Medicare Part B Premium 2026: How Much You'll Pay Based on Income

Medicare Part B is the component of Original Medicare that covers doctor visits, outpatient care, preventive services, and medical equipment. Every Medicare beneficiary who enrolls in Part B pays a monthly premium — and in 2026, that premium depends heavily on your income. Most people pay the standard rate, but higher earners face significant surcharges that can multiply their costs several times over.

This guide covers exactly what you will pay for Part B in 2026, including every IRMAA income bracket, the Part B deductible, what Part B covers, late enrollment penalties, and programs that can reduce or eliminate your Part B costs entirely.

Standard Part B Premium for 2026

The standard Medicare Part B premium for 2026 is $185.00 per month. This is the amount most beneficiaries pay — roughly 93% of Part B enrollees fall below the income thresholds that trigger higher premiums. The 2026 standard premium represents an increase from the 2025 premium of $185.00, reflecting continued growth in healthcare spending and physician payment rates.

Your Part B premium is typically deducted automatically from your monthly Social Security benefit. If you are not yet collecting Social Security, you receive a quarterly bill from Medicare (CMS Form 500). You can also set up automatic payments through Medicare Easy Pay, which debits your bank account each month.

The Part B premium covers approximately 25% of the overall cost of Part B services. The federal government pays the remaining 75% from general tax revenue. This 25/75 split has been in place since Part B was established, which is why even the standard premium amount increases as healthcare costs rise.

IRMAA Income Brackets and Surcharges for 2026

IRMAA — the Income-Related Monthly Adjustment Amount — is a surcharge that higher-income beneficiaries pay on top of the standard Part B premium. If your income exceeds certain thresholds, you pay more. Here are the 2026 Part B IRMAA brackets based on your modified adjusted gross income (MAGI). Individual filer thresholds are listed first, with married filing jointly amounts in parentheses.

• $106,000 or less ($212,000 or less): $185.00/month — standard premium, no IRMAA surcharge
• $106,001 – $133,500 ($212,001 – $267,000): $259.00/month — $74.00 IRMAA surcharge
• $133,501 – $167,000 ($267,001 – $334,000): $370.00/month — $185.00 IRMAA surcharge
• $167,001 – $200,000 ($334,001 – $400,000): $480.90/month — $295.90 IRMAA surcharge
• $200,001 – $500,000 ($400,001 – $750,000): $591.90/month — $406.90 IRMAA surcharge
• Above $500,000 (above $750,000): $628.90/month — $443.90 IRMAA surcharge

At the highest bracket, a married couple could pay a combined $1,257.80 per month — over $15,000 per year — just for Part B premiums. IRMAA adds a meaningful cost to Medicare for retirees with pensions, investment income, Roth conversions, or deferred compensation payouts.

How IRMAA Is Calculated

Social Security determines your IRMAA using your modified adjusted gross income (MAGI) from your federal tax return filed two years prior. For 2026 premiums, Social Security looks at your 2024 tax return. Your MAGI is your adjusted gross income plus any tax-exempt interest income — this includes interest from municipal bonds.

The two-year lookback means a single high-income year can trigger IRMAA surcharges even if your current income is much lower. Common triggers include:

• A large Roth IRA conversion
• Selling a home or business with significant capital gains
• Taking large distributions from traditional IRAs or 401(k)s
• Receiving a lump-sum pension payout
• Continued high earnings in the year before or after retirement

Social Security sends you a determination letter each year, typically in the fall, informing you of your Part B premium and any IRMAA surcharge for the coming year. If you disagree with the determination, you have the right to appeal.

How to Appeal Your IRMAA Determination

If a life-changing event has significantly reduced your income since the tax year used for your IRMAA calculation, you can request a new determination from Social Security. Qualifying life-changing events include:

• Marriage, divorce, or annulment
• Death of a spouse
• Work stoppage or reduction (retirement or job loss)
• Loss of income-producing property due to a disaster or other event beyond your control
• Loss or reduction of pension income
• Receipt of a settlement from an employer or former employer due to closure, bankruptcy, or reorganization

To appeal, complete Form SSA-44 (Medicare Income-Related Monthly Adjustment Amount — Life-Changing Event) and submit it to your local Social Security office along with documentation supporting the life-changing event and evidence of your reduced income. You can submit the form in person, by mail, or by fax. Social Security typically processes IRMAA appeals within a few weeks, and any premium reduction is applied retroactively to the beginning of the year if approved.

Part B Deductible and Cost-Sharing

The annual Part B deductible for 2026 is $257. This is the amount you must pay out of pocket each calendar year before Medicare begins covering its share of Part B services. Once you meet the deductible, Medicare pays 80% of the Medicare-approved amount for most covered services, and you pay the remaining 20% as coinsurance.

There is no annual out-of-pocket maximum under Original Medicare Part B. Unlike Medicare Advantage plans, which cap your annual costs, Original Medicare's 20% coinsurance has no ceiling. A $100,000 outpatient procedure would leave you responsible for $20,000. This unlimited exposure is the primary reason many beneficiaries purchase Medigap supplemental insurance or choose Medicare Advantage instead.

Many preventive services covered under Part B are exempt from the deductible and have no coinsurance. Your annual wellness visit, most recommended screenings, and vaccines are covered at 100% with no out-of-pocket cost.

What Medicare Part B Covers

Part B covers a broad range of medically necessary outpatient services and preventive care. Here is what is included:

• Doctor and specialist visits — office visits, consultations, and second opinions
• Outpatient hospital services — surgery, observation stays, and emergency room visits
• Lab tests and diagnostic imaging — blood work, X-rays, CT scans, MRIs, and PET scans
• Preventive services — annual wellness visits, flu shots, COVID-19 vaccines, mammograms, colonoscopies, and cardiovascular screenings (no cost-sharing for most)
• Durable medical equipment (DME) — wheelchairs, walkers, hospital beds, oxygen equipment, and CPAP machines
• Mental health services — outpatient therapy, psychiatric visits, and partial hospitalization
• Ambulance services — when medically necessary ground or air transportation is required
• Home health services — skilled nursing care, physical therapy, and medical social services when homebound
• Outpatient physical and occupational therapy — rehabilitation services following surgery, injury, or illness

Part B does not cover most dental, vision, or hearing services, long-term custodial care, or prescription drugs (which are covered under Part D). If you need these benefits, a Medicare Advantage plan may include them, or you can purchase separate coverage.

Part B Late Enrollment Penalties

If you do not sign up for Part B during your Initial Enrollment Period and you do not have qualifying coverage from a current employer or union, you will face a late enrollment penalty. This penalty is permanent — it stays with you for as long as you have Part B.

The penalty is 10% of the standard premium for each full 12-month period you were eligible but did not enroll. This penalty compounds over time and never goes away. Here is what delayed enrollment costs in 2026:

• 1 year late: 10% penalty — $203.50/month ($185.00 + $18.50)
• 2 years late: 20% penalty — $222.00/month ($185.00 + $37.00)
• 3 years late: 30% penalty — $240.50/month ($185.00 + $55.50)
• 5 years late: 50% penalty — $277.50/month ($185.00 + $92.50)

The penalty recalculates each year as the standard premium changes. It is a percentage, not a fixed dollar amount, so it grows as premiums increase. If you delayed enrollment because you had coverage through your own or a spouse's current employer, you will not face a penalty — but coverage through COBRA, retiree health plans, or the Marketplace does not count as qualifying coverage for this purpose.

If you missed your Initial Enrollment Period, you can only sign up during the General Enrollment Period from January 1 through March 31 each year, with coverage beginning July 1. During this gap, you will be without Part B coverage entirely.

How to Reduce Your Part B Costs

Even though the Part B premium is mandatory, several programs and strategies can reduce what you actually pay.

Medicare Savings Programs (MSPs)

These state Medicaid programs pay your Part B premium — and in some cases your deductibles and coinsurance — if your income is low enough. There are four levels:

• Qualified Medicare Beneficiary (QMB): Pays Part B premium, deductibles, coinsurance, and copayments. Income up to 100% of the federal poverty level ($1,255/month individual in 2026).
• Specified Low-Income Medicare Beneficiary (SLMB): Pays Part B premium only. Income 100% to 120% of poverty ($1,506/month individual).
• Qualifying Individual (QI): Pays Part B premium only. Income 120% to 135% of poverty ($1,694/month individual). Must reapply annually; first-come, first-served.
• Qualified Disabled and Working Individuals (QDWI): Pays Part A premium for people under 65 who lost premium-free Part A after returning to work. Income up to 200% of poverty.

Apply through your state Medicaid office. Enrollment in any Medicare Savings Program also automatically qualifies you for Extra Help with Part D prescription drug costs.

Extra Help (Low-Income Subsidy)

While Extra Help does not reduce your Part B premium directly, it significantly lowers your Part D drug costs — reducing the overall burden of Medicare expenses. Extra Help pays for part or all of your Part D premium, deductible, and copays. You may qualify if your annual income is below approximately $22,590 for individuals or $30,660 for married couples, with limited resources. Apply at ssa.gov or call 1-800-772-1213.

IRMAA Planning Strategies

If you are approaching Medicare eligibility or already enrolled, proactive income planning can help you avoid or minimize IRMAA surcharges:

• Spread Roth conversions across multiple years to stay below IRMAA thresholds in any single year
• Time the sale of appreciated assets to avoid stacking capital gains on top of other income
• Use qualified charitable distributions from IRAs to satisfy required minimum distributions without increasing MAGI
• If you retired recently and your current income is significantly lower, file Form SSA-44 to request a redetermination

Work with a financial advisor or tax professional who understands the IRMAA brackets. Even a small reduction in MAGI — staying just below a threshold — can save you thousands per year in Part B premiums.

The Bottom Line

The standard Medicare Part B premium for 2026 is $185.00 per month, but what you actually pay depends on your income, enrollment timing, and eligibility for assistance programs. IRMAA surcharges can push Part B costs above $628 per month for high earners, while late enrollment penalties permanently increase your premium by 10% for every year you delayed. On the other hand, Medicare Savings Programs can eliminate your Part B premium entirely if your income qualifies.

The key takeaways for 2026:

1. Enroll on time to avoid permanent penalties — there is no forgiveness for late Part B enrollment.
2. Review your IRMAA determination letter and appeal with Form SSA-44 if your income has dropped due to a qualifying life event.
3. Check whether you qualify for Medicare Savings Programs — millions of eligible beneficiaries never apply.
4. Plan your income strategically to minimize IRMAA exposure, especially around Roth conversions and asset sales.

For personalized guidance, contact your local SHIP program at shiphelp.org or call 1-877-839-2675. SHIP counselors provide free, unbiased Medicare advice and can help you navigate premiums, IRMAA appeals, and savings programs.