Medicare Part D
Milwaukie, Ore.: Part D Cap & Payment Plan 2027
MILWAUKIE, Ore. — As Medicare's Annual Enrollment Period runs through Dec. 7, higher-income retirees across Clackamas County are getting a fresh look at something that surprises a lot of people the first time it hits their mailbox: an income-related surcharge on top of their regular Medicare premiums.
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Key takeaways
- Medicare's Annual Enrollment Period runs through Dec. 7, and higher-income beneficiaries in Clackamas County may see an income-related surcharge called IRMAA added to their Part B and Part D costs.
- For 2026, IRMAA is based on your 2024 tax return income, and surcharges start once modified adjusted gross income goes above $109,000 for a single filer (roughly double for joint filers).
- If your income has dropped due to a life-changing event, you can file Form SSA-44 with Social Security to ask for your IRMAA to be recalculated instead of waiting two years.
- IRMAA applies the same way whether you have Original Medicare or a Medicare Advantage plan, since it's based on income rather than the type of coverage you choose.
Milwaukie retirees: here's how income affects your 2027 Medicare bill
If your income is above certain limits, you pay more for Part B (doctor visits and outpatient care) and Part D (prescription drugs). Medicare calls this extra amount IRMAA — the Income-Related Monthly Adjustment Amount. CMS publishes the 2027 Part B premium and IRMAA brackets later this fall, usually in November, so it's worth knowing where you stand before your next Social Security statement arrives.
What IRMAA is, in plain English
Most people on Medicare pay the standard Part B premium and whatever their Part D plan charges. But if your income is above a set line, Medicare adds a surcharge to both.
Here's the part that catches people off guard: Medicare looks at your tax return from two years ago. So your 2027 premiums are based on your 2025 income — specifically your modified adjusted gross income (MAGI).
For 2026, IRMAA surcharges start once income goes above $109,000 for a single filer (and roughly double that for a married couple filing jointly). There are several income tiers above that line, and the higher your income, the larger the surcharge on both Part B and Part D.
If you fall under the threshold, you don't pay IRMAA at all. This surcharge only affects a minority of beneficiaries — roughly the top slice of Medicare enrollees by income.
How the surcharge shows up
The Part B surcharge is added to your standard Part B premium, and Social Security usually deducts the full amount from your monthly benefit.
The Part D surcharge works a little differently. Even though you buy your Part D plan from a private insurer, the IRMAA portion is paid separately to Medicare — not to your plan. Many people are surprised to see a second, smaller charge come out of their Social Security check for this reason.
Both surcharges are recalculated every year using the most recent tax data the IRS has shared with Social Security.
What's new for 2027
A few things worth knowing as you review your coverage this fall:
- Part D out-of-pocket cap: Drug spending is capped at $2,100 for 2026. Once you hit that, you pay $0 for covered drugs the rest of the year.
- Part D deductible: The maximum a plan can charge is $615 in 2026.
- No more donut hole: The old coverage gap was eliminated starting in 2025. Part D now has three simpler phases.
- Medicare Prescription Payment Plan: You can ask to spread your yearly drug costs across smooth monthly payments instead of paying large amounts at the pharmacy counter.
None of these changes affect the IRMAA thresholds themselves, but they do change the overall picture of what Medicare costs in 2027.
If your income has dropped, you can appeal
This is the piece most people don't realize: if you had a life-changing event that lowered your income, you can ask Social Security to recalculate your IRMAA rather than wait two years for your tax return to catch up.
Qualifying events include:
- Retirement or reduced work hours
- Death of a spouse
- Marriage or divorce
- Loss of pension income
- Loss of income-producing property (not from your own choice)
You file Form SSA-44 with Social Security and include documentation. If approved, your surcharge is adjusted going forward. For someone in Milwaukie who just retired from a full-time job in 2025, this can matter a lot in 2027.
Where Milwaukie fits in
Milwaukie is in Clackamas County, where a full slate of Medicare Advantage and stand-alone Part D plans are available during Annual Enrollment. IRMAA applies the same way whether you stay with Original Medicare or choose a Medicare Advantage plan — it's based on your income, not the type of coverage you pick.
If you want help comparing options without a sales pitch, Oregon's SHIBA program (the state's SHIP) offers free, unbiased counseling for anyone on 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 Clackamas County
(MA penetration in Clackamas 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
2027 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 2027 surcharge will be based on your 2025 tax return. CMS publishes the 2027 brackets later this fall, usually in November; the 2026 figures shown below remain in effect until then.
| 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 got an IRMAA letter but my income has gone down. What do I do?
Q: Does IRMAA go away once I'm on Medicare a few years?
Q: Do Roth conversions or a one-time home sale count toward IRMAA?
- CMS — Medicare costs & IRMAA (medicare.gov)
For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.