2026 Medicare Part B IRMAA Calculator: Surcharge & Premium Estimator

Medicare Part B is the medical insurance portion of Original Medicare. It covers two broad categories of services. First, medically necessary services — things your doctor considers necessary to diagnose or treat a medical condition. Second, preventive services — screenings, vaccines, and annual wellness visits designed to prevent illness or catch it early.

Specific examples include: doctor visits and specialist consultations, outpatient surgery and procedures, emergency room care, lab tests and X-rays, mental health services (outpatient), physical and occupational therapy, durable medical equipment (wheelchairs, walkers, oxygen equipment), ambulance transport when medically necessary, and some home health care.

What Part B does NOT cover: prescription drugs (that is Part D), routine dental, vision, and hearing care, long-term custodial care, and most care received outside the United States.

Your Initial Enrollment Period (IEP) is a 7-month window: 3 months before, the month of, and 3 months after you turn 65. Signing up during the first 3 months of that window means coverage starts on your birthday month. Waiting until the last 3 months may delay your start date.

If you have employer coverage at 65: you can delay Part B enrollment without penalty as long as you or your spouse is actively working and you are covered under a current employer group health plan. Once that coverage ends, you get a Special Enrollment Period (SEP) of 8 months to sign up penalty-free.

Late enrollment penalty: if you miss both windows and have no qualifying employer coverage, you pay a 10% premium penalty for every full 12-month period you were eligible but not enrolled. This penalty is permanent — it stays on your premium for as long as you have Part B.

For 2026, the Medicare Part B annual deductible is $283. This is the amount you pay out of pocket before Part B begins covering services. The deductible resets every January 1.

After you meet the deductible, you generally pay 20% coinsurance of the Medicare-approved amount for most Part B services. Medicare pays the remaining 80%. Unlike most private insurance plans, there is no annual out-of-pocket maximum in Original Medicare — that 20% applies to every service all year with no cap.

For example: if your doctor bills $1,000 for a procedure and Medicare approves $800, you pay 20% of $800 = $160 after meeting your deductible. This is why many people purchase a Medigap supplemental policy — it pays all or part of that 20%.

Yes — you can voluntarily disenroll from Part B if you have other creditable health coverage, such as coverage from an employer or union based on active employment (yours or a spouse’s).

To disenroll, you complete Form CMS-1763 and submit it to your local Social Security office. Note: this requires a telephone interview with SSA because they are required to inform you of the risks before processing the disenrollment.

Important re-enrollment rules: if you later lose that employer coverage, you have an 8-month Special Enrollment Period to re-enroll in Part B without penalty. But if you miss that window, you will face the 10% late enrollment penalty on your premium for every 12-month period you were without Part B coverage after the SEP ended.

Medicare sets an approved payment rate for every covered service. Providers who accept Medicare assignment agree to accept that rate as payment in full — you pay only your 20% coinsurance. Most doctors and providers take assignment.

Providers who do not accept assignment (called non-participating providers) can charge up to 15% more than the Medicare-approved amount. That extra 15% is the “excess charge” and you pay it entirely out of pocket. Your Medigap plan pays excess charges only if you have Plan F or Plan G (Plan G is now the most comprehensive plan for new enrollees since Plan F was phased out for new enrollees after 2020).

To avoid excess charges: always confirm a provider accepts Medicare assignment before scheduling. You can search participating providers at medicare.gov/care-compare.

The standard monthly Medicare Part B premium for 2026 is $202.90 — an increase of $17.90 (about 9.7%) from the 2025 premium of $185.00. CMS announced this figure on November 14, 2025.

Most Medicare enrollees pay this standard rate. It covers roughly 25% of the actual cost of Part B services — the federal government subsidizes the remaining 75% for standard-rate enrollees.

For higher-income beneficiaries, the IRMAA surcharge adds between $81.20 and $487.00 per month on top of the $202.90 base premium, bringing the possible range to $284.10–$689.90 per month depending on income tier.

There are three reasons your Part B premium may exceed $202.90:

1. IRMAA surcharge: if your 2024 Modified Adjusted Gross Income (MAGI) exceeds $109,000 (single) or $218,000 (joint), you pay an income-related surcharge on top of the standard premium. This is the most common reason. The surcharge ranges from +$81.20 to +$487.00/month.
2. Late enrollment penalty: if you did not enroll in Part B when first eligible and had no employer coverage exception, you pay a 10% penalty on the base premium for every full 12-month period you delayed. This penalty is permanently added to your monthly premium.
3. Hold-harmless rule exception: a few beneficiaries who do not collect Social Security are billed directly and may be subject to different premium calculation rules that result in slightly different amounts.

Check your SSA Determination Notice or call SSA at 1-800-772-1213 to confirm which reason applies to your specific situation.

If you receive Social Security: your entire Part B premium — including any IRMAA surcharge — is automatically deducted from your monthly Social Security direct deposit or check. You see a net deposit rather than a gross benefit. There is no separate bill to pay.

If you do not yet receive Social Security: you receive a quarterly Medicare bill from CMS. You can pay it by check, online at pay.gov, through Medicare Easy Pay (automatic bank draft), or via your bank’s bill pay service. Quarterly billing means you pay 3 months at a time.

If you have Railroad Retirement Board (RRB) benefits: your premium is deducted from your RRB check, similar to the SSA process.

In practice, yes — the standard Part B premium has increased almost every year since Medicare’s inception. CMS typically announces the following year’s rate in November. The increase is driven by projected healthcare cost growth and Medicare program spending estimates.

However, the hold-harmless rule limits how much the premium can increase for most Social Security recipients: your Part B premium increase in any year cannot exceed the dollar amount of your Social Security cost-of-living adjustment (COLA). This protects your net Social Security benefit from shrinking due to premium increases.

The hold-harmless rule does not apply to IRMAA payers, new Medicare enrollees, or people who do not receive Social Security benefits. Those groups can see the full dollar increase applied without limitation.

This is one of the most common misunderstandings about Medicare Advantage. IRMAA applies to Part B and Part D regardless of whether you are in Original Medicare or Medicare Advantage.

When you enroll in a Medicare Advantage plan, you still pay your Part B premium (including any IRMAA). Your Part B IRMAA is deducted from your Social Security check the same way it would be in Original Medicare. The Medicare Advantage plan then receives a capitation payment from CMS to cover your care instead of CMS paying providers directly.

If your Medicare Advantage plan includes drug coverage (MA-PD plan), your Part D IRMAA is also still owed — deducted separately from your Social Security check, not paid to the MA plan. Many people enrolled in MA-PD plans are surprised to find Part D IRMAA charges on their Social Security statements.

Medicare uses your Modified Adjusted Gross Income (MAGI) — a specific income definition from your federal tax return. MAGI = your AGI (line 11 of Form 1040) plus any tax-exempt interest income (line 2a of Form 1040, typically municipal bond interest).

Income that counts toward MAGI: wages and salary, self-employment income, pension and annuity distributions, taxable Social Security benefits (up to 85%), Required Minimum Distributions (RMDs) from traditional IRAs and 401(k)s, Roth IRA conversions (the converted amount), capital gains (short and long-term), rental income, and tax-exempt municipal bond interest.

Income that does NOT count: qualified Roth IRA distributions, qualified Roth 401(k) distributions, HSA distributions used for medical expenses, life insurance proceeds, reverse mortgage loan proceeds, and inheritances or gifts received.

No — qualified Roth IRA distributions are completely excluded from gross income and therefore do not count toward MAGI for IRMAA purposes. This is one of the most powerful advantages of Roth accounts in retirement.

A qualified distribution requires that: (1) the Roth IRA has been open for at least 5 years, and (2) you are age 59½ or older (or meet another qualifying reason like disability or first home purchase up to $10,000).

The same exclusion applies to qualified Roth 401(k) distributions after separation from service at age 59½ or older and after the 5-year holding period is met.

Important distinction: a Roth IRA conversion — moving money from a traditional IRA to a Roth — is fully taxable in the year of conversion and does count toward MAGI. Only the distributions from an already-funded Roth account are excluded.

Yes — all capital gains count toward MAGI for IRMAA purposes. This includes short-term gains (taxed as ordinary income), long-term gains (from assets held over one year), gains from selling investment property, and gains from selling a business or other capital assets.

Even reinvested capital gain distributions from mutual funds and ETFs count — if your fund distributes a capital gain in December and automatically reinvests it, that gain still appears on your 1099 and flows into your MAGI for IRMAA.

One partial exception — home sale exclusion: if you sell your primary residence and qualify for the $250,000 / $500,000 home sale exclusion, the excluded portion does not count. But any gain above the exclusion limit does flow into MAGI.

Yes — but only the taxable portion of your Social Security benefit is included in your AGI and therefore in MAGI. The taxable portion is calculated using the IRS provisional income formula and is based on your combined income:

• Up to 50% of your Social Security is taxable if your provisional income is $25,000–$34,000 (single) or $32,000–$44,000 (joint).
• Up to 85% of your Social Security is taxable if your provisional income exceeds $34,000 (single) or $44,000 (joint).

Most Medicare-age retirees with IRMAA exposure have high enough incomes that 85% of their Social Security benefit is taxable and counted in MAGI. For someone with a $30,000 annual SS benefit, that means approximately $25,500 flows into MAGI.

This creates a feedback loop: higher investment income → more SS becomes taxable → higher MAGI → higher IRMAA → lower net SS check.

Yes — and this surprises many retirees. Tax-exempt interest income is added back into your AGI specifically to calculate MAGI for IRMAA purposes. Even though muni bond interest does not appear as taxable income on your return, it is reported on line 2a of Form 1040 and SSA adds it to your AGI when setting your Medicare premium.

This means a retiree with a $500,000 muni bond portfolio generating $18,000/year in tax-free interest still sees that $18,000 count toward their MAGI for IRMAA. If that $18,000 pushes them over an IRMAA threshold, the annual premium increase (e.g. +$1,332/year) may exceed the tax benefit of the muni bond interest over the regular taxable bond alternative.

This is worth modeling carefully before allocating heavily to municipal bonds in taxable accounts, especially if you are near an IRMAA cliff edge.

The two-year lookback exists because of data timing between the IRS and Social Security. When CMS sets your 2026 Medicare premium in the fall of 2025, your 2025 tax return has not yet been filed. The most recently available return is 2024. So SSA uses your 2024 MAGI to calculate your 2026 IRMAA surcharge.

The exact chain: you file your 2024 return by April 2025 → the IRS shares income data with SSA → SSA compares your MAGI to the 2026 bracket thresholds → SSA sends you an IRMAA notice in fall 2025 → the surcharge takes effect January 1, 2026.

This creates a delayed consequence for one-time income events. A large Roth conversion or property sale in 2024 affects your 2026 and 2027 premiums because the high-income year shows up in two consecutive lookback cycles.

IRMAA is not permanent — it is reassessed every single year. Each fall, SSA reviews your most recent available tax return and sends a new determination for the upcoming year. If your income drops, your tier drops (or disappears entirely) in the next premium year.

This means IRMAA is not a life sentence. A retiree who had a high-income year due to a one-time event (selling property, large Roth conversion) will pay elevated premiums for the two years that event follows them through the lookback system — but the third year can return to Tier 0 if subsequent income is lower.

The annual review also means that inflation-adjusted bracket increases can sometimes lift you out of a tier without any change in your real income. As bracket thresholds rise each year, some beneficiaries find themselves just below a threshold they previously crossed.

Congress deliberately set harsh IRMAA thresholds for Married Filing Separately (MFS) to prevent income-splitting games where a high-earning couple could lower each spouse’s individual MAGI by filing separately. The MFS structure has only two tiers: Tier 0 (MAGI ≤ $109,000) and Tier 4 (MAGI > $109,000). There are no intermediate tiers.

This means a person filing separately with $120,000 of MAGI pays the same surcharge as someone filing separately with $450,000 of MAGI — both land at Tier 4, which carries a $370/month Part B surcharge, bringing the total Part B premium to $572.90.

When MFS is worth considering despite the IRMAA penalty: income-driven student loan repayment plans (PAYE, SAVE) that are based on individual income, situations where one spouse has large unreimbursed medical expenses, or legal liability separation needs. Always compare the total tax + IRMAA cost of MFS versus joint filing before choosing.

Yes — IRMAA applies to both Part B and Part D. If your income exceeds the thresholds, you pay a Part D IRMAA surcharge in addition to your drug plan’s regular monthly premium. The 2026 Part D IRMAA surcharge ranges from $12.90 to $81.00 per month depending on your income tier.

The Part D IRMAA is not paid to your drug plan — it is deducted from your Social Security check separately, just like your Part B premium. Your drug plan bills you (or deducts) only its own base premium. If you receive an SSA statement, you may see both deductions listed separately.

Part D IRMAA applies whether you have a standalone Part D plan or get drug coverage through a Medicare Advantage Prescription Drug (MA-PD) plan. It also applies in Part D eligible individuals enrolled in PACE plans.

Yes — IRMAA is assessed per person, not per household. When two spouses are both enrolled in Medicare and their joint MAGI exceeds the filing threshold, both spouses independently owe Part B IRMAA and (if applicable) Part D IRMAA on their individual coverage.

The joint filing brackets are roughly double the single brackets (e.g., Tier 1 starts at $218,000 joint vs. $109,000 single) — but the surcharge dollar amounts are per-person, not halved for couples.

Example: a couple with $312,000 joint MAGI in Tier 2 each pays $185.00/month in Part B IRMAA — a combined household surcharge of $370.00/month, or $4,440.00/year for Part B alone. Adding Part D IRMAA for both brings the household total to over $5,200/year in surcharges.

This household doubling effect is one of the strongest arguments for IRMAA planning that couples do together — not each spouse in isolation.

No — you can appeal using Form SSA-44. Retirement is one of the qualifying life-changing events that allows you to request a reconsideration of your IRMAA determination. You do not have to wait for the annual automatic review cycle.

File Form SSA-44 at your local Social Security office or mail it to SSA as soon as you retire. You will need to provide: your IRMAA determination notice, proof of the retirement event (a retirement letter, final pay stub, or employer separation notice), and a current-year income estimate showing the lower projected MAGI.

SSA will use your current-year estimate to determine which tier applies going forward. If approved, your reduced premium typically takes effect in the month you file — adjustments are generally not retroactive to January. The sooner you file, the more months of lower premiums you capture.

SSA recognizes the following qualifying life-changing events for an IRMAA appeal:

• Marriage
• Divorce or annulment
• Death of your spouse
• You or your spouse stopped working (full retirement or resignation)
• You or your spouse reduced work hours significantly (partial retirement)
• Loss of income-producing property due to a disaster, fraud, or other event beyond your control
• Loss or reduction of pension income from an employer whose plan was terminated or reduced
• Employer settlement payment — a one-time payment received in the lookback year that was included in income but will not recur

Voluntary decisions like choosing to retire, sell a business, or take an early distribution do not qualify for the appeal if they were deliberate choices — only events that happened to you rather than decisions you made. Note: voluntary retirement does qualify because stopping work is explicitly listed.

If your IRMAA determination is based on incorrect income data — a different tax year than expected, an income figure that does not match your filed return, or data from an amended return that was not processed — you have the right to a formal reconsideration.

Steps to take:

1. Call SSA immediately at 1-800-772-1213 to flag the discrepancy. Request to speak with a Medicare specialist.
2. Bring or send supporting documentation: a copy of the tax return SSA should have used, your 1040 transcript from the IRS (available at irs.gov/get-transcript), and the IRMAA notice showing the incorrect figure.
3. If SSA used an older tax year as a fallback (because your recent return was not yet processed), you can request they substitute the more recent return once it has been filed and processed by the IRS — no life-event appeal required.
4. If you filed a 1040-X amended return that reduced your MAGI, proactively contact SSA with a copy rather than waiting for the correction to flow through automatically.

When you first enroll in Medicare, SSA applies the same two-year lookback rule: your first-year premium is based on your MAGI from two years prior. If you turn 65 in 2026 and your 2024 MAGI was $145,000, you start Medicare in Tier 2 — even if you retired in 2025 and now earn much less.

If your 2024 return is not yet available when SSA makes your initial determination, they may use your 2023 return as a fallback. Once your 2024 return is filed and processed, you can request SSA update the determination to use the more accurate recent data.

New Medicare enrollees who retired shortly before enrollment are among the most common candidates for an SSA-44 appeal — because the two-year lookback almost always captures their last high-earning year. File the appeal as soon as you enroll if your current income is substantially lower than the lookback year.

The most effective strategies financial advisors use to reduce IRMAA are:

• Roth conversions before age 63: Roth withdrawals are invisible to MAGI. Converting traditional IRA funds to Roth in low-income years before Medicare enrollment permanently reduces future RMDs and future MAGI.
• Qualified Charitable Distributions (QCDs): starting at age 70½, direct IRA-to-charity transfers up to $105,000/year satisfy RMD obligations without counting as income — zero MAGI impact.
• Tax-loss harvesting: offsetting capital gains with realized investment losses in the same tax year reduces net gains flowing into MAGI.
• Deferring discretionary distributions: if you are near a cliff edge, delaying a non-urgent IRA withdrawal to January 1 of the next year moves it out of the current lookback year entirely.
• HSA contributions while working: pre-Medicare HSA contributions reduce AGI dollar-for-dollar — up to $4,300 (self-only) or $8,550 (family) in 2026.
• SSA-44 appeal after a qualifying life event: if your income dropped due to retirement, death of a spouse, or another qualifying event, appeal promptly — reductions can take effect the month you file.

The best approach combines several of these strategies in a coordinated multi-year income plan. Use the Roth / RMD Impact tab in this calculator to model how different income amounts affect your tier two years forward.