Medicare income-related premium surcharges from your tax return two years back
Updated October 2026
From the CMS fact sheet of November 14, 2025. The surcharge is the amount above the $202.90 standard Part B premium plus the Part D adjustment, which is added to whatever your drug plan charges.
| Single MAGI | Joint MAGI | Part B per person | Part D add-on | Extra per person per year |
|---|---|---|---|---|
| $109,000 or less | $218,000 or less | $202.90 | $0.00 | $0 |
| $109,001-$137,000 | $218,001-$274,000 | $284.10 | $14.50 | $1,148 |
| $137,001-$171,000 | $274,001-$342,000 | $405.80 | $37.50 | $2,885 |
| $171,001-$205,000 | $342,001-$410,000 | $527.50 | $60.40 | $4,620 |
| $205,001-$499,999 | $410,001-$749,999 | $649.20 | $83.30 | $6,355 |
| $500,000 or more | $750,000 or more | $689.90 | $91.00 | $6,936 |
Married people who lived together at any time in the year but file separately pay the standard premium up to $109,000 and jump straight to the $649.20 Part B tier and $83.30 Part D add-on above that ($689.90 and $91.00 at $391,000 or more). Each spouse on Medicare pays the surcharge separately.
A single filer whose 2024 return shows $136,000 of AGI and $4,000 of tax-exempt municipal bond interest has IRMAA MAGI of $140,000. That is above $137,000 and not above $171,000, the second surcharge tier. Part B: $405.80 − $202.90 = $202.90 a month extra. Part D: $37.50 a month extra. Total: ($202.90 + $37.50) × 12 = $2,884.80 for 2026. Reducing 2024 MAGI by $3,000, to $137,000, would have dropped the surcharge to tier 1: ($81.20 + $14.50) × 12 = $1,148.40, a $1,736.40 difference for $3,000 of income.
For IRMAA, modified adjusted gross income is adjusted gross income (Form 1040 line 11) plus tax-exempt interest (line 2a), from the return two years before the premium year. Social Security gets it from the IRS, so it already includes Roth conversions, capital gains, required minimum distributions, pension and IRA withdrawals, and the taxable part of Social Security benefits. Roth IRA withdrawals, HSA withdrawals for medical costs, and money from a reverse mortgage do not count. If the two-year-old return is not available, Social Security uses the return from three years back and corrects it later.
| Household | 2024 MAGI | Tier | Part B each | Part D add-on each | Extra per year (household) |
|---|---|---|---|---|---|
| Single retiree right at the line | $109,000 | None | $202.90 | $0.00 | $0.00 |
| Single retiree $1 over | $109,001 | Tier 1 | $284.10 | $14.50 | $1,148.40 |
| Single retiree with a pension and RMDs | $140,000 | Tier 2 | $405.80 | $37.50 | $2,884.80 |
| Couple, both on Medicare | $280,000 | Tier 2 | $405.80 | $37.50 | $5,769.60 |
| Single, large stock sale in 2024 | $210,000 | Tier 4 | $649.20 | $83.30 | $6,355.20 |
| Married filing separately, lived together | $120,000 | Tier 4 | $649.20 | $83.30 | $6,355.20 |
The first two rows are one dollar apart and differ by more than $1,100 a year. The couple pays twice because each spouse on Medicare is billed separately.
2027 premiums will be based on 2025 tax returns. As of October 22, 2026, CMS had not announced the 2027 Part B premium or IRMAA brackets; it usually does so in November. The lower thresholds are adjusted each year for inflation, so the 2027 lines will likely sit above the 2026 ones, but this calculator does not guess them. When CMS publishes the figures, the brackets here will be updated.
One-time income. A home sale gain above the exclusion, a large Roth conversion, or a year-end mutual fund distribution can push one year over a line; spreading conversions across years can keep each under a threshold. Forgetting tax-exempt interest. Municipal bond interest is not taxed, but it is added back for IRMAA. Separate returns. Married couples who lived together and file separately face the harshest schedule. Not appealing after retirement. If your income fell because you stopped or reduced work, divorced, were widowed, or lost a pension or income-producing property, file form SSA-44 to have a more recent year used. Thinking a Medicare Advantage plan avoids it. The Part B surcharge applies whatever kind of plan you have, and the Part D add-on applies to drug coverage inside an Advantage plan too.
It does not model an SSA-44 appeal, an amended return, or a mid-year change in filing status, and it does not include your drug plan’s own premium or the Part B deductible ($283 in 2026). It assumes the published 2026 tables apply to you; people who buy into Part A or pay a late-enrollment penalty pay more. If you are planning Roth conversions or a large sale near a threshold, a tax professional can weigh the IRMAA cost against the tax saving before the end of the year, since the surcharge is set by the return itself.