If you are in your late 50s or early 60s, Medicare may feel years away. But one part of Medicare cost can be shaped by decisions you make before you ever enroll.
It is called IRMAA, the income-related monthly adjustment amount. It is an extra charge added to Medicare Part B and Part D premiums for people with higher incomes.
This article is educational. It is not tax, insurance, or investment advice.
Since 2007, a beneficiary's Part B monthly premium has been based on income, according to CMS. These adjustments affect roughly 8% of people with Medicare Part B. (CMS)
Part D has a similar income-related adjustment, added on top of your drug plan premium. (CMS)
IRMAA generally uses your modified adjusted gross income from the tax return two years earlier. So 2027 Medicare premiums are generally based on 2025 income, and 2028 premiums on 2026 income. If the IRS has not yet provided that return, Social Security may use the one from three years earlier. (SSA)
That is why this topic matters before Medicare. If you plan to retire at 63 and start Medicare at 65, your income at 63 may be the year that counts.
Things that can raise income in a given year include a large IRA withdrawal, a Roth conversion, selling appreciated investments, or a final year of salary and bonus.
Here is the official CMS table for 2026 Part B premiums with full Part B coverage. These are 2026 figures, not 2027. We show them only as a reference point until CMS announces the 2027 brackets. (CMS)
| Individual return MAGI | Joint return MAGI | Total monthly Part B premium |
|---|---|---|
| $109,000 or less | $218,000 or less | $202.90 |
| Over $109,000 to $137,000 | Over $218,000 to $274,000 | $284.10 |
| Over $137,000 to $171,000 | Over $274,000 to $342,000 | $405.80 |
| Over $171,000 to $205,000 | Over $342,000 to $410,000 | $527.50 |
| Over $205,000 and less than $500,000 | Over $410,000 and less than $750,000 | $649.20 |
| $500,000 or more | $750,000 or more | $689.90 |
For 2026, the Part D adjustment ranges from $14.50 to $91.00 per month at those same income levels. (CMS)
Married people who lived with their spouse during the year but file separately have a different, steeper table. See the CMS fact sheet.
As of October 13, 2026, CMS has not announced the 2027 Part B premium or IRMAA brackets. CMS released the 2026 figures on November 14, 2025, and has historically released the next year's figures in the fall. The 2027 premium and income brackets will be set by CMS. You may see projections online; those are estimates, not official figures. We will wait for CMS and update this article then.
IRMAA works in tiers. Going one dollar over a threshold can move you into the next tier for the whole year. That is why it can help to know where your income is likely to land before year-end decisions, especially in the years just before Medicare.
Life changes. SSA lets you ask to lower IRMAA after a life-changing event that reduced income, such as marriage, divorce or annulment, the death of a spouse, work stoppage or reduction, loss of income-producing property, loss of pension income, or an employer settlement payment. The form is SSA-44. (SSA)
For widows and widowers, this can matter. The year a spouse dies can change both filing status and income. Our first 90 days checklist covers other early steps.
IRMAA is not a penalty for faithfulness or success. It is a rule to understand. Seeing it early lets you make calm choices instead of surprised ones. If you are already on Medicare, our Medicare Open Enrollment 2027 checklist covers the yearly plan review. You can also read about our IRMAA planning services. Our Pre-Retiree Money Map and Houston retirement paycheck clarity page show how this fits the bigger picture.
Curious how Medicare costs fit into your retirement paycheck? Start with the Free Retirement Paycheck Readiness Scorecard or request a Retirement Clarity Call. Office: 620-670-9455.
I'm Will Snodgrass, a CFP® professional and fiduciary asset manager with Matt25 Capital, serving Christian households in The Woodlands, Houston, and across Texas.
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