Medicare Part D

Part B and Part D surcharges facing Nashville Medicare users

Nashville, Tenn. — As Medicare's Annual Enrollment Period runs through Dec. 7, higher-income retirees in Middle Tennessee are getting a closer look at something that surprises a lot of new enrollees: the income-related surcharges that can raise what you pay for Part B and Part D in 2027. The rules haven't changed dramatically, but the income thresholds and the way Social Security calculates them are worth understanding before you sign anything.

Here's a plain-English guide to how IRMAA works, who it hits, and what Nashville-area beneficiaries can do about it.

What IRMAA actually is

IRMAA stands for the Income-Related Monthly Adjustment Amount. It's an extra charge added to your standard Medicare Part B premium and, separately, to your Part D drug plan premium if your income is above certain thresholds.

A few things to know upfront:

• IRMAA is set by the Social Security Administration, not by your insurance company.
• It's based on your modified adjusted gross income (MAGI) from your tax return two years ago. So your 2027 IRMAA looks at your 2025 tax return.
• It applies whether you're on Original Medicare or a Medicare Advantage plan that includes drug coverage.
• Most people — roughly 92% of beneficiaries — don't pay IRMAA at all.

The income thresholds for 2026

For 2026, IRMAA surcharges begin when a single filer's MAGI is above $109,000, or when a married couple filing jointly is above $218,000. From there, the surcharges step up through five tiers, with the highest tier hitting individuals with incomes at or above $500,000 (or couples at or above $750,000).

Each bracket adds a set dollar amount to both your Part B premium and your Part D premium. CMS typically publishes the 2027 IRMAA brackets and dollar amounts later in the fall, alongside the 2027 Part B figures — check Medicare.gov for the official numbers before you plan around them.

A quick reality check: IRMAA is a "cliff." Go one dollar over a threshold, and you're in the next bracket for the whole year. That's why looking ahead matters.

How Nashville retirees typically get caught by it

In Davidson County, the folks who bump into IRMAA usually fall into a few groups:

• Recent retirees whose 2024 income still reflected a full salary, a bonus, or unused vacation payout.
• Homeowners who sold property during Nashville's hot market years — a large capital gain can push MAGI up for a single tax year.
• People taking large IRA or 401(k) withdrawals, or doing Roth conversions.
• Working spouses where one person is on Medicare and the other is still earning.

Because IRMAA looks back two years, the surcharge can feel like it comes out of nowhere — a one-time income event in 2025 can raise your 2027 Medicare costs even though your income today is lower.

The "life-changing event" appeal

Here's the part a lot of 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 stopping work or reducing hours
• Loss of pension income
• Loss of income-producing property (not from a normal market drop)

You file Form SSA-44 with documentation. If approved, Social Security uses your estimated current income instead of the two-year-old return. This is one of the most useful — and most overlooked — tools for newly retired Nashvillians.

What this means during Annual Enrollment

IRMAA itself isn't something you shop for during Open Enrollment — it's tied to your income, not your plan choice. But it does affect the total picture:

• Your Part D IRMAA is paid in addition to whatever your drug plan's premium is.
• Switching to a lower-premium drug plan does not reduce your IRMAA surcharge.
• The Part D out-of-pocket cap is $2,100 in 2026 and $2,400 in 2027, and the maximum deductible is $615 in 2026 and $700 in 2027 — these apply regardless of whether you owe IRMAA.

If you're comparing coverage between Oct. 15 and Dec. 7, factor IRMAA into your budget as a fixed cost for the year. Nashville is in Davidson County, where beneficiaries have a broad set of stand-alone Part D and Medicare Advantage options to compare on Medicare.gov's Plan Finder.