In 2026, a single Medicare enrollee whose 2024 modified adjusted gross income (MAGI) exceeds $109,000 by even one dollar will pay an income-related surcharge that adds up to $6,936 per year at the top tier, on top of the standard Part B and Part D premiums (Sources: SSA POMS HI 01101.020; Federal Register 2025-20251). This report assembles the complete 2026 and 2025 IRMAA tables, reconstructs the surcharge-threshold history back to the program’s 2007 inception, quantifies how many beneficiaries actually pay, and documents what the Medicare Trustees project through 2035. It is educational and factual, not advice.
Medicare IRMAA 2026: by the numbers
- Standard Part B monthly premium in 2026: $202.90, up 9.7% from $185.00 in 2025 (Source: Federal Register 2025-20251).
- Single-filer IRMAA entry threshold in 2026: MAGI above $109,000; married filing jointly above $218,000 (Source: SSA POMS HI 01101.020).
- Highest 2026 Part B surcharge: $487.00/month, pushing the total Part B premium to $689.90/month (Source: Federal Register 2025-20251; SSA POMS HI 01101.020).
- Beneficiaries who paid a Part B income-related premium in 2024: 4.8 million; the Trustees estimate 5.1 million for 2025 (Source: 2025 and 2026 Medicare Trustees Reports).
- Aggregate additional Part B premiums collected in 2024: $12.8 billion (Source: 2025 Medicare Trustees Report, Table V.E3).
- Share of Part B enrollees affected by IRMAA: roughly 8 percent (Source: CMS 2026 Parts A & B Premiums fact sheet).
- Trustees intermediate projection for IRMAA payers by 2035: 10.2 million, with collections of $55.8 billion (Source: 2026 Medicare Trustees Report, Table V.E3).
- Q3 Advisors IRMAA Bracket-Creep Index for 2026: 1.59 (2007 = 1.00), meaning the premium has grown about 59% faster than the surcharge-entry threshold since inception.
Proprietary metric: The IRMAA Bracket-Creep Index (BCI)
The BCI, developed by Q3 Advisors, measures how fast the standard Part B premium (the cost that IRMAA surcharges are stacked upon) has grown relative to the single-filer income threshold at which IRMAA first applies. Both series are indexed to 2007 = 100, IRMAA’s first year. BCI = Premium Index divided by Threshold Index. A reading above 1.0 means the premium has outrun the income line that defines who counts as “high income,” so identical real incomes drift into surcharge territory over time. The 2026 BCI is 1.59: from 2007 to 2026 the standard premium rose 117.0% (from $93.50 to $202.90) while the single-filer entry threshold rose only 36.3% (from $80,000 to $109,000). Inputs: SSA POMS HI 01001.014 (premiums), CRS R40082 Table B-1 (2007-2022 thresholds), and SSA POMS HI 01101.020 (2023-2026 thresholds).
What IRMAA is and how it works
IRMAA is the Income-Related Monthly Adjustment Amount, a surcharge added to the standard Medicare Part B and Part D premiums for beneficiaries above defined income levels. It was created by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (the MMA) and took effect in January 2007 for Part B; the Part D surcharge began in 2011 (Source: CRS R40082). Higher-income beneficiaries pay a larger share of the true cost of coverage. Where a standard enrollee pays 25 percent of the aged actuarial cost of Part B, IRMAA tiers are designed so that beneficiaries pay 35, 50, 65, 80, or 85 percent depending on income (Source: 2026 Medicare Trustees Report).
Three features define IRMAA and drive most of the surprises. First, it uses a two-year lookback: your 2026 surcharge is based on the MAGI reported on your 2024 tax return. Second, MAGI for this purpose is adjusted gross income plus tax-exempt interest income (Source: 20 CFR 418.1010). Third, IRMAA is a cliff, not a phase-in. One dollar over a threshold triggers the entire tier surcharge for the year. These mechanics interact with retirement income planning in ways that reach far beyond Medicare itself, which is why we also examine the related taxation of Social Security benefits and the Net Investment Income Tax in companion research.
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2026 Medicare IRMAA brackets: single, head of household, or qualifying surviving spouse
The table below shows the 2026 amounts for filers who are single, head of household, or a qualifying surviving spouse. The Part B column is the total monthly premium (the standard $202.90 plus the surcharge). The Part D column is the IRMAA add-on paid in addition to the enrollee’s own plan premium (Sources: SSA POMS HI 01101.020; Federal Register 2025-20251). A fuller walkthrough is maintained at Q3’s Medicare IRMAA 2026 brackets page.
| 2024 MAGI (single/HoH/QSS) | Part B surcharge | Total Part B / month | Part D IRMAA / month |
|---|---|---|---|
| $109,000 or less | $0.00 | $202.90 | $0.00 |
| Above $109,000 to $137,000 | $81.20 | $284.10 | $14.50 |
| Above $137,000 to $171,000 | $202.90 | $405.80 | $37.50 |
| Above $171,000 to $205,000 | $324.60 | $527.50 | $60.40 |
| Above $205,000 to below $500,000 | $446.30 | $649.20 | $83.30 |
| $500,000 or more | $487.00 | $689.90 | $91.00 |
2026 Medicare IRMAA brackets: married filing jointly
For married couples filing jointly, the income thresholds are exactly double the single-filer figures, but the surcharge amounts are identical per person. Each spouse enrolled in Medicare pays the surcharge separately (Source: SSA POMS HI 01101.020).
| 2024 MAGI (married filing jointly) | Part B surcharge | Total Part B / month | Part D IRMAA / month |
|---|---|---|---|
| $218,000 or less | $0.00 | $202.90 | $0.00 |
| Above $218,000 to $274,000 | $81.20 | $284.10 | $14.50 |
| Above $274,000 to $342,000 | $202.90 | $405.80 | $37.50 |
| Above $342,000 to $410,000 | $324.60 | $527.50 | $60.40 |
| Above $410,000 to below $750,000 | $446.30 | $649.20 | $83.30 |
| $750,000 or more | $487.00 | $689.90 | $91.00 |
2026 Medicare IRMAA brackets: married filing separately
Married filing separately uses only two IRMAA tiers, which map to the top two amount levels. This filing status can produce a steep surcharge at a relatively low income (Source: SSA POMS HI 01101.020).
| 2024 MAGI (married filing separately) | Total Part B / month | Part D IRMAA / month |
|---|---|---|
| $109,000 or less | $202.90 | $0.00 |
| Above $109,000 to below $391,000 | $649.20 | $83.30 |
| $391,000 or more | $689.90 | $91.00 |
One quirk deserves attention. The 2026 married-filing-separately second-tier entry point, $391,000, is actually lower than the 2025 figure of $394,000 (Source: SSA POMS HI 01101.020). Most thresholds rose year over year; this one moved the other way.
2025 versus 2026: what changed
The single-filer entry threshold rose $3,000 (from $106,000 to $109,000) and the joint entry threshold rose $6,000 (from $212,000 to $218,000). The top thresholds, $500,000 for single filers and $750,000 for joint filers, did not move; they are fixed by statute and are not inflation-indexed (Source: SSA POMS HI 01101.020). The standard premium rose from $185.00 to $202.90 and the annual deductible rose from $257 to $283 (Source: Federal Register 2025-20251; CMS 2026 fact sheet).
| 2024 MAGI (single/HoH/QSS) | 2025 total Part B / mo | 2025 Part D IRMAA / mo |
|---|---|---|
| $106,000 or less | $185.00 | $0.00 |
| Above $106,000 to $133,000 | $259.00 | $13.70 |
| Above $133,000 to $167,000 | $370.00 | $35.30 |
| Above $167,000 to $200,000 | $480.90 | $57.00 |
| Above $200,000 to below $500,000 | $591.90 | $78.60 |
| $500,000 or more | $628.90 | $85.80 |
The IRMAA cliff cost: what one dollar over the line costs
Because IRMAA is a cliff, the marginal cost of crossing a threshold by a single dollar can be significant. Q3 Advisors computes the annual “cliff cost” as (Part B monthly surcharge plus Part D monthly IRMAA add-on) times twelve, for a Part D-enrolled single filer in 2026 (Sources: Federal Register 2025-20251; SSA POMS HI 01101.020).
| Crossing (single-filer MAGI) | Combined monthly surcharge | Annual cliff vs. no-IRMAA baseline | Incremental jump from lower tier |
|---|---|---|---|
| Above $109,000 | $95.70 | $1,148.40 | $1,148.40 |
| Above $137,000 | $240.40 | $2,884.80 | $1,736.40 |
| Above $171,000 | $385.00 | $4,620.00 | $1,735.20 |
| Above $205,000 | $529.60 | $6,355.20 | $1,735.20 |
| Above $500,000 | $578.00 | $6,936.00 | $580.80 |
A single filer at $205,001 of MAGI pays $6,355 per year more than an otherwise identical filer at $109,000. The entry-tier cliff itself rose from $1,052.40 in 2025 to $1,148.40 in 2026, a 9.1 percent increase. For a married couple where both spouses are on Medicare, every figure roughly doubles because each pays the surcharge. These cliffs are why one-time income events, such as a large capital gain or a Roth conversion, can change which bracket applies; see our discussion of the retirement tax window and Roth conversion planning.
The history of the surcharge threshold, 2007 to 2026
IRMAA thresholds have not moved smoothly. They were CPI-indexed at first, then frozen for nearly a decade, then re-indexed. The Affordable Care Act of 2010, Section 3402, froze the income thresholds at their 2010 levels from January 1, 2011 through December 31, 2019 (Source: CRS R40082). Because the $85,000 single level was first reached in 2009, that single threshold sat unchanged at $85,000 for the eleven consecutive years 2009 through 2019. A common error in secondary sources is to state a flat $80,000 (or flat $85,000) for the entire 2007-2019 span; the primary CRS R40082 Table B-1 shows the correct progression of $80,000 (2007), $82,000 (2008), then $85,000 from 2009 onward through 2019 (Source: CRS R40082).
| Year | Standard Part B premium | Single-filer entry threshold | BCI (2007 = 1.00) |
|---|---|---|---|
| 2007 | $93.50 | $80,000 | 1.000 |
| 2008 | $96.40 | $82,000 | 1.006 |
| 2009 | $96.40 | $85,000 | 0.970 |
| 2010 | $110.50 | $85,000 | 1.112 |
| 2011 | $115.40 | $85,000 | 1.162 |
| 2012 | $99.90 | $85,000 | 1.006 |
| 2013 | $104.90 | $85,000 | 1.056 |
| 2014 | $104.90 | $85,000 | 1.056 |
| 2015 | $104.90 | $85,000 | 1.056 |
| 2016 | $121.80 | $85,000 | 1.226 |
| 2017 | $134.00 | $85,000 | 1.349 |
| 2018 | $134.00 | $85,000 | 1.349 |
| 2019 | $135.50 | $85,000 | 1.364 |
| 2020 | $144.60 | $87,000 | 1.422 |
| 2021 | $148.50 | $88,000 | 1.444 |
| 2022 | $170.10 | $91,000 | 1.599 |
| 2023 | $164.90 | $97,000 | 1.455 |
| 2024 | $174.70 | $103,000 | 1.451 |
| 2025 | $185.00 | $106,000 | 1.493 |
| 2026 | $202.90 | $109,000 | 1.593 |
The BCI climbs steeply during the 2011-2019 freeze, as premiums rose while the threshold stayed at $85,000. It peaks at 1.599 in 2022, when the premium spiked to $170.10 against a still-lagging threshold, then dips in 2023-2024 as the large threshold re-indexing catches up, before re-climbing to 1.593 by 2026. The Bipartisan Budget Act of 2018 added a new top (fifth) bracket effective for 2019, and re-indexation of thresholds resumed in 2020 (Source: CRS R40082).
How many beneficiaries actually pay IRMAA
The number of Part B enrollees paying an income-related premium grew from 1.7 million in 2007, the program’s first year, to a most recent actual of 4.8 million in 2024, with the Trustees estimating 5.1 million for 2025 (Sources: 2025 and 2026 Medicare Trustees Reports, Table V.E3). That is roughly a threefold increase. The share has remained in the range of roughly 7 to 8 percent of Part B enrollees; CMS states “roughly 8 percent” in its 2024, 2025, and 2026 fact sheets, while CRS R40082 cited about 7 percent for 2022 (Sources: CMS Parts A & B fact sheets; CRS R40082).
| Year | Part B IRMAA payers (millions) | Aggregate additional Part B premiums ($ billions) |
|---|---|---|
| 2007 | 1.7 | 0.7 |
| 2010 | 1.9 | 2.7 |
| 2015 | 2.9 | 3.8 |
| 2018 | 3.7 | 7.0 |
| 2019 | 4.3 | 8.4 |
| 2020 | 4.7 | 10.0 |
| 2021 | 4.8 | 10.5 |
| 2022 | 4.4 | 11.1 |
| 2023 | 5.3 | 13.4 |
| 2024 | 4.8 | 12.8 |
| 2025 (est.) | 5.1 | 14.1 |
Two policy events shaped this trend. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) lowered certain upper income thresholds effective 2018, “resulting in a greater number of beneficiaries paying the higher amounts” (Source: 2025 Medicare Trustees Report). The nine-year threshold freeze from 2011 to 2019 also pulled more people into surcharge tiers as incomes rose against a static line. The 2022 dip to 4.4 million (from 4.8 million in 2021) reflects the large 2022 threshold indexing jump. Part D IRMAA payers grew in parallel, from 0.9 million in 2011 to 4.2 million in 2024 (Source: 2025 Medicare Trustees Report, Table V.E4).
What the Medicare Trustees project through 2035
The following projections are made by the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds, not by Q3 Advisors, and use the Trustees’ intermediate (best-estimate) assumptions. The 2026 Medicare Trustees Report, transmitted to Congress June 9, 2026, projects the standard Part B premium roughly doubles over the decade, from $185.00 in 2025 to $360.60 in 2035 (Source: 2026 Medicare Trustees Report, Table V.E2). The 2027 premium of $209.50 is footnoted as already finalized.
| Year | Projected standard Part B premium | Projected Part B deductible |
|---|---|---|
| 2026 (actual) | $202.90 | $283 |
| 2027 (finalized) | $209.50 | $292 |
| 2028 | $224.50 | $313 |
| 2029 | $238.50 | $332 |
| 2030 | $255.50 | $356 |
| 2031 | $272.10 | $379 |
| 2032 | $290.20 | $404 |
| 2033 | $313.60 | $437 |
| 2034 | $338.50 | $472 |
| 2035 | $360.60 | $503 |
The Trustees also project the number of Part B enrollees paying IRMAA rises from 5.1 million in 2025 and 6.1 million in 2026 to 10.2 million by 2035, with aggregate IRMAA collections rising from $14.1 billion in 2025 to $55.8 billion in 2035 (Source: 2026 Medicare Trustees Report, Table V.E3).
| Year | Projected IRMAA payers (millions) | Projected aggregate premiums ($ billions) |
|---|---|---|
| 2026 | 6.1 | 18.8 |
| 2027 | 6.6 | 20.9 |
| 2028 | 7.0 | 24.1 |
| 2029 | 7.5 | 27.1 |
| 2030 | 8.0 | 30.8 |
| 2031 | 8.4 | 34.6 |
| 2032 | 8.8 | 38.8 |
| 2033 | 9.3 | 44.0 |
| 2034 | 9.7 | 49.9 |
| 2035 | 10.2 | 55.8 |
These are projections and they move materially year to year. The prior (2025) Trustees Report projected higher out-years, for example $347.50 for 2034, which the 2026 report revised down to $338.50, and it revised 2027 from $218.60 down to $209.50 (Source: MOAA reproductions of the 2025 and 2026 reports). The Trustees also project the Part A trust fund is depleted in the second quarter of 2033, one quarter earlier than the 2025 report estimated, and note that Part D IRMAA amounts “will increase more rapidly beginning in 2030” due to the Inflation Reduction Act of 2022 (Source: 2026 Medicare Trustees Report).
The two-year lookback and how to request relief
SSA sets your IRMAA using MAGI from the tax year two years prior to the premium year, referred to in agency terminology as PY-2. Under 20 CFR 418.1135, SSA “will use your modified adjusted gross income provided by IRS for the tax year 2 years prior to the effective year”; if that data is unavailable, it uses the tax year three years prior (PY-3) and corrects later (Source: 20 CFR 418.1135; SSA POMS HI 01101.030). For premium year 2026, that means your 2024 return.
Relief is available through a New Initial Determination (NID) when a qualifying life-changing event has reduced your income. The current SSA-44 form, edition 12-2025 (OMB No. 0960-0784), captures eight listed events: marriage; divorce or annulment; death of your spouse; work stoppage; work reduction; loss of income-producing property; loss of pension income; and an employer settlement payment (Sources: 20 CFR 418.1205; SSA POMS HI 01120.005; SSA-44 form). Importantly, a reduction only produces a change if it actually moves you to a lower IRMAA tier (Source: SSA POMS HI 01120.001).
Certain one-time income events do not qualify as life-changing events. POMS HI 01120.005 explicitly lists capital gains from the sale of property, lottery winnings, casino winnings, conversion of an IRA, and cashing bonds as non-qualifying (Source: SSA POMS HI 01120.005). A Roth conversion in year N raises MAGI, drives the IRMAA tier in premium year N+2, and SSA-44 relief is not available for that spike; the surcharge typically falls off two years after income normalizes, when the higher tax year rolls out of the PY-2 window. This interaction relates to Roth conversion timing and to the surviving-spouse filing transition described in our research on the widow’s penalty.
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Q3 Advisors is a registered investment adviser focused on retirement tax planning. This article is educational and is not advice; for guidance on your own circumstances, consult a qualified tax or financial professional.
Frequently asked questions
What is Medicare IRMAA?
IRMAA is the Income-Related Monthly Adjustment Amount, a surcharge added to standard Medicare Part B and Part D premiums for higher-income beneficiaries. It was created by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 and took effect for Part B in 2007 and Part D in 2011 (Source: CRS R40082).
What is the standard Part B premium in 2026?
The standard monthly Part B premium in 2026 is $202.90, up 9.7 percent from $185.00 in 2025 (Source: Federal Register 2025-20251).
What income triggers IRMAA in 2026 for a single filer?
A single filer, head of household, or qualifying surviving spouse begins paying IRMAA in 2026 when 2024 MAGI exceeds $109,000 (Source: SSA POMS HI 01101.020).
What income triggers IRMAA in 2026 for a married couple filing jointly?
A married couple filing jointly begins paying IRMAA in 2026 when 2024 MAGI exceeds $218,000 (Source: SSA POMS HI 01101.020).
What is the highest IRMAA surcharge in 2026?
The highest Part B surcharge in 2026 is $487.00 per month, bringing the total Part B premium to $689.90 per month, plus a Part D IRMAA add-on of $91.00 per month (Source: SSA POMS HI 01101.020; Federal Register 2025-20251).
What tax year does 2026 IRMAA use?
2026 IRMAA is based on the MAGI reported on your 2024 tax return, reflecting the two-year lookback rule (Source: 20 CFR 418.1135; CMS 2026 fact sheet).
How is MAGI defined for IRMAA?
For IRMAA, MAGI is adjusted gross income as defined by the Internal Revenue Code plus tax-exempt interest income (Source: 20 CFR 418.1010).
Is IRMAA a cliff or a gradual phase-in?
IRMAA is a cliff. One dollar of MAGI over a threshold triggers the entire tier surcharge for the year (Source: SSA POMS HI 01101.020).
How much does crossing the first IRMAA tier cost in 2026?
For a Part D-enrolled single filer, crossing above $109,000 adds a combined $95.70 per month, or $1,148.40 per year, versus the no-IRMAA baseline (Q3 Advisors calculation from Federal Register 2025-20251 and SSA POMS HI 01101.020).
How much did the entry-tier cliff rise from 2025 to 2026?
The first-tier annual cliff rose from $1,052.40 in 2025 to $1,148.40 in 2026, an increase of 9.1 percent (Q3 Advisors calculation from SSA POMS HI 01101.020).
How many people pay IRMAA?
Approximately 4.8 million beneficiaries paid a Part B income-related premium in 2024, and the Trustees estimate 5.1 million for 2025 (Source: 2025 and 2026 Medicare Trustees Reports).
What share of Medicare beneficiaries pay IRMAA?
CMS states that IRMAA affects roughly 8 percent of people with Medicare Part B (Source: CMS 2026 Parts A & B Premiums fact sheet).
How much revenue does IRMAA generate?
Aggregate additional Part B premiums collected in 2024 were $12.8 billion, and additional Part D premiums were $2.2 billion (Source: 2025 Medicare Trustees Report, Tables V.E3 and V.E4).
What do the Trustees project the Part B premium will be in 2035?
The Trustees project the standard Part B premium reaches $360.60 in 2035 under intermediate assumptions, roughly double the 2025 level (Source: 2026 Medicare Trustees Report, Table V.E2).
How many people do the Trustees project will pay IRMAA by 2035?
The Trustees project 10.2 million Part B enrollees paying IRMAA by 2035, with aggregate collections of $55.8 billion (Source: 2026 Medicare Trustees Report, Table V.E3).
Why has the number of IRMAA payers grown so much?
The Trustees attribute growth to MACRA 2015 lowering certain thresholds effective 2018 and to threshold-indexing changes beginning 2020; the nine-year freeze from 2011 to 2019 also pulled more incomes into surcharge tiers (Source: 2026 Medicare Trustees Report).
Were IRMAA thresholds always frozen at one level?
No. Thresholds were CPI-indexed at first ($80,000 in 2007, $82,000 in 2008, $85,000 in 2009), then frozen at 2010 levels from 2011 through 2019 by the Affordable Care Act, then re-indexed starting 2020. The single threshold stayed at $85,000 for the eleven years 2009 through 2019 (Source: CRS R40082).
Can I appeal or reduce my IRMAA?
Yes, through a New Initial Determination if you experienced a qualifying life-changing event that reduced your income enough to move you to a lower tier. You file Form SSA-44 (Source: 20 CFR 418.1205; SSA POMS HI 01120.001).
What counts as a life-changing event?
The SSA-44 lists eight events: marriage; divorce or annulment; death of a spouse; work stoppage; work reduction; loss of income-producing property; loss of pension income; and an employer settlement payment (Source: SSA POMS HI 01120.005).
Does a Roth conversion qualify for IRMAA relief?
No. POMS HI 01120.005 expressly lists “Conversion of an IRA” as a non-qualifying event, along with capital gains, lottery and casino winnings, and cashing bonds. The resulting surcharge typically falls off two years after income normalizes (Source: SSA POMS HI 01120.005).
Do married couples pay IRMAA once or twice?
Each spouse enrolled in Medicare pays the surcharge separately, so a couple with both spouses on Medicare effectively pays the per-person surcharge twice (Source: SSA POMS HI 01101.020).
How does married filing separately affect IRMAA?
Married filing separately uses only two tiers mapped to the top two amount levels. In 2026, MAGI above $109,000 lands in the second-highest amounts, and $391,000 or more lands in the top (Source: SSA POMS HI 01101.020).
Is the top IRMAA threshold indexed to inflation?
No. The top thresholds, $500,000 for single filers and $750,000 for joint filers, are fixed by statute and are not inflation-indexed, so more incomes reach them over time (Source: SSA POMS HI 01101.020).
Sources
SSA POMS HI 01101.020, IRMAA Sliding Scale Tables (updated 12/02/2025). SSA POMS HI 01001.014, Part B Premiums and Surcharges in Effect after 1989 (updated 01/06/2026). SSA POMS HI 01101.001, HI 01101.030, HI 01120.001, HI 01120.005, and HI 01120.025. Federal Register 2025-20251, Medicare Part B Monthly Actuarial Rates, Premium Rates, and Annual Deductible Beginning January 1, 2026 (published 11/19/2025). CMS Fact Sheet, 2026 Medicare Parts A & B Premiums and Deductibles. Congressional Research Service R40082, Medicare Part B: Enrollment and Premiums (May 19, 2022), Table B-1. 2025 Medicare Trustees Report (released June 18, 2025), Tables V.E3 and V.E4. 2026 Medicare Trustees Report (transmitted June 9, 2026), Tables V.E2, V.E3, and V.E4. 20 CFR 418.1010, 418.1135, and 418.1205. Form SSA-44 (edition 12-2025, OMB No. 0960-0784).
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