Higher-income Medicare beneficiaries can pay hundreds of dollars more each month because federal rules add income-related surcharges to Part B and Part D premiums. In 2026, the standard Part B premium is $202.90, but the highest-income enrollees pay $689.90 a month for full Part B coverage, before their Part D plan premium.
Why Some Medicare Enrollees Pay Hundreds More
Some Medicare beneficiaries face substantially higher monthly healthcare costs because their premiums depend partly on income, not just their enrollment in the program. The issue, explained in NBC News’ report on Medicare enrollees facing higher premiums, is tied to income-related monthly adjustment amounts, commonly known as IRMAA. These surcharges apply to higher-income beneficiaries enrolled in Medicare Part B, which covers outpatient medical services, and Part D, which covers prescription drugs.
For 2026, the Centers for Medicare & Medicaid Services set the standard monthly Part B premium at $202.90, up from $185 in 2025. The annual Part B deductible also rose to $283 from $257.
Beneficiaries with higher reported incomes pay additional amounts on top of the standard Part B premium. The income thresholds differ for individual and joint tax filers, and the surcharge is determined using modified adjusted gross income from a tax return generally filed two years earlier. That means a beneficiary’s 2026 premium is generally based on income reported for 2024.
For an individual tax filer with modified adjusted gross income of $109,000 or less, the standard Part B premium is $202.90 a month. Above that threshold, the monthly total rises by income bracket.
At the highest tier, individuals with income of at least $500,000 pay $689.90 per month for full Part B coverage. Joint filers with income of at least $750,000 face the same monthly amount. That is $487 more per month than the standard premium, or $5,844 in additional annual Part B premiums.
Part D has its own income-related surcharge, which is paid in addition to the premium charged by a beneficiary’s chosen prescription drug plan. In 2026, the monthly Part D adjustment ranges from $14.50 to $91, depending on income. The highest-income beneficiaries can therefore face an additional $1,092 a year in Part D surcharges, on top of their plan’s regular premium.
These amounts can add up quickly for retirees who are also managing housing, food and other healthcare expenses. They are not universal increases: roughly 8% of people with Medicare Part B pay the income-related adjustment, according to CMS, and about the same proportion of Part D enrollees pay the additional charge.
What Beneficiaries Can Do About Higher Medicare Costs
Medicare beneficiaries approaching retirement or experiencing a significant income change should review how their income may affect future premiums. IRMAA is generally based on tax information from two years earlier, so a person’s current financial circumstances may differ from the information used to calculate the surcharge.
People who experience certain qualifying life-changing events — such as retirement or a reduction in work — may be able to ask the Social Security Administration to reconsider an IRMAA decision. The agency explains the process and qualifying circumstances through its official Medicare income-related premium guidance.
Beneficiaries should also compare plan options during the annual enrollment period. The national average premium does not determine the cost of every individual policy, and a lower plan premium does not necessarily mean lower overall spending if deductibles, prescription coverage or provider networks change.
For 2027, the enrollment window runs from October 15 through December 7, 2026. Medicare Advantage premiums are projected to fall in 2027, but national averages may not reflect every enrollee’s costs. Its coverage of insurers narrowing Medicare Advantage networks also highlights why beneficiaries should check whether their doctors and hospitals remain covered before choosing a plan.
Some recipients may also qualify for assistance. Medicare Savings Programs can help eligible people with certain Medicare costs, while the federal Extra Help program supports qualifying beneficiaries with prescription drug expenses. Eligibility depends on financial and other requirements, so people should review the rules through Medicare.gov or their state assistance office.
Higher premiums can also affect how much of a retiree’s Social Security benefit remains after deductions. The standard Part B premium is commonly withheld from monthly benefits, and higher charges can reduce the amount deposited into a beneficiary’s bank account. The 2027 Social Security cost-of-living adjustment examines how benefit increases and Medicare deductions can affect retirees’ take-home payments.
The central point is that Medicare does not charge every enrollee the same premium. Income-related surcharges can add thousands of dollars a year for higher-income beneficiaries, making tax planning, premium reviews and careful comparison of coverage important parts of retirement budgeting.