Most Medicare beneficiaries will pay $202.90 per month for Part B in 2026 — that’s up from $185.00 in 2025. But that standard premium is only the starting point. If your income is above certain thresholds, the Income-Related Monthly Adjustment Amount, known as IRMAA, can add anywhere from $81.20 to $487.00 on top of your base premium.
Understanding how these numbers affect you — and what you can do about them — is one of the most important parts of Medicare planning.
What Part B Covers and What It Costs
Medicare Part B covers outpatient medical services: doctor visits, preventive screenings, lab work, outpatient surgery, and durable medical equipment. It’s the half of Original Medicare that handles everything that doesn’t happen in a hospital.
For 2026, the key numbers are:
- Monthly premium: $202.90 (standard, for most enrollees)
- Annual deductible: $283 (up from $257 in 2025)
- Coinsurance: After you meet the deductible, you generally pay 20% of the Medicare-approved amount for covered services
The $202.90 standard premium applies if your modified adjusted gross income (MAGI) from your most recent tax return is at or below $109,000 for individuals or $218,000 for married couples filing jointly.
How IRMAA Works
IRMAA is a surcharge that Medicare applies to higher-income beneficiaries. It’s based on your MAGI from two years prior — so your 2024 tax return determines your 2026 IRMAA bracket. If your income has gone up or down significantly since then, you may be able to request a reassessment.
Here are the 2026 IRMAA brackets for individuals:
| MAGI Range | IRMAA Surcharge | Total Monthly Part B Premium |
|---|---|---|
| $109,000 or less | $0.00 | $202.90 |
| $109,001 – $137,000 | $81.20 | $284.10 |
| $137,001 – $171,000 | $202.90 | $405.80 |
| $171,001 – $205,000 | $324.60 | $527.50 |
| $205,001 – $499,999 | $446.30 | $649.20 |
| $500,000 or more | $487.00 | $689.90 |
And for married couples filing jointly:
| MAGI Range | IRMAA Surcharge | Total Monthly Part B Premium |
|---|---|---|
| $218,000 or less | $0.00 | $202.90 |
| $218,001 – $274,000 | $81.20 | $284.10 |
| $274,001 – $342,000 | $202.90 | $405.80 |
| $342,001 – $410,000 | $324.60 | $527.50 |
| $410,001 – $749,999 | $446.30 | $649.20 |
| $750,000 or more | $487.00 | $689.90 |
At the highest bracket, a couple could pay a combined $1,379.80 per month for Part B alone — nearly seven times the standard premium.
Why IRMAA Matters More Than You Think
Many retirees don’t realize that IRMAA is based on income from two years ago. If you had a high-income year — from selling a property, taking a large retirement distribution, or collecting capital gains — you could face a surcharge you didn’t expect.
The most common triggers that push people into higher IRMAA brackets:
- Retirement account distributions: Large 401(k) or IRA withdrawals count as income
- Roth conversions: Converting significant amounts in a single year can spike your MAGI
- Capital gains: Selling investments or real estate at a profit
- Part-time work: Continued employment income in early retirement
The key thing to understand is that IRMAA isn’t a penalty — it’s a premium adjustment based on what the government considers your ability to pay. But that doesn’t make it any less painful when it shows up on your bill.
Can You Challenge an IRMAA Determination?
Yes. If your income has changed because of a life event — retirement, divorce, death of a spouse, or reduction in work hours — you can request that Medicare reconsider your IRMAA bracket. You’ll need to fill out Form SSA-44 and provide documentation of the qualifying event.
Common life events that qualify for a reassessment:
- Retirement or significant reduction in work hours
- Marriage or divorce
- Death of a spouse
- Loss of income-producing property
- Employer settlement or severance
The reassessment is not automatic — you have to file the request. Many beneficiaries don’t know this option exists, which means they overpay for months or even years.
What Part B Doesn’t Cover
Part B is an important piece of Medicare, but it has gaps. It doesn’t cover:
- Routine dental care
- Vision exams and glasses
- Hearing aids
- Prescription drugs (that’s Part D)
- Skilled nursing facility care beyond what Part A covers
- Private-duty nursing
This is where supplemental coverage becomes relevant. A Medicare Supplement (Medigap) plan can help cover the out-of-pocket costs that Original Medicare doesn’t — including the 20% coinsurance after your Part B deductible. Some Medicare Advantage plans also bundle extra benefits like dental, vision, and hearing.
Planning Ahead: Steps to Take Now
Whether you’re already on Medicare or approaching 65, here are practical steps to manage your Part B costs:
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Review your tax returns. Your MAGI from two years ago determines today’s IRMAA bracket. Look at your 2024 return to understand where you currently sit.
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Plan large income events carefully. If you’re considering a Roth conversion, property sale, or other significant distribution, talk to a tax professional about how it might affect your Medicare premiums in future years.
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Don’t ignore the reassessment process. If you’ve had a qualifying life event, file Form SSA-44. The worst that happens is your request is denied — but many beneficiaries successfully lower their premiums.
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Consider your full coverage picture. Part B is just one piece. Evaluate whether a Medigap plan or Medicare Advantage plan makes sense for your situation, your budget, and your health needs.
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Work with an independent advisor. An independent insurance agent can walk you through your options across multiple carriers and plans — not just one company’s products. That means you get a recommendation based on what fits you, not what fits a sales quota.
The Bottom Line
Medicare Part B costs are going up in 2026, and IRMAA makes that increase significantly worse for higher-income beneficiaries. The standard premium of $202.90 is manageable for most people, but if your income places you in one of the higher brackets, your monthly bill could be two, three, or even six times that amount.
The good news: there are ways to plan for and potentially reduce these costs. But it requires understanding the rules, reviewing your income history, and taking action before the surcharge lands on your bill.
Trek Insurance Solutions is a Third-Party Marketing Organization (TPMO). We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
For more information, visit us at trekis.net or call 888-960-0442.