IRMAA in Texas: What Higher Earners Pay for Medicare
If your income is above $109,000 filing single or $218,000 filing jointly, you pay more than the standard Medicare premium. The surcharge is called IRMAA, and it is based on a tax return from two years ago.
How the surcharge works
IRMAA stands for Income-Related Monthly Adjustment Amount. It is added to both your Part B and Part D premiums, and it is calculated in tiers rather than phased in gradually.
For 2026, the tiers are based on your 2024 modified adjusted gross income. That two-year lookback is why a high-income year well in the past can drive up a premium today.
The 2026 Part B tiers
At or below $109,000 single or $218,000 joint, you pay the standard $202.90. Above that, monthly Part B premiums step up to $284.10, then $405.80, then $527.50, then $649.20 at the higher brackets, with a further tier above that.
A Part D surcharge applies alongside these, on top of whatever your drug plan charges.
The cliff problem
IRMAA brackets are cliffs, not ramps. One dollar of income over a threshold moves you into the next tier for the entire year, for both spouses if you file jointly. Crossing the first threshold by a small amount can cost well over a thousand dollars across the year for a couple.
This makes year-end income management genuinely valuable for Texas households near a line. Timing a Roth conversion, capital gain, or retirement account distribution across two tax years rather than one can keep you under a threshold.
When you can appeal
If your income has dropped since the tax year being used because of a life-changing event, you can ask Social Security to use current income instead. Qualifying events include retirement or reduced work hours, marriage, divorce, death of a spouse, and loss of income-producing property.
Retirement is the most common one and the most commonly missed. Someone who retired last year is often still being charged based on their final full working year. The request is made on Form SSA-44, and it is worth filing rather than waiting for it to correct itself.
Worth coordinating with whoever does your taxes
IRMAA sits at the intersection of tax planning and insurance, which means it frequently falls between two advisors and gets handled by neither. If you are within a bracket of a threshold, the decision about when to realize income belongs in the same conversation as your Medicare choices.
Who this hits in Texas
IRMAA lands most often on people in their first year or two of Medicare who are still being assessed on their peak earning years, and on retirees managing large tax-deferred balances. A single required minimum distribution, a business sale, or a property sale can push a Texas household across a bracket for a year without any change in their standard of living.
Because both spouses on Medicare pay the surcharge separately when filing jointly, crossing a threshold effectively doubles the cost for a couple. That is what makes the planning worth doing rather than absorbing.
IRMAA questions
Is IRMAA permanent? No. It is recalculated annually from the tax return two years prior, so a one-year income spike raises premiums for one year and then falls away.
Does tax-exempt interest count? Yes. The IRMAA calculation uses modified adjusted gross income, which adds tax-exempt interest back in. Municipal bond income does not shelter you from it.
What if I am appealing? File Form SSA-44 with documentation of the life-changing event. Retirement counts, and it is the most commonly overlooked ground for appeal among people newly on Medicare.
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