5.1 Million Retirees Are Paying a Hidden Medicare Surcharge, and That Number Keeps Going Up
A growing number of retirees are paying higher Medicare Part B and Part D premiums because their income pushes them into IRMAA surcharge brackets, with 2026 surcharges based on 2024 modified adjusted gross income and adding substantial monthly costs on top of standard premiums.
Source: Thefinancebuff ·
A single high-income year—from a Roth conversion, bonus, or investment gains—can lock you into higher Medicare premiums for two years running, turning a one-time financial move into an ongoing tax you didn't plan for. If you're 10 years from retirement and considering a Roth conversion to manage tax brackets later, that converted income counts toward IRMAA thresholds based on modified adjusted gross income from two years prior. Part B premiums alone can climb from roughly $203 to nearly $690 monthly for high earners, with Part D adding another meaningful layer on top. Worth running the numbers on whether any planned conversions, large bonuses, or capital gains in your mid-50s could inadvertently trigger surcharges in early retirement.
- •Standard Medicare Part B premiums in 2026 are about $202.90 per month, but IRMAA brackets can lift total premiums to nearly $690 per month for high earners.
- •Part D IRMAA adds an extra $14.50 to $91 per month per person on top of the plan’s own drug premium, significantly raising prescription coverage costs.
- •IRMAA is based on income from two years prior, so one high-income year near retirement (from Roth conversions, capital gains, or large bonuses) can raise Medicare premiums later unless proactively managed.
Mid‑career savers doing Roth conversions or realizing large gains after age 50 need to factor in IRMAA thresholds so they do not unintentionally trigger much higher Medicare premiums in retirement.