IRMAA explained: how income raises your Medicare premiums

Most people pay the same premium for Medicare Part B. People with higher incomes pay more, and the extra has a clumsy name: the income-related monthly adjustment amount, or IRMAA. Here is where it starts and how much it adds.

What IRMAA is

Since 2007, the Part B premium has been based on income. Since 2011, the Part D premium has been too. In both cases the Centers for Medicare & Medicaid Services says roughly 8% of enrollees pay the extra amount. Everyone else pays the standard premium.

Where it starts

For 2026, the extra applies when your modified adjusted gross income is above $109,000 on an individual tax return, or above $218,000 on a joint return. At or below those figures you pay the standard Part B premium of $202.90 a month.

How much it adds to Part B

There are five steps above the standard premium. The first adds $81.20 a month, for a total of $284.10. The last applies to income of $500,000 or more on an individual return, or $750,000 or more on a joint return, and brings the premium to $689.90 a month.

The brackets are steps, not a slope. Income of $109,000 pays the standard premium. Income of $109,001 pays $81.20 more every month.

And to Part D

The same income brackets add an amount to your drug plan premium, from $14.50 to $91.00 a month. You pay it on top of whatever your plan charges.

Married and filing separately

If you are married, lived with your spouse at any time during the year and file a separate return, the table is much steeper. Above $109,000 the Part B premium goes straight to $649.20 a month.

What about 2027?

Medicare has not published the 2027 premiums or brackets yet. It released the 2026 figures on November 14, 2025. The IRMAA brackets page has the full tables and a lookup for your income, and it will carry the 2027 figures once they are out.