Medicare IRMAA 2026: What Higher-Income Greensboro Retirees Should Know
If you have built up savings, a pension, or investment income for retirement, there is a Medicare cost that can catch you by surprise: a higher-income surcharge called IRMAA. For 2026, the standard Part B premium is $202.90 a month, but higher earners pay more, sometimes a great deal more. This is Medicare IRMAA 2026 in plain English: who pays it, what the income brackets are, why it is based on a tax return from two years ago, and what you can do if a life change has already lowered your income.
What is IRMAA, and who pays it in 2026?
IRMAA stands for the Income-Related Monthly Adjustment Amount. It is an extra charge added on top of your standard Part B and Part D premiums when your income is above a set threshold. It is not a separate bill you sign up for. Social Security simply adjusts your premium, and for most people the amount comes right out of the Social Security check.
The good news is that IRMAA affects a relatively small group. According to the Centers for Medicare and Medicaid Services, only about 8 percent of people with Medicare Part B pay it. If your 2024 income was $109,000 or less as a single filer, or $218,000 or less as a married couple filing jointly, you are below the first threshold and you pay the standard premium with no surcharge at all.
The 2026 Part B IRMAA brackets
Here is what you actually pay each month for Part B in 2026, based on the income you reported on your 2024 tax return. The figure in the last column is the total monthly premium, not an add-on.
| 2024 income, single filer | 2024 income, married filing jointly | Total Part B premium each month (2026) |
|---|---|---|
| $109,000 or less | $218,000 or less | $202.90 (standard) |
| Above $109,000 up to $137,000 | Above $218,000 up to $274,000 | $284.10 |
| Above $137,000 up to $171,000 | Above $274,000 up to $342,000 | $405.80 |
| Above $171,000 up to $205,000 | Above $342,000 up to $410,000 | $527.50 |
| Above $205,000 and below $500,000 | Above $410,000 and below $750,000 | $649.20 |
| $500,000 or more | $750,000 or more | $689.90 |
One detail matters here, and it surprises many people. IRMAA is a cliff, not a gentle slope. If your income lands even one dollar over a threshold, you pay the full surcharge for that whole bracket. And the surcharge is per person. If you and your spouse are both on Medicare, each of you pays your own amount, so a couple in the first surcharge bracket pays the higher premium twice.
The 2026 Part D IRMAA surcharges
Higher income also raises what you pay for Part D prescription drug coverage. This surcharge is separate from what you pay your drug plan. You keep paying your plan its normal premium, and the IRMAA amount below is added on top and paid to Medicare, usually through your Social Security check.
| 2024 income, single filer | 2024 income, married filing jointly | Extra Part D cost each month (2026) |
|---|---|---|
| $109,000 or less | $218,000 or less | $0 |
| Above $109,000 up to $137,000 | Above $218,000 up to $274,000 | $14.50 |
| Above $137,000 up to $171,000 | Above $274,000 up to $342,000 | $37.50 |
| Above $171,000 up to $205,000 | Above $342,000 up to $410,000 | $60.40 |
| Above $205,000 and below $500,000 | Above $410,000 and below $750,000 | $83.30 |
| $500,000 or more | $750,000 or more | $91.00 |
Why your 2024 income sets your 2026 premium
This is the part that trips up new retirees. Social Security does not look at what you earn today. It looks back at your most recent tax return on file, which is generally the one from two years earlier. So your 2026 IRMAA is built on the income you reported for 2024.
That two-year lookback creates a common trap. Say you sold a home in 2024, converted a traditional IRA to a Roth, or took a large one-time withdrawal. Your income for that single year may have jumped well above your normal level. Even if your income in 2026 is modest, that 2024 spike can still push your Medicare premiums up for the year. It is worth knowing this is temporary. Because Social Security recalculates every year, a single high year does not lock you in forever.
What counts as income for IRMAA?
The number that matters is your modified adjusted gross income, or MAGI. In simple terms, that is your adjusted gross income plus any tax-exempt interest, such as interest from municipal bonds. It includes more than most people expect: withdrawals from traditional IRAs and 401(k) accounts, Roth conversions, capital gains from selling investments or property, dividends, taxable pension income, and wages if you are still working. Money you already paid tax on, like a Roth withdrawal, does not count again, which is one reason Roth accounts can be helpful in retirement planning.
What to do if a life change lowered your income
If your income has dropped since 2024 because of a major life event, you do not have to simply accept a surcharge built on old numbers. Social Security lets you ask for a new decision using Form SSA-44, titled Medicare Income-Related Monthly Adjustment Amount, Life-Changing Event. If your situation fits one of these eight events, it is worth filing:
- The death of your spouse
- Marriage
- Divorce or annulment
- You or your spouse stopped working, including retirement
- You or your spouse reduced your work hours
- You lost income from income-producing property through no fault of your own
- You lost or had a reduction in certain pension income
- You received a settlement from an employer due to the employer's closure, bankruptcy, or reorganization
On the form you note the event and its date, give your expected income for the year you want Social Security to use, and attach proof, such as a retirement letter, a final pay stub, a marriage certificate or divorce decree, or a death certificate. You can mail or fax it to your local Social Security office, bring it in person, or call Social Security at 1-800-772-1213 for help. Retirement is the most common reason people file, and it is exactly the kind of change the form is designed for.
Simple ways to plan ahead
You cannot change your 2024 return, but you can plan future years so IRMAA does not catch you off guard:
- Before a large IRA withdrawal, Roth conversion, or the sale of an investment property, check where it would place your income against the brackets above. Sometimes spreading the income across two years keeps you under a threshold.
- If you give to charity and are 70 and a half or older, a Qualified Charitable Distribution from your IRA can satisfy a required withdrawal without adding to your MAGI.
- Remember the cliff. If you are close to a bracket line, a small change can be the difference between two premium levels for the whole year.
- Coordinate with your tax professional. We do not give tax advice, but we do help you see how a financial decision would land on your actual Medicare costs, so you and your accountant can plan with the full picture.
A note for Greensboro and Piedmont families
IRMAA is a federal rule, so your state does not change it. North Carolina does not tax Social Security benefits, which is a real comfort for retirees here, but remember that IRA and 401(k) withdrawals, Roth conversions, and investment gains still count toward the federal MAGI that drives your Medicare premium. It is one more reason to look at the whole picture before a big financial move.
IRMAA is a concern for higher-income households. If money is tight instead, the picture is very different, and there is real help available through Medicare Savings Programs and Extra Help. And whatever your income, the 2026 Part D out-of-pocket cap now limits what anyone pays for covered drugs in a year. Medicare has a lot of moving parts, and you do not have to sort them out alone.
Frequently asked questions
What is the Medicare IRMAA for 2026?
Medicare IRMAA 2026 is an income-related surcharge added to your Part B and Part D premiums when your 2024 income was above $109,000 for a single filer or $218,000 for a couple filing jointly. Total Part B premiums for higher earners range from $284.10 to $689.90 a month, with Part D surcharges from $14.50 to $91.00 a month.
What income does 2026 IRMAA use?
It uses the modified adjusted gross income from your 2024 tax return, because Social Security applies a two-year lookback. That is your adjusted gross income plus any tax-exempt interest.
How can I lower or avoid IRMAA?
If a life change such as retirement or the death of a spouse has reduced your income, file Form SSA-44 to ask Social Security to use more recent figures. Going forward, planning the timing of IRA withdrawals, Roth conversions, and large sales can help keep your income under a bracket threshold.
Does IRMAA last forever?
No. Social Security recalculates it every year based on your latest tax return, so a single high-income year does not set your premium permanently.
Ready to look at how your income and Medicare costs fit together for 2026? Reach out to Seniors Insurance Hub for a friendly, no-cost review. We serve seniors and their families across Greensboro and the Piedmont, and we are happy to walk through it with you.
This article is general information for residents of North Carolina and is not tax, legal, or financial advice. Premium and income figures are for plan year 2026 as published by the Centers for Medicare and Medicaid Services. Confirm your own situation with Social Security, Medicare, and your tax professional. Seniors Insurance Hub is not connected with or endorsed by the federal Medicare program or any government agency.
