Medicare’s prescription drug coverage comes with its own income-based surcharge, separate from the one attached to Part B, and it hits a different group of people for a different amount. For 2026, the top tier of that surcharge climbed to $91 a month, charged on top of whatever premium a person already pays for their own separate drug plan.
The Five New IRMAA Tiers for Drug Coverage
The Centers for Medicare & Medicaid Services set five income-related monthly adjustment amounts for 2026 Part D coverage: $14.50, $37.50, $60.40, $83.30 and $91.00. Each tier is tied to modified adjusted gross income reported on a tax return from two years earlier, so 2026 surcharges are based on 2024 income. A single filer with income at or below $109,000, or a married couple filing jointly at or below $218,000, owes none of these add-ons.
Above that, according to CMS’s 2026 premiums and deductibles fact sheet, the tiers climb in steps up to the top bracket, individual income at or above $500,000 or joint income at or above $750,000, which carries the full $91.00 monthly add-on.
Free retirement updates: One number can cost or save hundreds a month in retirement. The free Retirement Shield newsletter surfaces the ones worth knowing. Sign up free.
How Your 2024 Tax Return Sets Your 2026 Surcharge
This surcharge affects roughly 8% of people enrolled in Part D, the same share CMS reports for the equivalent Part B income surcharge. The amount is added on top of whatever premium a person’s specific Part D plan charges, since plan premiums vary widely by insurer and by drug formulary. Most enrollees pay their plan premium directly to the insurance company, but Medicare notes that roughly two-thirds of beneficiaries handle it that way while the remaining third have it deducted from their Social Security benefit, and the IRMAA portion itself is either deducted from Social Security or billed directly to the beneficiary depending on how their premium is normally collected. For context on the base cost this surcharge sits on top of, Medicare’s own 2026 cost sheet lists the national base Part D premium at $38.99, a figure the government uses to calculate late-enrollment penalties and these very surcharge amounts, even though individual plan premiums typically differ from that base number.
Why This Is a Different Bill Than the Part B Surcharge
It’s easy to conflate this with the income-related surcharge attached to Part B Medicare coverage, but the two are separate charges with separate tables, and a high-income household can owe both at the same time. The Part B version tops out with a total monthly premium of $689.90 once the base premium and its own income-related add-on are combined; the Part D version described here is only the add-on amount, capped at $91.00, layered on top of a separate plan premium that Medicare itself doesn’t set. A retired couple with income above the top threshold on both sides could be paying the maximum Part B surcharge, their Part B base premium, their Part D plan premium, and the maximum $91.00 Part D surcharge, all in the same month, from four distinct line items rather than one combined bill.
The Other End of the Income Scale
IRMAA only moves in one direction: it adds cost for higher earners, and it never reduces anyone’s bill. On the opposite end of the income spectrum, Medicare runs a separate program called Extra Help for beneficiaries with limited income and resources, which can lower or eliminate Part D premiums, deductibles and copayments for people who qualify, and anyone approved for Extra Help also avoids the Part D late-enrollment penalty that otherwise accumulates for going too long without creditable drug coverage. The two programs sit at opposite ends of the same premium structure: one adds a surcharge above a certain income, the other subsidizes cost below a different income and asset threshold, and a household’s eligibility for either one is reassessed based on current financial information rather than a single one-time determination.
How to Ask Social Security to Lower It
A surcharge based on income from two years ago doesn’t always reflect a household’s current situation, and Social Security has a specific process for that mismatch. Beneficiaries who’ve had a life-changing event, including marriage, divorce or annulment, the death of a spouse, a work stoppage or reduction, loss of income-producing property, loss of pension income, or an employer settlement payment tied to a closure, can file Form SSA-44 to ask Social Security to base the surcharge on more recent income instead of the two-year-old tax return. The form can be submitted online, by fax or mail, or in person at a local Social Security office, and Social Security also accepts a simple phone call when the change stems from an amended tax return rather than a separate life event. Filing doesn’t guarantee approval, since Social Security still reviews the supporting evidence, but it replaces a wait for the next annual redetermination with a request that can be resolved in a matter of weeks.
This article was produced with AI assistance and reviewed by a human editor. Figures are linked to their primary sources; where a claim could not be verified from the public record, we say so.
More Financial Reading
