Medicare Part D
2027 Medicare income surcharges in Bismarck, N.D.
BISMARCK, N.D. — As the Medicare Annual Enrollment Period runs through Dec. 7, higher-income retirees in Bismarck and across Burleigh County are getting a closer look at something that often surprises people: the extra amount they may pay for Medicare Part B and Part D because of their income.
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Key takeaways
- IRMAA is an extra charge added to Part B and Part D premiums for higher-income beneficiaries, based on tax returns from two years earlier, so 2027 charges will be based on 2025 income.
- Most Medicare beneficiaries don't earn enough to trigger IRMAA, but retirees with pensions, investment income, or one-time income spikes can be affected.
- If income has dropped since 2024 due to a life-changing event, beneficiaries can file Form SSA-44 with documentation to have IRMAA reduced or waived.
- The Part B IRMAA amount is deducted from Social Security checks, while the Part D IRMAA is billed separately, even if the drug plan premium is paid another way.
It's called IRMAA — the Income-Related Monthly Adjustment Amount — and the income thresholds that trigger it are updated each year. The 2027 brackets haven't been published yet; CMS typically releases them in the fall along with the Part B figures. Here's a plain-English look at how it works, who it hits, and what you can do if you think it applies to you.
What IRMAA is (and isn't)
IRMAA is not a penalty. It's an extra monthly charge that gets added to your standard Part B premium and, if you have drug coverage, your Part D premium. It's based on your tax return from two years ago — so your 2027 IRMAA will be calculated from your 2025 income.
Most people don't pay it. According to CMS, only a small share of Medicare beneficiaries earn enough to cross the first income threshold. But if you're a retiree with a pension, strong investment income, or a one-time bump like a home sale or Roth conversion, IRMAA can catch you off guard.
The IRMAA income thresholds
The 2026 IRMAA brackets, which apply to 2026 premiums and are based on 2024 modified adjusted gross income (MAGI), kick in above:
- $109,000 for a single filer
- $218,000 for a married couple filing jointly
Above those numbers, there are five tiers. Each tier adds a set dollar amount to both your Part B premium and your Part D premium. The highest tier applies to single filers with income above roughly $500,000 and joint filers above roughly $750,000.
You can see the current tier chart on medicare.gov under "Part B costs" and "Part D costs."
How Social Security tells you
If IRMAA applies, the Social Security Administration mails you a "predetermination notice" explaining what you'll owe and how they calculated it. The extra Part B amount is pulled from your Social Security check, just like your regular premium. The Part D extra is billed separately — even if your drug plan premium itself is paid another way.
That surprise second bill is one of the most common questions we hear from readers in North Dakota. It's not a mistake; it's just how Part D IRMAA is handled.
Life-changing events can lower it
Here's the part many people miss: if your income has dropped since 2024, you may qualify to have IRMAA reduced or waived. Social Security calls these "life-changing events," and they include:
- Retirement or reduced work hours
- Death of a spouse
- Divorce or marriage
- Loss of pension income
- A settlement from an employer
You file Form SSA-44 with documentation. If you moved from a full salary in 2025 to fixed retirement income in 2026 or 2027, this form exists for you. It's worth the paperwork.
Why this matters during Open Enrollment
IRMAA doesn't change which plan you pick, but it does change the true cost of Part D coverage for higher earners. When you compare drug plans during Annual Enrollment (Oct. 15 – Dec. 7), remember the plan's advertised premium isn't the whole story if you're subject to IRMAA. You'll pay the plan's premium plus your Part D adjustment.
A few other numbers worth knowing as you compare 2027 coverage:
- The Part D out-of-pocket cap is $2,100 in 2026 and $2,400 in 2027.
- The maximum Part D deductible is $615 in 2026 and $700 in 2027.
- The coverage gap ("donut hole") is gone — Part D now has three simpler phases.
- The Medicare Prescription Payment Plan lets you spread drug costs across the year in monthly installments instead of paying big bills at the pharmacy.
Bismarck is in Burleigh County, where beneficiaries have a range of stand-alone Part D and Medicare Advantage options to weigh. The 2027 lineup is detailed in each plan's Annual Notice of Change and on Medicare.gov's Plan Finder. A licensed agent or your local SHIP counselor can walk through what's available without steering you.
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 Burleigh County
(MA penetration in Burleigh 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; the 2027 brackets will be published by CMS later this fall. The table below reflects the 2026 brackets.
| 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 turned 65 and my income was high in 2024 because I was still working. Am I stuck with IRMAA?
Q: Does IRMAA ever go away on its own?
Q: Do I pay IRMAA if I have a Medicare Advantage plan instead of Original Medicare?
- CMS — Medicare costs & IRMAA (medicare.gov)
For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.