Medicare Part B: the premium, and why yours is not the standard one
The 2026 Part B premium is $202.90 a month — unless your income two years ago was higher. The brackets behind the surcharge, who is protected, and who is not.
Uses the 2026 brackets, which apply to your 2024 tax return. Enter the modified adjusted gross income from that return — not this year's.
Brackets move one dollar at a time, but the surcharge does not: crossing a threshold by $1 puts you in the next bracket for the whole year. A one-off income spike — a Roth conversion, a property sale — therefore lands two years later, when the income is gone.
Part B is the part of Medicare you pay for every month, and it is the part where two people enrolled in the same country, in the same year, can be billed very different amounts. The base rate is published every fall for the following year and applies to almost everyone. What moves you off it is a short list of provisions, and only one of them has anything to do with how much care you use.
The short version
- The standard Part B premium is $202.90 a month in 2026, with a $283 annual deductible.
- Above an income threshold, an income-related monthly adjustment amount is added — from $81.20 to $487.00 a month, on top of the standard premium.
- The income used is from two years earlier. Your 2026 premium is set from your 2024 return.
- It is a cliff, not a rate. A dollar over a threshold moves the whole year into the next bracket.
- Filing a separate return while married is penalized by design — the top surcharge starts at $109,001 instead of $500,000.
- The hold-harmless rule that caps premium increases for people on a Social Security check does not apply to anyone paying the surcharge.
The premium is up to three things added together
The published standard rate is what you pay if none of the following applies to you. If any of them does, your notice shows the total, and the total is the published rate plus:
- A late-enrollment surcharge — 10% of the premium for each full 12 months you were eligible to enroll and did not. It is not a one-off: the increase stays with the premium for as long as you have Part B in that continuous period of eligibility.
- An income-related monthly adjustment amount — the surcharge this page is mostly about.
- A hold-harmless limitation, which works in the opposite direction and can hold the standard premium increase down. It is a ceiling on the increase, not a discount, and it applies to fewer people than most descriptions suggest.
Part D — drug coverage — has a parallel income-related adjustment on the same income thresholds, and it is added to whatever your plan charges. So a high-income enrollee can pay an income adjustment on two premiums at once, on the same tax return.
The income brackets
The 2026 amounts, for a beneficiary with full Part B coverage. “Your premium” is the standard rate plus the adjustment, per month:
| Modified adjusted gross income (individual) | Modified adjusted gross income (joint) | Adjustment | Your premium |
|---|---|---|---|
| $109,000 or less | $218,000 or less | $0.00 | $202.90 |
| over $109,000, to $137,000 | over $218,000, to $274,000 | $81.20 | $284.10 |
| over $137,000, to $171,000 | over $274,000, to $342,000 | $202.90 | $405.80 |
| over $171,000, to $205,000 | over $342,000, to $410,000 | $324.60 | $527.50 |
| over $205,000, under $500,000 | over $410,000, under $750,000 | $446.30 | $649.20 |
| $500,000 or more | $750,000 or more | $487.00 | $689.90 |
The Part D adjustment for the same brackets is $0.00, $14.50, $37.50, $60.40, $83.30 and $91.00 a month. It attaches to the drug premium, not to Part B, but both are withheld from the same Social Security benefit — or billed together if you do not receive one.
The brackets are not arbitrary numbers. The standard premium covers about a quarter of what Part B costs, and the statute names the share a higher-income enrollee covers instead: 35, 50, 65, 80 or 85 percent. The dollar amounts published each year are that ladder, indexed, and rounded to the nearest ten cents. The rungs are 15 percentage points apart after the first, except the last, which is 5 — which is why the step into the top bracket is a fraction of the three below it.
The two brackets that do not behave
Filing separately is penalized by design. If you are married at the end of the year, do not file a joint return, and did not live apart from your spouse for the entire year, each threshold is reduced by the single-filer threshold. That collapses the ladder to three rows:
| Modified adjusted gross income, filing separately | Adjustment | Your premium |
|---|---|---|
| $109,000 or less | $0.00 | $202.90 |
| over $109,000, under $391,000 | $446.30 | $649.20 |
| $391,000 or more | $487.00 | $689.90 |
The second-highest surcharge therefore begins at $109,001 — the income at which a joint filer would still be paying nothing. There is no gradual ramp into it.
The top bracket has been frozen since 2019. The Bipartisan Budget Act of 2018 added the 85% level for individuals at $500,000 and couples at $750,000, and set those two figures to stay put until 2028. Every other threshold is indexed to inflation each year; those two are not. The gap between them and the brackets below therefore narrows a little every year.
Why your premium is set by a tax return you have already forgotten
The income measure is fixed by statute: modified adjusted gross income for the last taxable year beginning in the second calendar year before the year involved. Your 2026 premium looks at 2024. Your 2027 premium will look at 2025.
That is not an administrative lag — it is when the data exists. The statute anticipates the consequence: if the Treasury does not have adequate electronic data for that year by October 15 before the premium year, Social Security falls back to the year before and adjusts later.
The practical shape of it is a delay of twelve to eighteen months between a decision and its price. A Roth conversion, a property sale, or a large capital gain raises your income this year and your Medicare premium in the year after next, arriving on a notice in November when the income is long spent. Retiring, by contrast, does not lower the premium immediately — the two years of higher working income are still in the window.
If the change was one of seven listed events, you can ask for a new determination. The regulation lists them exactly: your spouse dies; you marry; your marriage ends through divorce or annulment; you or your spouse stop working or reduce your hours; you or your spouse lose income-producing property, provided the loss was not at your direction and not the ordinary risk of investment; your employer’s pension plan is scheduled to cease, terminate or reorganize; or you receive a settlement because an employer closed, went bankrupt or reorganized. The reduction also has to be significant — enough to move you to a lower bracket or below the threshold entirely. The form is SSA-44, and the documentation has to relate to the event.
Note what is absent from that list. A one-year income spike is not a life-changing event, however much it changed your life, and neither is a fall in income from ordinary investment returns. Stopping work is on the list — but what qualifies is the stopping, in the year it happened. A retirement from an earlier year is not a new event, and lower income on its own is not an event at all.
Who the hold-harmless rule protects
If your Part B premium is withheld from a Social Security benefit, a general rule limits how much the premium can rise: the increase is capped at the dollar increase in your benefit, so your net check does not fall from one year to the next. It binds hardest when the increase in the premium would be larger than the increase in the benefit, which is what happens when the cost-of-living adjustment is small. The Part B premiums for 2010 and 2017 each carried an additional increase for everyone else, designed to offset the revenue this rule cost.
Three conditions have to hold. You must be entitled to monthly Social Security or Railroad Retirement benefits for November and December of the preceding year. The premium must actually be deducted from those benefits. And the premium must not be adjusted for income.
That last condition is the one to remember. An enrollee paying the income-related adjustment is outside the hold-harmless rule by definition, because the statute applies it only to premiums that are not adjusted under the income provision. So the people most likely to see a large increase are the ones least likely to be sheltered from it, and their surcharge shows up as a reduction in the net Social Security payment.
What the premium does not buy
Part B pays 80% of the Medicare-approved amount for most covered services, after the deductible. Original Medicare has no annual limit on what you pay out of pocket — the 20% runs all year, however large the total. That is the gap Medigap exists to fill, and it is why a year with one hospital episode can cost far more than a year of premiums. Medicare Advantage plans do have an annual limit, because they are required to; Original Medicare does not.
For how that 20% interacts with a deductible and a maximum on a single bill, see Deductible, coinsurance, out-of-pocket max — the arithmetic is the same for Medicare as for any other plan, with the difference that the fourth number is missing.
The standard premium in history
Selected years, from the Trustees Report’s own table. The premium is monthly; the deductible is annual.
| Year | Standard premium | Annual deductible |
|---|---|---|
| 1970 | $4.00 | $50 |
| 1975 | $6.70 | $60 |
| 1980 | $8.70 | $60 |
| 1985 | $15.50 | $75 |
| 1990 | $28.60 | $75 |
| 1995 | $46.10 | $100 |
| 2000 | $45.50 | $100 |
| 2005 | $78.20 | $110 |
| 2010 | $110.50 | $155 |
| 2015 | $104.90 | $147 |
| 2016 | $121.80 | $166 |
| 2017 | $134.00 | $183 |
| 2018 | $134.00 | $183 |
| 2019 | $135.50 | $185 |
| 2020 | $144.60 | $198 |
| 2021 | $148.50 | $203 |
| 2022 | $170.10 | $233 |
| 2023 | $164.90 | $226 |
| 2024 | $174.70 | $240 |
| 2025 | $185.00 | $257 |
| 2026 | $202.90 | $283 |
Two things to read carefully here. Before 1984 the premium ran on a July–June cycle, so the early rows are twelve-month periods ending June 30, not calendar years — the table above keeps the Trustees Report’s labels rather than pretending otherwise. And the deductible was fixed by statute until 2005; only since 2006 has it moved with the growth in Part B spending per person. That is why the two columns drift apart in the earlier years and move together afterwards.
2027 is a projection until it is not
CMS announces the following year’s premium, deductible and brackets in the fall, usually during open enrollment. The 2026 figures were released on November 14, 2025. As of this page’s last check the 2027 figures had not been published.
What exists is the Trustees Report’s intermediate projection: a standard premium of $209.50 and a deductible of $292 for 2027, with surcharges of $83.70, $209.40, $335.10, $460.70 and $502.60 across the five brackets. The report does not project the 2027 income thresholds, because they are indexed and published with the premium.
Treat those as planning placeholders. The Trustees themselves describe projected values as estimates that “are likely to be somewhat different as experience emerges.” For this year the same report, read a year earlier, put the 2026 premium at $206.50; CMS published $202.90, so the projection overshot by $3.60 a month. The direction is reliable; the figure is not, until it is published. We will check this page when it is.
What this page does not model
- Your late-enrollment surcharge, which is 10% per full 12 months and stacks on top of whatever the income brackets produce.
- State programs. Every state runs Medicare Savings Programs that can pay the Part B premium for enrollees below an income limit, and the limits differ by state. Whether you qualify is a state determination and is not part of this calculation.
- Your Part D plan premium. The adjustment here is the income-related portion only. The plan’s own charge varies by plan and is not a published national figure.
- Medicare Advantage giveback. Some Advantage plans reduce the Part B premium as a benefit. That is a plan feature, it is capped, and it does not change the amount the brackets assign to you.
- Any year other than 2026. The brackets index annually; applying these numbers to another year will be wrong in a direction we can predict and an amount we cannot.
Frequently asked questions
- Is the Part B premium the same for everyone?
- No. There is a standard rate — $202.90 a month in 2026 — but three separate provisions move an individual off it. One is a surcharge of 10% for each full 12 months you could have enrolled and did not. One is the income-related adjustment, which adds $81.20 to $487.00 a month. One is a hold-harmless rule that can hold the increase down for people whose premiums come out of a Social Security check. Your notice states your total, and the parts are not always spelled out.
- Does the surcharge use this year's income?
- No. It uses the return you filed two calendar years earlier — 2026 premiums are set from the 2024 return, and 2027 premiums will be set from the 2025 return. That lag is why a single high-income year can raise your Medicare premium long after the income is gone, and why a lower income does not lower the premium immediately.
- My income dropped. Can I get the surcharge removed?
- Only if the change was one of the events the regulation lists: a spouse's death, marriage, divorce, you or your spouse stopping work or cutting hours, a loss of income-producing property that was neither at your direction nor the ordinary risk of investment, your employer's pension plan being terminated or reorganized, or a settlement because your employer closed, went bankrupt or reorganized. If your income fell because of a one-year event such as a Roth conversion, a large capital gain or a property sale, there is no appeal — those events are not on the list. The form is SSA-44.
- Does the hold-harmless rule protect me from the surcharge?
- No. Hold-harmless limits how much the standard premium can rise for someone whose premium is withheld from Social Security. It applies only to a premium that is not adjusted for income, so an enrollee paying the income-related adjustment is outside it by definition. The surcharge can reduce your net Social Security check.
Sources
- 42 U.S.C. § 1395r — the Part B premium statute: subsection (b) adds 10% for each full 12 months of delayed enrollment, (c) rounds the premium to the nearest 10 cents, (f) is the hold-harmless limitation, and (i) creates the income-related adjustment, sets the applicable percentages at 35, 50, 65, 80 and 85 percent of program cost against the standard 25 percent, and in (i)(4)(B)(i) fixes the income measure to the last taxable year beginning in the second calendar year before the year involved (govinfo.gov, United States Code 2023 edition, title 42, chapter 7, subchapter XVIII, section 1395r)
- 20 CFR 418.1005 — the purpose of the income-related monthly adjustment amount: to reduce the federal subsidy of Part B for beneficiaries above a threshold, where Part B premiums cover approximately 25 percent of program cost and the remaining 75 percent is federally subsidized (ecfr.gov/current/title-20/section-418.1005)
- 20 CFR 418.1205 — the seven major life-changing events that can support a new determination: death of a spouse, marriage, divorce or annulment, stopping work or reducing hours, loss of income-producing property not at your direction, a scheduled cessation or reorganization of an employer's pension plan, and a settlement because an employer closed, went bankrupt or reorganized (ecfr.gov/current/title-20/section-418.1205)
- 20 CFR 418.1215 — what counts as a significant reduction in income: a decrease that lowers your applicable percentage, or brings modified adjusted gross income below the threshold and eliminates the adjustment entirely (ecfr.gov/current/title-20/section-418.1215)
- Social Security Administration — Premiums: Rules for Higher-Income Beneficiaries: Social Security makes the determination from the return the IRS provides, the additional amount is called the income-related monthly adjustment amount, higher-income enrollees pay 35, 50, 65, 80 or 85 percent of total Part B cost against the usual 25 percent, the 2026 thresholds are $218,000 for a joint return and $109,000 otherwise, the events that support a new decision are listed, and the form is SSA-44 (ssa.gov/benefits/medicare/medicare-premiums.html)
- Centers for Medicare & Medicaid Services — 2026 Medicare Parts A & B Premiums and Deductibles, November 14, 2025: the standard 2026 Part B premium of $202.90 a month and annual deductible of $283; the six Part B income brackets for individual, joint and separate returns; and the 2026 Part D income-related amounts of $0.00, $14.50, $37.50, $60.40, $83.30 and $91.00 (cms.gov/newsroom/fact-sheets/2026-medicare-parts-b-premiums-deductibles)
- 2026 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds, June 9, 2026 — Table V.E2 for the historical and projected Part B standard premium and deductible, including the $209.50 premium and $292 deductible projected for 2027; Table V.E3 for the income-related adjustment amounts by tier since 2007 and the 6.1 million beneficiaries estimated to pay one in 2026; and the appendix text explaining that the income thresholds were not indexed to inflation from 2011 through 2019, that the top bracket added by the Bipartisan Budget Act of 2018 will not be indexed until 2028, and how the hold-harmless provision works (cms.gov/oact/tr/2026)
- 2025 Annual Report of the same Boards, June 18, 2025 — Table V.E2, whose intermediate estimates put the 2026 standard Part B premium at $206.50 against the $202.90 CMS later published, a miss of $3.60 a month (cms.gov/oact/tr/2025)
- Medicare.gov — costs: Part B has no yearly limit on what you pay out of pocket unless you have supplemental coverage, and Part B generally pays 80 percent of the Medicare-approved amount after the deductible (medicare.gov/basics/costs/medicare-costs)