Some people with higher incomes pay extra each month for Medicare. That extra charge is called IRMAA, short for Income-Related Monthly Adjustment Amount. It can apply to Part B, which covers services such as doctor visits, and Part D prescription-drug coverage. It raises your Medicare premiums rather than your income-tax bill.
For 2026, Social Security generally uses your 2024 tax return. IRMAA uses modified adjusted gross income (MAGI): for this purpose, adjusted gross income (AGI) from your tax return plus tax-exempt interest. AGI is income after certain adjustments but before the standard or itemized deduction. A tax deduction that reduces taxable income without reducing AGI, such as personal SALT, generally does not reduce this measure. SSA explanation.
How much could my Medicare premiums increase?
The table below can help you estimate your monthly costs. The single or joint column refers to how you filed your tax return; each premium amount is for one person.
This table covers full Part B coverage and single or joint filers. Part B amounts include the standard premium; Part D amounts are added to the chosen plan’s premium. Dollar ranges are inclusive where shown.
| Single MAGI | Joint MAGI | Part B monthly total per person | Part D monthly extra per person |
|---|---|---|---|
| Up to $109,000 | Up to $218,000 | $202.90 | $0 |
| Over $109,000 to $137,000 | Over $218,000 to $274,000 | $284.10 | $14.50 |
| Over $137,000 to $171,000 | Over $274,000 to $342,000 | $405.80 | $37.50 |
| Over $171,000 to $205,000 | Over $342,000 to $410,000 | $527.50 | $60.40 |
| Over $205,000, below $500,000 | Over $410,000, below $750,000 | $649.20 | $83.30 |
| $500,000 or more | $750,000 or more | $689.90 | $91.00 |
Official CMS 2026 tables. These are not 2027 figures.
Can one extra dollar of income really raise my premiums?
IRMAA uses income bands. Crossing a boundary can change the premium for the whole band, so it is useful to see what happens at a threshold.
Assume a single beneficiary has both Part B and Part D all year. At $109,000 of applicable MAGI, no IRMAA applies. At $109,001, the first tier adds $81.20 for Part B plus $14.50 for Part D each month. That is $1,148.40 more over 12 months, excluding the unchanged Part D plan premium.
For a joint-filing couple with both spouses enrolled in both programs all year, moving from $218,000 to $218,001 creates twice that increase: $2,296.80 annually. If only one spouse is enrolled, only that spouse incurs the surcharge. This is a step in premiums, not a marginal tax applied only to the extra dollar.
Could filing separately increase our Medicare costs?
A couple comparing tax returns should also compare Medicare premiums. An income-tax saving may come with a separate premium increase.
For married separate filers who lived together at any point in the income year, 2026 MAGI above $109,000 and below $391,000 triggers a $446.30 monthly Part B surcharge and $83.30 for Part D. That is $6,355.20 a year per person enrolled in both.
Illustration: two spouses each have $110,000 MAGI under a legally correct separate allocation. Jointly their $220,000 falls in the first surcharge tier, costing $2,296.80 a year for both. Separately the surcharges total $12,710.40. The difference is $10,413.60, before comparing income taxes. CMS’s detailed 2026 premium tables provide the separate-filer amounts. If you lived apart throughout the year, different rules may apply. Social Security or a Medicare counselor can help you check which table applies to you.
When will income I receive now affect my Medicare premiums?
The tax return used to set a premium usually comes from two years earlier. That delay can make a Medicare notice surprising, especially if your income has since fallen.
Under the usual two-year lookback, 2025 income affects 2027 premiums, while 2026 income affects 2028 premiums. A taxable conversion, gain, or distribution can matter when it raises the relevant income. The dollar amounts in this article are for 2026. For a later year, use that year’s official Medicare table; these examples do not predict future premiums.
What if I retire and my income is now lower? You may be able to ask Social Security to review the extra charge. Retirement and certain other changes can qualify for a review using Form SSA-44. A one-time increase in income alone does not qualify under those rules. Social Security or a Medicare counselor can help you understand the available options. Social Security’s review guidance.
Will the new senior tax deduction also lower my Medicare premiums?
The deduction can lower your income tax, but it does not by itself lower your Medicare premiums. The two calculations use different income amounts.
The law commonly called the One Big Beautiful Bill added a deduction of up to $6,000 for each eligible person age 65 or older, for tax years 2025 through 2028. The amount gets smaller at higher incomes, and married people must file jointly to claim it. A deduction means less income is taxed; it is not a $6,000 payment or a $6,000 reduction in the tax bill. IRS explanation of the senior deduction.
Why can my tax go down while my Medicare payment stays the same?
When calculating income tax, you subtract the senior deduction from the income being taxed. When Social Security checks whether you owe extra for Medicare, it uses an income figure from before that deduction. It does not subtract the senior deduction. IRS deduction instructions; Social Security’s explanation of the income it counts.
For a simple example, suppose you qualify for a $3,000 senior deduction, and that entire amount would otherwise be taxed at 22%. Your federal income tax falls by $660: $3,000 × 22%. The deduction does not change the income counted for Medicare, so it produces no Medicare premium saving. Your own deduction and tax saving may differ.
Why does this matter for 2027?
Social Security generally looks back two years when setting the extra Medicare charge. That means 2027 premiums generally depend on income from your 2025 tax return—the first year the senior deduction was available. Claiming that deduction on the 2025 return does not reduce the income used for this Medicare calculation.
For your budget, it helps to look at income-tax savings and Medicare costs separately. You can receive a tax saving while your Medicare payment stays the same. If you would like help checking the amounts, there are both professional and free assistance options below.
Where can I get help with my own situation?
These are educational examples to help you understand your options and prepare questions. Your circumstances may differ, and you do not need to have an accountant already to find help.
For Medicare questions: Your State Health Insurance Assistance Program (SHIP) offers free, personalized Medicare counseling. A counselor can help you understand coverage, costs and appeals. Find Medicare counseling through SHIP.
For help with a tax return: The Tax Counseling for the Elderly (TCE) program offers free tax help, particularly for people age 60 and older, including pension and retirement questions. Volunteer Income Tax Assistance (VITA) also offers free basic return preparation for eligible people. The IRS provides tools to find a nearby site; services depend on eligibility and the complexity of the return. Find free tax help through the IRS.
For a Medicare premium notice: Social Security makes the decision about the income-based extra charge. If your income has fallen or the notice appears incorrect, you can contact Social Security about a review. A SHIP counselor can help you understand the process. Social Security’s premium and review guidance.
For more complex tax planning: A qualified accountant can help compare choices such as selling a property or taking money from a retirement account. Free tax-preparation programs may not cover this kind of planning. It is reasonable to ask about the service and its cost before arranging an appointment.