Medicare Part B premiums range from $203 to $690 monthly based on income earned two years prior, blindsiding retirees who missed the connection. Seven common moves can push retirees over IRMAA thresholds and spike premiums two years later, including Roth conversions, selling property, part-time work, and rental income. Retirees whose income drops after a qualifying life event can file Form SSA-44 to lower their Medicare premiums immediately rather than waiting.
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For 2026, the standard monthly premium is $202.90. That number is real, but it is not universal. Higher-income enrollees pay significantly more, and a substantial number of retirees end up in a higher premium bracket because of financial decisions made two years earlier that nobody warned them would affect their Medicare costs.
The mechanism behind this is the Income-Related Monthly Adjusted Amount, or IRMAA. What is less understood are the specific planning mistakes that most commonly push retirees across the income thresholds that trigger higher premiums. Medicare Part B premiums for a given year are based on the tax return filed two years prior.
The premiums a retiree pays in 2026 reflect their modified adjusted gross income from 2024. This two-year lag is the source of most planning surprises, because decisions that seemed reasonable in 2024 can produce Medicare cost increases in 2026 that arrive with little warning. The standard $202.90 monthly premium applies to individual filers with 2024 MAGI at or below $106,000 and to joint filers at or below $212,000.
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