Medicare Part D

How IRMAA Raises Medicare Premiums for Lebanon Residents

LEBANON, Tenn. — As Medicare's Annual Enrollment Period runs through Dec. 7, many people here in Wilson County are reviewing their 2027 coverage and running into a surprise: your Part B and Part D premiums aren't the same for everyone. If your income is above a certain line, Medicare adds a monthly surcharge called IRMAA — the Income-Related Monthly Adjustment Amount. Here's how it works, who it affects, and what to do if your income has dropped.

What IRMAA is, in plain English

Most people pay the standard Part B premium and whatever their Part D plan charges. But if your income is higher than a set threshold, Medicare adds an extra amount on top of both — that extra is IRMAA.

A few things to know up front:

• IRMAA applies to Part B and Part D separately.
• It's billed monthly. For Part B, it's taken out of your Social Security check (or billed to you). For Part D, it's paid directly to Medicare, not to your drug plan.
• Medicare uses your tax return from two years ago to decide. So your 2027 IRMAA is based on your 2025 income.

The IRMAA income thresholds

For 2026, IRMAA surcharges begin when your modified adjusted gross income (MAGI) is above:

• $109,000 for a single filer
• $218,000 for a married couple filing jointly

Below those numbers, you pay the standard Part B premium and no Part D surcharge. Above them, the surcharge grows in tiers — the higher your income, the higher your IRMAA. The top tier kicks in at very high incomes (roughly $500,000 single / $750,000 joint).

For the exact tier-by-tier amounts, the authoritative source is medicare.gov's "Costs" page, which CMS updates each fall. The 2027 figures are expected later this fall.

Why some Lebanon retirees get hit unexpectedly

The most common surprise stories we hear sound like this:

• You sold a house in 2024 and the capital gain pushed your income over the line.
• You did a Roth conversion in 2024 to plan for the future — and it counted as income.
• A spouse was still working in 2024, but has since retired.
• You took a large IRA withdrawal for a one-time expense.

Any of those can trigger an IRMAA letter for a future plan year, even if your income is now much lower.

You can appeal after a "life-changing event"

This is the part people miss. If your income has dropped because of a specific life event, you can ask Social Security to recalculate your IRMAA using more recent income. Qualifying events include:

• Marriage, divorce, or the death of a spouse
• You or your spouse stopped working or reduced hours
• Loss of a pension
• Loss of income-producing property (not from a sale you chose)

The form is SSA-44, "Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event." You submit it to Social Security with proof (like a retirement letter or death certificate). If approved, your surcharge is adjusted — sometimes eliminated.

How Part D costs are changing in 2027 — separate from IRMAA

IRMAA is only one piece of your drug costs. Two big program changes are worth knowing:

• The Part D out-of-pocket cap is $2,100 in 2026 and $2,400 in 2027. Once your covered drug spending reaches that, you pay nothing for covered drugs the rest of the year.
• The maximum Part D deductible is $615 in 2026 and $700 in 2027 (plans can set theirs lower).
• The old "donut hole" is gone. Part D now has three simple phases: deductible, initial coverage, and catastrophic.
• The Medicare Prescription Payment Plan lets you spread your out-of-pocket drug costs across the year in monthly installments instead of paying big amounts at the pharmacy counter. It's optional and free to opt into.

None of these change your IRMAA — but they can meaningfully change what you pay overall.

What to do during Annual Enrollment

Lebanon is in Wilson County, where Medicare beneficiaries have a range of stand-alone Part D and Medicare Advantage options to compare each year. During AEP (through Dec. 7), it's worth:

1. Checking whether Social Security has sent you an IRMAA determination letter. 2. If it looks wrong or your income has dropped, gathering documents for an SSA-44 appeal. 3. Using the Plan Finder at medicare.gov to compare drug plans based on the medications you actually take. 4. Remembering that Medicare Advantage members get a second window — Jan. 1 to March 31 — to switch plans once.