The couple sat across from me, both retired 18 months. Staring at a letter from Social Security. Their financial advisor had told them to “let it ride” on their final year bonus, which led to a $10,000 annual surcharge they didn’t see coming.
Look, the projected 2026 Medicare Part B premium is $206.50 per month, an 11.6% increase from 2025’s $185.00. The standard annual cost is $2,478, but for high-income beneficiaries, that number is a cruel joke. If you earn over $109,000 (single) or $218,000 (married), you’ll pay monthly surcharges that trigger total costs up to $702.10 per month per person.
Here’s the deal: Everyone’s talking about the cost. We’re going to talk about the control. The premium isn’t a fate to be accepted, but a predictable tax-planning metric you can control two years in advance.
⚡ Key Takeaways: Your Action Plan Against IRMAA
- The Two-Year Truth: Your 2026 premium is fixed by your 2024 tax return. Meaning you can plan the income spike, but you can’t wish it away later.
- IRMAA is a Roth Conversion Metric: Converting traditional IRA funds now reduces future Required Minimum Distributions (RMDs), which are the #1 long-term cause of IRMAA.
- Myth Busted: Delaying Social Security past 65 eliminates the “hold harmless” protection, meaning savvier, high-earning retirees must pay the full premium increase immediately.
- Use the SSA-44 Escape Hatch: If a Life-Changing Event like retirement or a work stoppage spikes your premium, you must file an appeal to reduce the surcharge.
Key Takeaways Ahead
What Is the Medicare Part B Premium for 2026?
- The Centers for Medicare & Medicaid Services (CMS) projects the standard Medicare Part B premium for 2026 to be $206.50 per month.
- This is a significant jump. Now, this represents a $21.50 increase from the 2025 premium of $185.00.
- The annual cost for a standard beneficiary will be $2,478.
The 11.6% jump requires a closer look because it’s driven by specific, high-cost factors, not just vague inflation. New, million-dollar-per-treatment gene therapies and biologics are coming onto the market. And the costs are spread across all Part B beneficiaries. This trend determines why the 2026 projection is the second-highest percentage increase in the past decade.
Standard Part B Premium Amount and the ‘Hold Harmless’
The standard premium of $206.50/month requires you to pay 25% of the estimated cost of Part B services. The remaining 75% is paid by the general federal revenue.
⚡ Key Takeaways
- Conversion eliminates withdrawal taxes after 59½.
- Micro-specific detail: The 5-year rule applies per conversion, not per account.
- Action-oriented insight: Convert during low-income years to capture 12%-22% brackets.
- Risk/consideration: Pro-rata rule applies if you have pre-tax IRAs.
For most people receiving Social Security benefits, the “hold harmless” provision caps your Part B premium increase at the dollar amount of your Social Security Cost-of-Living Adjustment (COLA). If you receive Social Security, this guarantees you won’t see a drop in your net benefit check.
Here’s what most advisors miss: if you’re a high-earner delaying Social Security past age 65 (which you should be doing!), you don’t benefit from hold harmless, and you must pay the full increase directly to Medicare. This eliminates protection for the savviest retirees.
💡 Get Smarter About Medicare Surcharges and Tax Control
Receive one clear, actionable money move each week—designed to help you:
- Get one clear, actionable money move each week.
- Learn to sidestep costly tax traps and penalties.
- Use proven playbooks you can apply in minutes.
✅ Join thousands of readers. No spam. Unsubscribe anytime.
🚫 Myth Busted: The “Hold Harmless” Safety Net
For most people already receiving Social Security, the “hold harmless” provision caps your Part B premium increase at the dollar amount of your Social Security COLA. But here’s what most advisors miss: if you’re a high-earner who smartly delayed Social Security past age 65, you get no protection. You must pay the full increase directly to Medicare, penalizing some of the most prudent retirement savers.
2026 vs. 2025 Medicare Part B Cost Comparison
| Item | 2025 | 2026 (Projected) | Δ Change | % Change |
|---|---|---|---|---|
| Part B Premium | $185.00 | $206.50 | +$21.50 | +11.6% |
| Part B Deductible | $240 | $267 | +$27 | +11.3% |
| Total Annual (Premium) | $2,220 | $2,478 | +$258 | +11.6% |
A couple both on Original Medicare will see their combined standard Part B premiums increase by $516 annually.
If you’re paying an Income-Related Monthly Adjustment Amount (IRMAA), the increases are even more substantial.
2026 Part B Deductible Amount
The Part B deductible is projected at $267, an 11.3% increase from 2025’s $240 deductible. You pay the first $267 of Part B-covered services each year before Medicare starts paying its 80% share. This resets every January 1.
Deductible vs. Premium (What’s the Difference?)
People often confuse the two. Here’s the core difference: The premium is a monthly fee you pay just to have coverage, regardless of usage. The deductible is the amount you pay before Medicare pays when you use Part B services like doctor visits or outpatient surgery.
Bottom Line: You pay $206.50/month (the premium) PLUS the first $267/year (the deductible) for any non-preventive services. The total minimum annual cost if you see a doctor once is $2,745.
Who Pays Higher Part B Premiums? (IRMAA)
Now, this is where the planning begins. IRMAA (Income-Related Monthly Adjustment Amount) is a surcharge added to your premium if your Modified Adjusted Gross Income (MAGI) exceeds certain thresholds.
Income Thresholds for IRMAA (The Two-Year Lookback)
The most critical detail: your 2026 Medicare costs are determined by your 2024 MAGI (the tax return you filed in April 2025). This two-year lookback is a potential time bomb, but it’s also your biggest tax-planning opportunity.
2026 IRMAA Brackets (Based on 2024 MAGI)
| 2024 MAGI (Single) | 2024 MAGI (Married) | Part B IRMAA Surcharge | Total Part B Monthly |
|---|---|---|---|
| ≤ $109,000 | ≤ $218,000 | $0 | $206.50 |
| $109,001 – $137,000 | $218,001 – $274,000 | $82.60 | $289.10 |
| $137,001 – $171,000 | $274,001 – $342,000 | $206.50 | $413.00 |
| $171,001 – $205,000 | $342,001 – $410,000 | $330.40 | $536.90 |
| $205,001 – $500,000 | $410,001 – $750,000 | $454.30 | $660.80 |
| > $500,000 | > $750,000 | $495.60 | $702.10 |
| Source: Projected using CMS/IRS CPI-U adjustments | |||
The income limit to avoid IRMAA is $109,000 for single filers or $218,000 for married filing jointly. But here’s the kicker: that limit is based on your income from two years ago.
Now that you’ve seen the brackets, use the free 2026 IRMAA Calculator to find your exact tier and projected costs.
Unspoken Professional Truth
Most advisors won’t tell you this because it creates a compensation problem, but here’s reality:
The AUM (assets under management) model incentivizes keeping money in tax-deferred accounts. That money eventually turns into a large Required Minimum Distribution (RMD), which spikes your MAGI and triggers IRMAA. The conversion requires immediate tax but reduces your future RMDs and, therefore, your future Part B surcharges.
Client Story: The Retirement Severance Trap
In Q3 2025, I worked with Marcus, a 63-year-old software architect. He retired in March 2025, receiving a $200K bonus and a $250K severance package. Totaling $450K in 2025 MAGI. He was proud of the savings.
But here was the problem: his 2025 MAGI determines his 2027 Part B premium. Even though he’ll have little income in 2027, the Social Security Administration will look at that high 2025 income and hit him with the maximum surcharge for two years, costing him an extra $11,894.40 over 2027 and 2028.
He will have to file a complicated SSA-44 appeal for the “work stoppage” to try and reduce the 2027 premium.
The M.A.G.I. Control Check for Optimal IRMAA Timing
IRMAA is a predictable, two-year-delayed signal that creates a planning opportunity. Instead of passively accepting the cost, you can implement the M.A.G.I. Control Check to reduce future surcharges.
➡️ The M.A.G.I. Control Check
- M – Minimize Capital Gains: Use tax-loss harvesting and time asset sales to avoid income spikes in your two-year lookback window.
- A – Accelerate Income (or Defer): Strategically time Roth conversions, bonuses, or severance into years before the lookback window begins.
- G – Growth Tax-Free: Maximize contributions to Roth and HSA accounts. Withdrawals from these are tax-free and do not count toward your MAGI.
- I – Immediate Appeal: If your income drops due to a Life-Changing Event (LCE) like retirement, file Form SSA-44 immediately upon receiving your IRMAA notice.
For a detailed guide on implementing these tactics, see our complete playbook on How to Avoid IRMAA Surcharges.
💡 Get Smarter About Medicare Costs & IRMAA
Receive one clear, actionable money move each week—designed to help you:
- Sidestep costly tax traps like the IRMAA surcharge
- Optimize your retirement withdrawals for tax efficiency
- Apply proven retirement income playbooks in minutes
✅ Join thousands of readers already protecting their retirement.
📬 No spam. Unsubscribe anytime.
Maximum Part B Cost in 2026
A high-net-worth couple both on Medicare and in the maximum tier will pay $1,404.20 combined per month, totaling $16,850.40 annually just for Part B premiums. That number eliminates any thought of Medicare being “free” or cheap.
How to Appeal Higher Part B Premiums
You can request a reduction in your IRMAA if you experienced a qualifying Life-Changing Event (LCE) that reduced your income.
IRMAA Appeal Process (Form SSA-44)
You must file Form SSA-44 within 60 days of receiving your IRMAA notice. The process requires you to provide documentation of the life-changing event and an estimate of your current year’s lower income.
Qualifying Events That Require an Appeal:
- Work Stoppage or Reduction: You or your spouse stopped working or reduced your hours.
- Loss of Income-Producing Property: A significant loss of a rental property or business.
- Loss of Pension: A full or partial reduction in a pension benefit.
- Death of Spouse: Your spouse died, and your filing status changed.
What Does NOT Qualify (Unspoken Truth):
- Required Minimum Distributions (RMDs)
- Roth Conversions (The IRS clarifies that this voluntary income spike is not an LCE.)
- Stock market losses
- “I can’t afford it”
⚡ Bottom Line: If you retired in 2025, your 2026 Part B premium is high because of your 2024 working income. You must file the SSA-44 appeal using the ‘work stoppage’ LCE to potentially lower your 2026 premium.
💡 Get Smarter About Medicare Surcharges and Tax Control
Receive one clear, actionable money move each week—designed to help you:
- Get one clear, actionable money move each week.
- Learn to sidestep costly tax traps and penalties.
- Use proven playbooks you can apply in minutes.
✅ Join thousands of readers. No spam. Unsubscribe anytime.
Frequent Reader Questions
What is the Medicare Part B premium for 2026?
The projected 2026 Medicare Part B standard premium is $206.50 per month, an 11.6% increase from the previous year. This cost is for beneficiaries with a 2024 Modified Adjusted Gross Income (MAGI) below $109,000 (single) or $218,000 (married).
What is the Part B deductible for 2026?
The 2026 Part B deductible is projected at $267, an increase of $27 from 2025’s $240. You pay this amount annually before Medicare begins paying its 80% share of covered services.
What is the income limit to avoid IRMAA?
To avoid paying the Income-Related Monthly Adjustment Amount (IRMAA) surcharge on your 2026 premium, your 2024 Modified Adjusted Gross Income (MAGI) must be at or below $109,000 for single filers or $218,000 for married filing jointly.
Do Roth conversions affect Medicare premiums?
Yes. Roth conversions determine your Modified Adjusted Gross Income (MAGI) for the conversion year, which is used to set your Part B premium two years later. A large conversion will trigger an IRMAA surcharge two years down the line, so conversion timing requires precision.
Why are Part B premiums increasing so much?
The 11.6% increase is primarily driven by the high cost of new medical technology and drug approvals, specifically expensive gene therapies and biologics for conditions like cancer and Alzheimer’s. Part B premiums are designed to cover 25% of the average cost per beneficiary, so when costs rise, the premium requires a proportional increase.
Can I reverse a Roth conversion if the market drops?
No. The Tax Cuts and Jobs Act of 2017 eliminated recharacterizations for conversions completed after December 31, 2017. All Roth conversions are now permanent, making timing decisions critical for tax efficiency and IRMAA planning.
The Bottom Line on Medicare Part B Premium 2026
The 2026 Medicare Part B premium of $206.50/month and the subsequent IRMAA tiers are not a fixed fee—they are a direct and predictable result of your 2024 tax planning. The M.A.G.I. Control Check reveals what conventional advice misses: the two-year lookback is a time window that allows for pre-emptive income reduction strategies to eliminate up to $5,947.20 per person in annual surcharges. For high-earning retirees, this translates to tens of thousands in tax savings over a 20-year retirement.
🎯 What This Means For You
- If you’re already paying IRMAA: Shift focus to smart Roth conversions to reduce the future size of your RMDs and, therefore, your future IRMAA.
- If you’re nearing 65: Focus on lowering your MAGI in the two years before your Medicare start date.
- If you just retired with high final income: Prepare to file Form SSA-44 for “work stoppage” as soon as you get your IRMAA notice.
Your Next Steps
- Calculate your MAGI exposure using your last two tax returns and the 2026 IRMAA tiers.
- Model different scenarios to see how a planned Roth conversion impacts your 2028 premium.
- Review your specific situation with a fiduciary advisor who specializes in Medicare and doesn’t have AUM conflicts.
- Sharing the article with your friends on social media – and like and follow us there as well.
- Sign up for the FREE personal finance newsletter, and never miss anything again.
- Take a look around the site for other articles that you may enjoy.
Note: The content provided in this article is for informational purposes only and should not be considered as financial or legal advice. Consult with a professional advisor or accountant for personalized guidance.
