Medicare Part D
2026 Medicare IRMAA: Raleigh Income Limits Start at $109,000
RALEIGH, N.C. — As Medicare's fall Annual Enrollment Period runs through Dec. 7, higher-income retirees in the Triangle are getting a fresh look at what they'll actually pay next year. The income thresholds that trigger Medicare's high-income surcharges — known as IRMAA — are rising for 2026, and the first bracket now starts above $109,000 for a single filer, according to CMS.
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Key takeaways
- Medicare's Annual Enrollment Period runs through Dec. 7, and 2026 IRMAA surcharge brackets start above $109,000 in income for a single filer.
- IRMAA is an extra charge added to Part B and Part D premiums for higher earners, but most people with Medicare don't pay it, and Social Security calculates and applies it automatically.
- 2026 IRMAA is based on 2024 tax returns, so a one-time high-income event like a home sale or Roth conversion in 2024 could trigger a surcharge even if income has since dropped.
- Starting in 2026, Part D out-of-pocket drug costs cap at $2,100 a year with a deductible of up to $615, but that cap doesn't cancel any IRMAA surcharge, which is still billed separately, and people can request a reconsideration using form SSA-44 if they've had a qualifying life-changing event.
Here's what that means if you live in Raleigh, and how to check whether it applies to you.
What IRMAA is, in plain English
IRMAA stands for the Income-Related Monthly Adjustment Amount. It's an extra charge added to your Medicare Part B (doctor visits, outpatient care) and Part D (prescription drug) premiums if your income is above a certain level.
It is not a penalty. It's a tiered surcharge, based on the income you reported to the IRS. Most people with Medicare do not pay IRMAA. Social Security determines whether you owe it and adjusts your premium automatically.
The 2026 income brackets
For 2026, IRMAA kicks in when your modified adjusted gross income (MAGI) is more than:
- $109,000 for a single filer, or
- $218,000 for a married couple filing jointly.
Above those numbers, the surcharge climbs through several tiers. The highest bracket applies to single filers with income above roughly $500,000 (and married couples above roughly $750,000).
One important quirk: 2026 IRMAA is based on your 2024 tax return. Medicare looks back two years because that's the most recent full return the IRS can share. If your income was unusually high in 2024 — say, you sold a home, took a large IRA distribution, or converted to a Roth — that can push you into an IRMAA bracket next year, even if your income has since dropped.
Why the timing matters this fall
Two things are happening at once for 2026:
1. Part D is getting a new out-of-pocket ceiling. In 2026, what you pay out of pocket for covered prescriptions caps at $2,100 for the year. The Part D deductible can be up to $615. The old "donut hole" coverage gap was eliminated in 2025, so drug coverage now has three phases instead of four. 2. IRMAA still applies on top of that. The Part D cap limits your drug spending, but if you're in an IRMAA bracket, you still pay the Part D income surcharge separately — usually deducted from Social Security.
There's also the Medicare Prescription Payment Plan, an optional program that lets you spread your drug costs across the calendar year in monthly payments instead of paying at the pharmacy counter. It doesn't lower what you owe; it just smooths it out.
What Raleigh retirees should know locally
Raleigh sits in Wake County, which is where Medicare plan availability is actually set. Wake County has a robust menu of stand-alone Part D drug plans and Medicare Advantage plans offered by multiple carriers each year. The specific number changes annually, and CMS posts the current count on Medicare.gov's Plan Finder when you enter a ZIP code.
Because Wake County is served by major health systems — including WakeMed, Duke Health, and UNC Health — provider networks can vary meaningfully from plan to plan. If you're comparing options, check that your doctors and preferred hospital are in-network before you enroll, not after.
If you think your IRMAA is wrong
You can ask Social Security to reconsider your IRMAA if you've had a "life-changing event" since the tax year they're using. Qualifying events include:
- Marriage, divorce, or the death of a spouse
- You or your spouse stopped working or reduced hours
- Loss of pension income
- Loss of income-producing property (not from a sale you chose)
The form is SSA-44, available at ssa.gov. Bring documentation. If approved, Social Security recalculates your premium using your more recent, lower income.
Key dates to keep on the calendar
- Oct. 15 – Dec. 7: Medicare Annual Enrollment Period. You can join, switch, or drop a Medicare Advantage or Part D plan. Changes take effect Jan. 1.
- Jan. 1 – Mar. 31: Medicare Advantage Open Enrollment. If you're already in a Medicare Advantage plan, you get one chance to switch to another MA plan or return to Original Medicare.
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 Wake County
(MA penetration in Wake 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
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: I got a letter from Social Security saying my premium is going up. Is that IRMAA?
Q: Does IRMAA apply to Medicare Advantage plans too?
Q: Will the new $2,100 drug cap help me if I'm in an IRMAA bracket?
- CMS — Medicare Part D program rules (medicare.gov)
For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.