The 2026 Medicare Part B premium hasn’t been officially announced yet, but I’m betting it’s higher than what you’re paying right now. It almost always is. The Centers for Medicare & Medicaid Services (CMS) typically releases the official figures in November for the following year, so if you’re reading this close to that window, check Medicare.gov directly for the confirmed number.

What I can actually help with: how the premium gets calculated, why it keeps climbing, what the income-based surcharges look like (and how to fight them if you think they’re wrong), and what options exist for people struggling to pay. Nobody explains this stuff clearly. Let’s fix that.

How the Part B Premium Actually Gets Set

Part B covers outpatient care: doctor visits, lab work, preventive screenings, durable medical equipment, and most things that don’t require an overnight hospital stay. You pay a monthly premium for this coverage, set each fall by CMS for the following year.

The standard premium in 2025 is $185.00 per month. In 2024 it was $174.70. In 2023, $164.90. You see where this is going.

By law, roughly 25% of Part B program costs are supposed to be covered by beneficiary premiums. General federal revenue covers the other 75%. So when healthcare spending goes up, your premium goes up with it. The specific culprits tend to be prescription drug costs, expensive new treatments Medicare approves, and overall utilization of outpatient services. When CMS announced the 2025 increase, they pointed specifically to projected spending on Part B drugs, which includes some pricey cancer therapies, as a contributing factor.

There’s also a statutory protection called the “hold harmless” provision that most people don’t know about. If your Social Security benefit wouldn’t increase enough to cover a Part B premium increase, CMS is required to cap your premium increase at the dollar amount of your Social Security cost-of-living adjustment (COLA). This protects most people who have their Part B premium deducted directly from their Social Security check. It does not apply to higher-income beneficiaries or people newly enrolling in Part B.

The IRMAA Surcharge: The Part of the Bill Nobody Warns You About

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Income Range (Single Filer)IRMAA Surcharge2025 Total Monthly Premium
$106,000 or less$0$185.00
$106,001-$133,000~$74~$259.00
$133,001-$167,000~$187~$372.00
$167,001-$200,000~$300~$485.00
$200,001-$500,000~$374~$559.00
Above $500,000~$443~$628.00

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If your income is above a certain threshold, you don’t just pay the standard premium. You pay it plus an Income-Related Monthly Adjustment Amount, which everyone calls IRMAA (pronounced “er-mah”).

I’ve seen people get blindsided by this completely. They budget for $185 a month, and then their first Medicare bill shows up at $295 or $406 or more. It’s jarring.

CMS looks at your income from two years prior. For 2026 premiums, they’re using your 2024 tax return. The income figure is your Modified Adjusted Gross Income (MAGI), which for most people is their adjusted gross income plus any tax-exempt interest income.

Here’s what the 2025 IRMAA thresholds look like for individuals filing single (2026 will be similar, adjusted slightly for inflation):

  • $106,000 or less: standard premium only
  • $106,001 to $133,000: approximately $74 extra per month
  • $133,001 to $167,000: approximately $187 extra per month
  • $167,001 to $200,000: approximately $300 extra per month
  • $200,001 to $500,000: approximately $374 extra per month
  • Above $500,000: approximately $443 extra per month

For married couples filing jointly, the thresholds roughly double. These surcharges apply to Part D (prescription drug coverage) as well, but that’s calculated separately.

One thing that trips people up constantly: a one-time income event can push you into an IRMAA tier for a full year. Selling a rental property, taking a large IRA distribution, converting to a Roth IRA. I’ve talked to people who did a Roth conversion in their early retirement years and ended up paying hundreds of dollars more per month in Medicare premiums two years later. Not a reason to avoid those moves necessarily, but absolutely worth factoring into the math before you do them.

How to Appeal an IRMAA Determination

If your income has dropped significantly since the year CMS is using (retirement, death of a spouse, divorce, loss of income-producing property, or certain other life events), you can appeal using the SSA-44 form. You file it with your local Social Security office.

This appeal process works. I’ve seen people get their IRMAA surcharge reduced or eliminated entirely after a successful appeal. The key is documenting your change in income with something concrete: a retirement letter, a final pay stub, tax estimates. You can download the SSA-44 directly from the Social Security Administration’s website, and most local SSA offices can walk you through it over the phone.

What People on Fixed Incomes Actually Do

Related video

Medicare Part B Premium Cost - Shocking! What is IRMAA? · Medicare on Video - Medicare Specialist on YouTube

The standard Part B premium can genuinely be a hardship for people living primarily on Social Security. $185 a month sounds manageable until you do the math on what Social Security actually pays a lot of retirees. The average Social Security retirement benefit in early 2025 was around $1,976 per month. Part B alone eats nearly 10% of that, before you count any supplemental coverage or Part D.

Real programs exist to help with this, and they’re significantly underused.

The Medicare Savings Programs (MSPs) are state-administered programs that pay your Part B premium for you if your income and assets fall below certain limits. The most common one, the Qualified Medicare Beneficiary (QMB) program, also covers your Part A and Part B deductibles and cost-sharing. The income limits vary by state, but in many states, a single person earning under roughly $1,255 a month (in 2025) may qualify. You apply through your state Medicaid office.

Extra Help (also called the Low Income Subsidy, or LIS) is a separate federal program that helps with Part D drug costs, not Part B premiums specifically, but it’s worth knowing about because people who qualify for MSPs often qualify for Extra Help too.

If you or someone you’re helping might qualify for any of these, don’t assume the income or asset limits will disqualify you without actually checking. The rules are more forgiving than most people expect, and several states have expanded their limits in recent years.

What to Expect for 2026 Specifically

I’d be doing you a disservice if I gave you a specific dollar figure for 2026 right now. CMS makes that announcement in November 2025, and projecting it precisely before then is guesswork dressed up as analysis. What I can tell you is that every credible Medicare projection I’ve seen anticipates continued upward pressure on Part B costs. The trustees’ reports consistently show that Part B spending is expected to grow faster than general inflation for the foreseeable future.

A reasonable planning assumption: the 2026 premium will likely land somewhere around $190 to $200 per month for the standard amount, though it could be outside that range depending on drug spending and policy changes. Don’t hold me to that. When CMS publishes the official figure, it’ll be on Medicare.gov the same day.

What you can do right now: if you’re turning 65 soon, build your retirement budget around a premium that’s at least $10 to $20 higher than current rates to give yourself a cushion. If you’re already enrolled, your annual notice of change materials in the fall will spell out exactly what your premium will be in 2026.

This article is for informational purposes only. Medicare rules change annually. Always verify current plan details at Medicare.gov or by calling 1-800-MEDICARE (1-800-633-4227). This site does not sell insurance or recommend specific plans.

Sources

Disclosure: As an Amazon Associate, we earn a small commission from qualifying purchases at no extra cost to you. We only recommend products that genuinely support the topics covered in this article.

  • Medicare For Dummies (~$22), The definitive consumer guide to Medicare, enrollment windows, Part A/B/C/D, and supplement plans.
  • Get What’s Yours for Medicare (~$17), Maximize your Medicare benefits and minimize out-of-pocket costs. Covers Part D drug coverage gaps and Medigap in depth.

Disclosure: As an Amazon Associate, we earn a small commission from qualifying purchases at no extra cost to you. We only recommend products that genuinely support the topics covered in this article.

  • Medicare For Dummies (~$22), The definitive consumer guide to Medicare, enrollment windows, Part A/B/C/D, and supplement plans.
  • Get What’s Yours for Medicare (~$17), Maximize your Medicare benefits and minimize out-of-pocket costs. Covers Part D drug coverage gaps and Medigap in depth.