For many Americans nearing or enrolled in Medicare, understanding how premiums are calculated is more important than ever—and the latest changes mean that what you pay in 2026 will hinge heavily on your income. Medicare premiums based on income 2026 present a clear picture of how higher-income beneficiaries will face significantly different costs starting next year.
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What’s new for 2026
Earlier in November 2025, the Centers for Medicare & Medicaid Services (CMS) released the finalized 2026 premiums, deductibles and income-related adjustment amounts (IRMAA) for Parts A, B and D.
Here are the key take-aways for the premium side of things:
- The standard monthly premium for Part B (medical insurance) in 2026 is set at $202.90—an increase of $17.90 from the 2025 level of $185.
- For beneficiaries with higher income, the premium becomes income-related: the surcharge (IRMAA) is added based on your modified adjusted gross income (MAGI) from two years earlier (for 2026, your 2024 tax return).
- The income brackets triggering the surcharge start at incomes above $109,000 for individual filers (or $218,000 for joint filers).
- The total monthly Part B premiums for high-income filers rise in tiers from $284.10 up to $689.90 in 2026.
- For example: an individual with MAGI between $109,001 and $137,000 will pay $284.10 in 2026; if your income is $500,000 or more you’ll pay $689.90.
- The Part D (prescription drug) premiums also have income-related surcharges for high-income beneficiaries, with amounts for 2026 ranging from about $14.50 up to $91.00 depending on the income bracket.
Here’s a table summarizing the income-based premium tiers for Part B in 2026:
| Tax-filing status | Income range (MAGI) | IRMAA surcharge | Total monthly premium |
|---|---|---|---|
| Individual ≤ $109,000 / Joint ≤ $218,000 | – | $0.00 | $202.90 |
| Individual > $109,000 ≤ $137,000 / Joint > $218,000 ≤ $274,000 | $81.20 | $284.10 | |
| Individual > $137,000 ≤ $171,000 / Joint > $274,000 ≤ $342,000 | $202.90 | $405.80 | |
| Individual > $171,000 ≤ $205,000 / Joint > $342,000 ≤ $410,000 | $324.60 | $527.50 | |
| Individual > $205,000 < $500,000 / Joint > $410,000 < $750,000 | $446.30 | $649.20 | |
| Individual ≥ $500,000 / Joint ≥ $750,000 | $487.00 | $689.90 |
Additionally, the base premium increase means even those whose income falls below the surcharge threshold will see a higher bill in 2026.
Why the income-based premiums matter
The principle behind income-based Medicare premiums is that beneficiaries with higher incomes pay a larger share of their Medicare Part B and Part D costs. CMS estimates roughly 8% of Medicare Part B beneficiaries will pay these income-related premiums in 2026.
Here are a few important implications:
- Your 2026 premium amount is based on your 2024 tax return income (or 2023 if 2024 is unavailable).
- Just $1 over the threshold can move you into the next tier, significantly raising your premium.
- Income from all sources matters: your MAGI includes adjusted gross income plus tax-exempt interest, so higher investment or retirement account income can trigger higher premiums.
- Planning matters. If you expect your income to fall (for example, you retire or sell a business), you may qualify for a change of status or appeal to lower your IRMAA.
What to watch for in 2026
1. Open Enrollment Timing
While the premium schedule is set for 2026, beneficiaries can use the upcoming open enrollment period (typically October 15 through December 7) to review and switch plans (Part D or Medicare Advantage) in light of these changes. The cost of coverage in 2026 will include these premium changes.
2. Holding-Harmless Impact
Certain beneficiaries are protected by the “hold-harmless” provision: if your Social Security benefit is too low, your Part B premium may not rise more than the COLA in your Social Security benefit. However, if your income triggers IRMAA, you may still face the higher premium.
3. Budgeting for Increased Premiums
Many older Americans receive Social Security payments that feed into their budgeting. Because the Part B premium is deducted automatically from Social Security for most beneficiaries, a higher premium can significantly affect net income. According to a recent analysis, the 2026 increase in Part B (~10%) will absorb roughly one-third of the average retiree’s Social Security cost-of-living adjustment (COLA) for 2026.
4. Income Planning Ahead of Time
If you’re approaching Medicare eligibility or examining your retirement withdrawals, be mindful that the income you report in 2024 determines your 2026 premium bracket. Some retirees may alter the timing of Roth conversions, investment sales, or retirement account distributions to reduce MAGI in the relevant year. The surcharge threshold gap is narrow—just $1 over can move you up a tier.
5. Understanding the Difference Between Base Premium & Surcharge
It’s important to separate the “standard” premium (which is what most beneficiaries pay) from the income-related surcharge. For 2026, $202.90 is the standard Part B premium for those whose income falls below the initial threshold. If your income is higher, you’ll pay the $202.90 plus the IRMAA surcharge.
Real-world examples
- Example A: Jane is single, with no spouse, and her MAGI (2024 tax year) is $100,000. Since she falls below the $109,000 threshold, her 2026 Part B premium will be $202.90 monthly.
- Example B: John and Mary file jointly, with MAGI of $300,000 for 2024. That places them in the bracket > $274,000 ≤ $342,000 for joint filers. Their 2026 monthly Part B premium will be $405.80.
- Example C: Robert is single with MAGI of $600,000. He falls in the top bracket (≥ $500,000 for individual). His 2026 monthly Part B premium will be $689.90.
These examples illustrate how income-based premiums apply and why they vary so much.
Why premiums are rising overall
While income-based surcharges apply only to higher income beneficiaries, the base premium and deductibles are rising for everyone. According to CMS, the 2026 Part B premium increase is driven by projected utilization and price changes:
- The Part B standard premium increase is largely due to higher expected healthcare service usage and costs.
- CMS noted that this year’s increase would have been about $11 more per month if changes to spending on skin substitutes (wound-care products) hadn’t been implemented.
In short, higher health-care cost pressures across the board are pushing up premiums—meaning even beneficiaries well below the income thresholds will pay more in 2026.
What this means for you
Whether you’re already enrolled in Medicare or planning for the future, these income-based premium changes mean:
- If you’re below the income thresholds, your premium will increase—but you’ll still pay the standard amount ($202.90 monthly for Part B in 2026).
- If you expect to have higher income, you’ll need to factor in the surcharge—budget for $284.10 or more monthly, depending on your bracket.
- If you are close to the threshold (for example your MAGI might be just above $109,000 or $274,000 jointly), you may want to consult a tax or retirement specialist about timing income in 2024 to avoid or minimize the surcharge.
- Review your Medicare plan options during open enrollment: while the premium is one element, your total cost (deductibles, copays, plan premiums, drug coverage) still matters.
- Keep in mind that the Premium for Part A, deductibles and coinsurance for hospital inpatient and skilled nursing days are also rising. For example, the Part A deductible for 2026 is $1,736.
Common Questions & Clarifications
Will everyone pay the higher premium in 2026?
No. Only enrollees whose income exceeds the thresholds will pay the higher premium due to IRMAA. If your income falls below the threshold ($109,000 individual / $218,000 joint for 2026), you’ll pay the standard $202.90 monthly premium.
Does the surcharge apply immediately?
The surcharge for 2026 is determined based on your tax return for 2024 (or 2023 if 2024 data isn’t available). That means even if you retire or your income falls, the premium you pay may reflect income from two years prior.
Can I appeal or reduce my IRMAA surcharge?
Yes. If you experience a life-changing event (such as marriage, divorce, loss of employment, or death of a spouse) that significantly reduces your income, you may request a reconsideration by Social Security Administration (SSA). A form (SSA-44) is available for this purpose.
In closing, understanding how Medicare premiums based on income 2026 will impact you or your household can help with budgeting, retirement-planning and plan selection. If you have thoughts or questions, feel free to share or comment below—let’s stay informed together.
Disclaimer: This article is for informational purposes only and does not constitute legal, tax, or financial advice. Always consult qualified professionals if you have questions about how Medicare premiums or income-related adjustments apply to your situation.
