — a retirement letter, a death certificate, a divorce decree. If approved, they'll use your more recent (lower) income instead.

Selling a house at a profit is not on the life-changing event list. Neither is a Roth conversion. Those are considered planned financial decisions, and the surcharge stands.

Part D surcharges work the same way

The IRMAA rules apply to Part D drug coverage too. If your income is over the threshold, you'll pay an extra amount on top of whatever your Part D plan charges — and Medicare bills this separately, often through your Social Security check. Even people with employer or union drug coverage may see it if they're enrolled in a Part D plan.

A few Part D figures are already set: the annual out-of-pocket cap for Part D drug costs is $2,100 in 2026 and $2,400 in 2027, and the maximum Part D deductible is $615 in 2026 and $700 in 2027. The coverage gap (the old "donut hole") was eliminated in 2025, so drug coverage now has three phases instead of four. If your drug costs are high, ask about the Medicare Prescription Payment Plan, which lets you spread out-of-pocket costs across the year in monthly installments.

Where Pinehurst residents can get help

Pinehurst is in Moore County, where several Medicare Advantage and stand-alone Part D plans were available for 2026. The 2027 lineup is detailed in each plan's Annual Notice of Change and on Medicare.gov's Plan Finder. Availability and plan details change every year, so the Annual Enrollment Period (Oct. 15 – Dec. 7) is the time to review. If you're already in a Medicare Advantage plan, you have a second window — the Medicare Advantage Open Enrollment Period — from Jan. 1 through March 31 to make one change.

For IRMAA questions specifically, call Social Security at 1-800-772-1213, since Social Security (not Medicare) handles the surcharge calculation and appeals.