Does Medicare Cost More If You Have a Higher Income? (2026)

Direct Answer: Yes, Medicare Costs More the More You Earn

Yes. Medicare charges higher earners more for Part B and Part D through a surcharge called the Income-Related Monthly Adjustment Amount (IRMAA). Social Security looks at your Modified Adjusted Gross Income (MAGI) from two years earlier, so your 2024 tax return sets your 2026 premium. Singles above $109,000 and joint filers above $218,000 pay extra on top of the standard $202.90 Part B premium, up to $689.90 a month, plus a Part D surcharge up to $91.00 a month.

How IRMAA Works With Original Medicare (Part B and Part D)

Original Medicare has two premium-bearing parts: Part B (medical insurance) and, if you add a standalone drug plan, Part D. Both are subject to IRMAA. Social Security, not CMS, sends the IRMAA notice each fall, and it is based on the MAGI from the tax return filed two years before the coverage year, meaning your 2024 return sets your 2026 premium. If your income has since dropped due to a documented life-changing event, you can ask Social Security to use a more recent year instead of automatically waiting for the standard two-year lookback to catch up.

Medicare Part A (hospital insurance) is different: it has no IRMAA and, for the vast majority of beneficiaries who paid Medicare payroll taxes for at least 10 years, no premium at all in 2026. IRMAA only touches Part B and Part D. That means a retiree who owes the top Part B and Part D surcharges could pay $780.90 a month in 2026 just in premiums ($689.90 for Part B plus $91.00 for Part D), even though their Part A hospital coverage remains premium-free.

Medicare Advantage and Part D Plans: The Surcharge Still Applies

Switching to Medicare Advantage does not make IRMAA go away. Medicare Advantage (Part C) plans replace Original Medicare's Part A and Part B benefits, but enrollees still owe Part B, and if the plan bundles drug coverage (an MA-PD plan), they still owe Part D IRMAA on top of it. Many Medicare Advantage plans advertise a $0 monthly plan premium, but that $0 refers only to the insurer's own charge; it does not cancel the Part B premium (standard or IRMAA-adjusted) that Social Security deducts, and it does not cancel any Part D IRMAA.

The one place where plan choice can matter is the plan's own premium and the drug plan's IRMAA base rate. Because Part D IRMAA is a flat dollar amount added to whichever plan you choose, picking a lower-premium MA-PD or standalone Part D plan lowers your total bill even though it does not change the surcharge itself. For 2026, comparing plans on Medicare's Plan Finder at medicare.gov before your Medicare Advantage Open Enrollment window (January 1 to March 31, 2026) can reduce your out-of-pocket cost even if IRMAA still applies.

2026 IRMAA Brackets: Part B and Part D Costs by Income

The table below lists the full 2026 IRMAA bracket structure. Thresholds are based on your Modified Adjusted Gross Income (MAGI) from your 2024 tax return, and the brackets are indexed for inflation each year, so 2026 amounts are higher than the 2025 brackets.

How to Appeal an IRMAA Determination

If a life-changing event lowered your income after the tax year Social Security used, you do not have to wait two years for your premium to catch up. Qualifying events include marriage, divorce or annulment, death of a spouse, work stoppage or reduction, loss of income-producing property beyond your control, loss of pension income, or an employer settlement payment. You can file Form SSA-44 (Medicare Income-Related Monthly Adjustment Amount, Life-Changing Event) with evidence of both the event and your reduced income.

If you believe Social Security used the wrong tax year or made a calculation error, rather than a life-changing event, you can instead request a reconsideration within 60 days of your IRMAA notice. You will need your notice, your tax return, and any documentation showing the correct MAGI. Most SSA-44 requests are decided within a few weeks, and if approved, the lower premium applies going forward and sometimes retroactively to the start of the coverage year.

• Marriage, divorce, or annulment
• Death of a spouse
• You or your spouse stopped working or reduced hours
• Loss of income-producing property because of a disaster or other event beyond your control
• Loss of pension income
• Employer settlement payment because of the employer's closure or bankruptcy

Medigap Premiums Are Never Based on Income

Medigap, also called Medicare Supplement insurance, works completely differently from Part B and Part D. Insurers price Medigap policies using age, health status, tobacco use, and location, never MAGI. Outside your 6-month Medigap Open Enrollment Period, insurers in most states can use medical underwriting and may deny coverage or charge more because of a preexisting condition, but even then, pricing is never based on income. A retiree earning $500,000 a year and a retiree earning $30,000 a year pay the exact same Medigap premium for the same plan letter, insurer, and zip code in 2026. That makes Medigap an important budgeting tool for high earners who already owe the top IRMAA tiers on Part B: the supplemental coverage itself will not add an income penalty on top.

The tradeoff is that Medigap does not include drug coverage, so most Medigap enrollees still pair it with a standalone Part D plan, and that Part D plan's IRMAA surcharge still applies if their income is above the threshold. Comparing Medigap plan letters (A through N) side by side with Medicare Advantage can help higher-income beneficiaries decide whether the predictable Medigap premium or Medicare Advantage's typically lower plan premium (with its IRMAA-only cost variability) fits their 2026 budget better.

Where to Check Your IRMAA Notice and 2026 Costs

Social Security mails IRMAA determination notices each fall, before the new premium year starts, and posts your current premium in your online my Social Security account at ssa.gov. Medicare.gov's Plan Finder shows plan premiums for Medicare Advantage, Part D, and Medigap so you can add your personal IRMAA amount on top and estimate your real 2026 monthly cost. If you also qualify for a Medicare Savings Program or Extra Help based on limited income and resources, those programs can offset Part B and Part D costs even for beneficiaries who are not paying IRMAA.

The essential health benefits framework from the Affordable Care Act does not govern Medicare directly since Medicare is a separate federal program, but Medicare Advantage plans must still cover everything Original Medicare covers, and many voluntarily model extra benefits, like dental, vision, and hearing, on the kinds of categories ACA-compliant marketplace plans are required to include. Whichever plan type you choose, IRMAA is billed the same way: usually deducted automatically from your Social Security check alongside your standard Part B premium.

What income counts toward Medicare's IRMAA calculation?

Social Security uses your Modified Adjusted Gross Income (MAGI): adjusted gross income from your tax return plus tax-exempt interest, such as municipal bond interest. It includes wages, self-employment income, investment gains, pension and IRA withdrawals, and taxable Social Security benefits. Your 2026 IRMAA is based on the MAGI reported on your 2024 federal tax return, the most recent return the IRS has on file when Social Security sets premiums each fall.

Can I avoid IRMAA by switching to Medicare Advantage?

No. IRMAA is tied to your income, not your plan type. Medicare Advantage enrollees still owe the Part B IRMAA surcharge, and if their plan includes drug coverage, the Part D IRMAA surcharge too. Choosing a lower-premium plan can lower your total monthly bill, but it cannot cancel the income-based surcharge itself.

How do I appeal my 2026 IRMAA determination?

File Form SSA-44 if a life-changing event, such as retirement, divorce, or the death of a spouse, lowered your income after the tax year Social Security used. Attach proof of the event and your updated income. If you think Social Security used incorrect information rather than an outdated income year, request a reconsideration within 60 days of your notice instead.

What if my income has dropped since my 2024 tax return?

If the drop was caused by a qualifying life-changing event, like work reduction, divorce, or loss of pension income, submit Form SSA-44 with documentation so Social Security can use a more current estimate instead of the standard two-year lookback. Without a qualifying event, Social Security must wait for your income to actually change on a filed tax return before adjusting your premium.

Do Medicare Advantage and Part D use the same IRMAA brackets?

Yes. Part D IRMAA uses the identical MAGI thresholds as Part B: $109,000 for single filers and $218,000 for joint filers in 2026, rising through the same six tiers. The dollar surcharge amounts differ ($14.50 to $91.00 for Part D versus $284.10 to $689.90 in total Part B premium), but the income brackets that trigger each tier are the same.

Are Medigap premiums based on income like Part B and Part D?

No. Medigap premiums are set by age, health, tobacco use, and location under state insurance rules and never factor in your MAGI or IRMAA status. A high earner and a low earner pay the same Medigap premium for the identical plan letter, insurer, and zip code in 2026.

When will I find out my 2026 IRMAA amount?

Social Security typically mails IRMAA determination notices in the fall before the new premium year begins, using the most recent tax return the IRS has on file, generally your 2024 return for 2026 premiums. You can also check your current premium anytime in your online my Social Security account at ssa.gov.

What is the difference between the standard Part B premium and IRMAA?

The standard Part B premium is what roughly 92% of beneficiaries pay: $202.90 a month in 2026. IRMAA is an additional surcharge added only for the highest-earning roughly 8% of beneficiaries, based on their MAGI from two years earlier. IRMAA is not a separate program: it is simply a higher total premium for Part B and Part D.