A tax return you filed two years ago is setting this year's premium.
Medicare premiums are income tested, from a return filed two years earlier, in steps rather than a slope. What the 2026 bands cost, what the income figure is made of, the seven life events that let you argue it down, and the ones that do not count.
Updated September 2026, 24 minute read
What changed: 2026-09-05: First published.
Contents (10 sections)
- 1.The bill arrives two years late
- 2.What the surcharge actually costs
- 3.One dollar, and a year of it Members only
- 4.What the figure is actually made of Members only
- 5.The seven events that let you argue Members only
- 6.What is not on the list Members only
- 7.The filing status that costs the most Members only
- 8.How it reaches you, and the bill people miss Members only
- 9.The one afternoon checklist Members only
- 10.Where these numbers come from Members only
Section 1 of 10, about 21 minutes left
Part 1. The bill arrives two years late
Most people meet this rule by opening a letter. The premium is going up, by an amount nobody quoted, for a reason that is not explained in the letter in any way that helps.
The reason is a federal surcharge with an unmemorable name: the income-related monthly adjustment amount. It is added on top of the standard Medicare Part B premium, and separately on top of whatever a Part D drug plan charges. The agency puts it at roughly eight percent of people with Medicare Part B, and roughly eight percent of those with Part D.
Two features make it behave unlike almost anything else in a household budget. It is normally calculated from a tax return filed two years earlier, so the income that triggers it belongs to a year that is closed, filed and spent. And it does not phase in. Income is sorted into bands, and crossing from one band into the next by a single dollar moves the whole premium to the higher figure for twelve months.
Where the tax authority has not yet supplied that two year old figure, the agency uses the three year old one instead until it can. And where no return was filed at all for a year in which income was above the threshold, federal rules direct the agency to impose the highest adjustment for that filing status until the position is corrected. Not filing is the most expensive option available.
These are federal rules, applied identically in every state. State income tax treatment of the same money varies, but the Medicare surcharge itself does not.
This guide is educational information. It is not legal, tax or financial advice.
Part 2. What the surcharge actually costs
The surcharge is set from modified adjusted gross income, sorted into six bands. The first band is where the surcharge is zero. Both Part B and Part D carry their own surcharge at each step, and both are charged per person, so a couple who are both on Medicare each pay it.
| Income, filing alone | Income, filing jointly | Part B surcharge | Part D surcharge |
|---|---|---|---|
| $109,000 or less | $218,000 or less | None | None |
| Over $109,000 to $137,000 | Over $218,000 to $274,000 | $81.20 | $14.50 |
| Over $137,000 to $171,000 | Over $274,000 to $342,000 | $202.90 | $37.50 |
| Over $171,000 to $205,000 | Over $342,000 to $410,000 | $324.60 | $60.40 |
| Over $205,000, under $500,000 | Over $410,000, under $750,000 | $446.30 | $83.30 |
| $500,000 or more | $750,000 or more | $487.00 | $91.00 |
Every figure above is a monthly amount for 2026, and every one is on top of what would otherwise be paid. The standard Part B premium in 2026 is $202.90 a month, so someone in the top band pays $689.90 for Part B alone, plus $91.00 added to their drug plan.
Read down the Part B column and the shape of the thing becomes clear. The steps are not gentle. The second band adds $81.20 a month. The third more than doubles that. At the top, the surcharge on Part B alone is more than twice the standard premium.
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- One dollar, and a year of it
- What the figure is actually made of
- The seven events that let you argue
- What is not on the list
- The filing status that costs the most
- How it reaches you, and the bill people miss
- The one afternoon checklist
- Where these numbers come from
About 19 minutes of reading left.
Part 3. One dollar, and a year of it Members only
This is not a tax rate applied to the amount above a threshold. It is a step, and the whole step lands on the dollar that crosses it.
Part 4. What the figure is actually made of Members only
Modified adjusted gross income is not taxable income, and the difference catches people who assumed tax-free meant invisible.
Part 5. The seven events that let you argue Members only
Federal regulation lists the life changes that justify using a more recent year's income. The list is short and it is closed.
Part 6. What is not on the list Members only
The events that most commonly cause a surcharge are the ones the regulation does not accept as a reason to remove it.
Part 7. The filing status that costs the most Members only
Married and filing separately sends a household to the fifth band at an income the first band would have covered.
Part 8. How it reaches you, and the bill people miss Members only
Two surcharges, two different collection routes, and one of them arrives as a government bill for a plan you already pay privately.
Part 9. The one afternoon checklist Members only
The first three establish whether you are paying it and why. The rest decide whether you can stop.
Part 10. Where these numbers come from Members only
The 2026 figures come from the agency that set them, and the rules from the regulations that create them.